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Subject: Health

  • Public health should be led by doctor alone

    public healthContext

    • Doctor shortages are creating hurdles in health emergency response

    What is the crux of the article in simple words?

    • Medical qualification and expertise is necessary to deliver quality health services by medical professionals unlike by general health care workers who lack competency.

    What is public health?

    • Public health has been defined as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals”.

    Why there is need of qualification?

    • Lack of training: Health workers have no training in public health; they are grassroots-level service providers. Asking them to be part of public health cadre trivialises the profession of public health.
    • Separate profession: It is important to understand that public health is a separate profession with a specific set of competencies.

    public healthWhat are 4 pillars of public health?

    • Academics: Academics refers to a good understanding of evidence generation and synthesis by having a good grounding in epidemiology and biostatistics. These competencies are also critical for monitoring and evaluating programmes, conducting surveillance, and interpreting data and routine reporting.
    • Activism: Public health is inherently linked to ‘social change’ and an element of activism is core to public health. Public health requires social mobilisation at the grassroots level by understanding community needs, community organisation, etc. This requires grounding in social and behavioural sciences.
    • Administration: Administration refers to administering health systems at different levels from a primary health centre to the district, State, and national level. This includes implementing and managing health programmes, addressing human resource issues, supply and logistical issues, etc. It includes microplanning of programme delivery, team building, leadership as well as financial management to some extent.
    • Advocacy: In public health, there is little that one can do at an individual level; there must be communication with key stakeholders to change the status quo at different levels of government. This requires clear enunciation of the need, analysis of alternative set of actions and the cost of implementation or non-implementation. Good communication and negotiation skills are critical to perform this function. The related subjects are health policy, health economics, health advocacy and global health.

    public healthWhat are the hurdles in absorbing others as public health professionals?

    • Lack of skill: Many doctors and other health professionals work at the grassroots level and develop a good sense of public health due to their inclination. But they do not become public health professionals as they may not have the necessary skills. Nevertheless, they are valuable.
    • Lack of critical expertise: Clinicians with training in epidemiology and biostatistics would not qualify to be public health professionals as they lack not only other essential and critical expertise but also an appropriate perspective.
    • Compromise on quality:

    Current challenges faced by public healthcare in India

    • Deficiency: The doctor-patient ratio of 1:1655 in India as against WHO norm of 1:1000 clearly shows the deficit of MBBS. While the government is working towards a solution and targeting to reach the required ratio, there is a need to relook at the overall medical education.
    • Post pandemic scenario: The lag in formal medical education has come up evidently post-pandemic when the nation saw the medical fraternity struggling to fill the doctor deficit.
    • Limited government seats: The number of seats available for medical education in India is far less than the number of aspirants who leave school with the dream of becoming doctors.
    • Lack of skills: Though the institutes are managing to hire professors and lecturers, there is a lack of technical skills. Finding faculties in clinical and non-clinical disciplines is difficult and there are very few faculty development programs for upskilling the existing lot.
    • Lack of infrastructure: The gap in digital learning infrastructure is currently the biggest challenge the sector is facing. There is an urgent need to adopt technology and have resources available to facilitate e-learning.
    • Lack of research and innovation: The medical research and innovation needs an added push as there haven’t been many ground-breaking research here. The education system needs to focus more on increasing the quality of research. Additionally since industry academia partnership is not available, hence innovation also takes a back-seat.

    Conclusion

    • By establishing new medical colleges, the government can increase student intake as well as enhance equitable access to public health as separate profession. This will attract the best and the brightest people into this discipline, which is very important for the nation’s health. This is one lesson that we should learn from the pandemic.

    Mains question

    Q. What do you understand by public health? Do you think it is a separate profession requiring a specific set of competencies? Examine.

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  • TB mukt India

    TBContext

    • People’s participation in the ‘TB-Mukt India’ campaign can help eliminate the disease by 2025.

    What is TB?

    • A potentially serious infectious bacterial disease that mainly affects the lungs.

    How TB is caused?

    • Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis. It’s spread when a person with active TB disease in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

    What does TB do to humans?

    • It mainly affects the lungs, but it can affect any part of the body, including the tummy (abdomen), glands, bones and nervous system.

    TBHow long has the TB infected us?

    • TB is as old as humanity itself, infecting us for at least 5,000 years. The infecting agent, a bacterium, was identified way back in 1882, by Robert Koch, signalling one of the landmark discoveries which laid the foundation of modern medicine

    Is TB painful?

    • If TB affects your joints, you may develop pain that feels like arthritis. If TB affects your bladder, it may hurt to go to the bathroom and there may be blood in your urine. TB of the spine can cause back pain and leg paralysis. TB of the brain can cause headaches and nausea.

    Can we get TB if vaccinated?

    • BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. The BCG vaccine is not very good at protecting adults against TB. We can still get TB infection or TB disease even if you were vaccinated with BCG.

    When do TB symptoms start?

    TB

     

    • TB disease usually develops slowly, and it may take several weeks before you notice you’re unwell. Your symptoms might not begin until months or even years after you were initially infected. Sometimes the infection does not cause any symptoms. This is known as latent TB.

    Is TB curable permanently?

    • TB can usually be completely cured by the person with TB taking a combination of TB drugs. The only time that TB may not be curable is when the person has drug resistant TB.

    What are drug-resistant tuberculosis?

    • Drug-resistant tuberculosis (DR-TB) is a form of antimicrobial resistance that is difficult and costly to treat. It is caused by TB bacteria that are resistant to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates.

    Risk factors for TB include

    • Poverty
    • HIV infection.
    • Being in jail or prison (where close contact can spread infection)
    • Substance abuse.
    • Taking medication that weakens the immune system.
    • Kidney disease and diabetes.

    TB statistic for mains

    We are home to 1 in 4 of the world’s TB patients.

    Over 2.5 million Indians are infected.

    Government initiatives

    • Nikshay Poshan Yojana: in which TB patients receive Rs 500 every month while on treatment was launched. Nikshay Poshan Yojana ensure that the patients have economic support and nutrition during the required period.
    • TB Harega Desh Jeetega Campaign: was launched to accelerate the efforts to end TB by 2025. The campaign aims to initiate preventive and promotive health approaches.
    • Community-led approach: By applying “multi-sectoral and community-led” approach, the government is building a national movement to end TB by 2025.
    • Ni-kshay Mitra: Any individual or organisation can register as Ni-kshay Mitra on the Ni-kshay 2.0 portal to support people affected by the disease. The initiative intends to provide essential nutritional and social support to people with TB and root out stigma and discrimination against them.

    Some positive suggestions to eliminate TB

    • Sincere efforts need to be made to make our health systems more accessible and reliable.
    • It also required to ensure that those seeking care trust the healthcare system and get the appropriate care for completing treatment.
    • There is a need to create more labs, point of care tests, an assured drug pipeline, access to new drugs.
    • The government should also ensure counselling and support for those affected.
    • Every patient who is diagnosed late and does not receive timely treatment continues to infect others.
    • To break this cycle, government machinery at the field level should work with communities and provide free diagnosis and treatment to every affected individual.

    Conclusion

    • We have ignored TB for too long. It’s time we acknowledge the magnitude of the disease, and work harder at offering individuals equitable healthcare access and resources that the disease warrants.

    Mains question

    Q. Do you think we can eliminate TB by 2025? Discuss the roadmap and give some affirmative actions to be taken by government.

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  • Global pandemic treaty to avert future mishap

    pandemic treatyContext

    • The outline of an essential global pandemic treaty.

    Purpose of the treaty

    • A pandemic treaty under the umbrella of the World Health Organization would build coherence and avoid fragmentation of response.

    Severity of this pandemic demands such treaty

    • COVID-19 would count as being among some of the most severe pandemics the world has seen in the last 100 years. An estimated 18 million people may have died from COVID-19, according various credible estimates, a scale of loss not seen since the Second World War.
    • Further, with over 120 million people pushed into extreme poverty, and a massive global recession, no single government or institution has been able to address this emergency singlehandedly.
    • This has given us a larger perspective of how nobody is safe until everybody is safe.

    Catchy line for value addition

    Nobody is safe until everybody is safe

    pandemic treatyThere is widespread inequity in healthcare

    • Gross inequity in distribution: Health-care systems have been stretched beyond their capacity and gross health inequity has been observed in the distribution of vaccines, diagnostics, and therapeutics across the world.
    • Irreversible consequences: While high-income economies are still recovering from the aftereffects, the socioeconomic consequences of the novel coronavirus pandemic are irreversible in low and low middle-income countries.
    • The monopolies: Held by pharma majors such as Pfizer, BioNTech, and Moderna created at least nine new billionaires since the beginning of the COVID-19 pandemic and made over $1,000 a second in profits, even as fewer of their vaccines reached people in low-income countries.
    • Skewed distribution: As of March 2022, only 3% of people in low-income countries had been vaccinated with at least one dose, compared to 60.18% in high-income countries. The international target to vaccinate 70% of the world’s population against COVID-19 by mid-2022 was missed because poorer countries were at the “back of the queue” when vaccines were rolled out.

    https://www.civilsdaily.com/yojana-archive-the-pandemic-global-synergy/India’s lead role

    • Dynamic response: India’s response to the COVID-19 pandemic and reinstating global equity by leveraging its own potential has set an example to legislators worldwide.
    • Vaccine diplomacy: India produces nearly 60% of the world’s vaccines and is said to account for 60%-80% of the United Nations’ annual vaccine procurement “vaccine diplomacy” or “vaccine maitri” with a commitment against health inequity.
    • We lead by example: India was unfettered in its resolve to continue the shipment of vaccines and other diagnostics even when it was experiencing a vaccine shortage for domestic use. There was only a brief period of weeks during the peak of the second wave in India when the vaccine mission was halted.
    • A classic example of global cooperation: As of 2021, India shipped 594.35 lakh doses of ‘Made-in-India’ COVID-19 vaccines to 72 countries a classic example of global cooperation. Among these, 81.25 lakh doses were gifts, 339.67 lakh doses were commercially distributed and 173.43 lakh doses were delivered via the Covax programme under the aegis of Gavi, the Vaccine Alliance.

    Why the treaty is needed for?

    • Data sharing: A treaty should cover crucial aspects such as data sharing and genome sequencing of emerging viruses.
    • Rapid response mechanism: It should formally commit governments and parliaments to implement an early warning system and a properly funded rapid response mechanism.
    • Health investments: Further, it should mobilise nation states to agree on a set of common metrics that are related to health investments and a return on those investments. These investments should aim to reduce the public-private sector gap.

    Conclusion

    • A global pandemic treaty will not only reduce socioeconomic inequalities across nation states but also enhance a global pandemic preparedness for future health emergencies. India must take the lead in this.

    Mains question

    Q. Nobody is safe until everybody is safe. What do you understand by this? Why there is need of global pandemic treaty?.

     

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  • Mental Health in india

    mental wellnessContext

    • How to deal with mental wellness challenges in the uniformed forces

    What is stress?

    • Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stress is your body’s reaction to a challenge or demand.

    What is mental wellness?

    • Mental wellness encompasses emotional, psychological, and social well-being. It influences cognition, perception, and behaviour. It also determines how an individual handles stress, interpersonal relationships, and decision-making.

    Why is Mental Health Important?

    • Mental health is more important now than ever before; it impacts every area of our lives. The importance of good mental health ripples into everything we do, think, or say.

    mental wellnessReasons 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 the 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.

    mental wellnessOngoing challenges in mental wellness regime

    • There is a need to expand understanding of the full scope of what uniformed Services and other mental health experts can achieve.
    • Stigma regarding mental health both domestically and around the world remains strong.
    • There is a lack of trained personnel and healthcare and public health systems in many areas of the world.
    • Training needs are broad and reach beyond direct patient care, especially regarding cultural competence, crisis communication, and consultation.
    • There is a need for expanded support for the value of multi-professional and multi-organizational integration and collaboration.

    Government 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.

    What needs to be done?

    • Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance. This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
    • Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
    • Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.

    Conclusion

    • Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.

    Mains question

    Q. Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990. Examine.

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  • Ban on Conversion Therapy for the LGBTQIA+ Community

    The National Medical Commission (NMC), the apex regulatory body of medical professionals in India, has written to all State Medical Councils, banning sexual conversion therapy and calling it a “professional misconduct”.

    What is the news?

    • The NMC has empowered the State bodies to take disciplinary action against medical professionals who breach the guideline.
    • The NMC was following a Madras High Court directive to issue an official notification listing conversion therapy as a wrong, under the Indian Medical Council (Professional Conduct, Etiquettes and Ethics) Regulations, 2002.

    What is Sexual Conversion Therapy?

    • Conversion or reparative therapy is an intervention aimed at changing the sexual orientation or gender identity of an individual.
    • It uses either psychiatric treatment, drugs, exorcism and even violence, with the aim being to make the individual a heterosexual.
    • The conversion therapy umbrella also includes efforts to change the core identity of youth whose gender identity is incongruent with their sex anatomy.
    • Often, the therapy is offered by quacks with little expertise in dealing with the issue.
    • As late as 2018, medical books listed homosexuality and lesbianism as a “perversion”.

    What are the risks?

    • The interventions under conversion therapy are provided under the false premise that homosexuality and diverse gender identities are pathological.
    • They are not; the absence of pathology means there is no need for conversion or any other like intervention.
    • Conversion therapy poses the risk of causing or exacerbating mental health conditions, like anxiety, stress and drug use which sometimes even lead to suicide.

    What is the role of the Madras High Court in the ban?

    On June 7, 2021, Justice N. Anand Venkatesh of the Madras High Court gave a landmark ruling on a case he was hearing about the ordeal of a same-sex couple who sought police protection from their parents.

    • Pending adequate legislation more protective of the community, Justice Venkatesh issued a slew of interim guidelines.
    • It aimed for the police, activists, Union and State Social Welfare Ministries, and the National Medical Commission to ensure their safety and security to lead a life chosen by them.
    • The ruling prohibited any attempt to medically “cure” or change the sexual orientation of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual or of any other orientation) people.
    • It urged the authorities to take action against professionals involving themselves in any form or method of conversion therapy,” which could include the withdrawal of licence to practice medicine.
    • On July 8, 2022, the court gave an order to the NMC directing it to issue necessary official notification by enlisting ‘Conversion Therapy’ as a professional misconduct.

    What were some of the other guidelines issued by the court?

    • The court asked the Ministry of Social Justice & Empowerment to draw up a list of NGOs and other groups which could handle the issues faced by the community, and gave it a time of 8 weeks from the date of the order.
    • The court said the community should be provided with legal assistance by the District Legal Services Authority in coordination with law enforcement agencies.
    • It asked agencies to follow the Transgender Persons (Protection of Rights) Rules, 2020, and the Transgender Persons (Protection of Rights) Act, 2019, in letter and spirit.
    • The court said it was imperative to hold sensitisation programmes for an all-out effort to understand the community and its needs.

    Way forward

    • Schools and colleges must effect changes in curricula for a better understanding of the community.
    • People of a different sexual orientation or gender identity often narrate harrowing tales of bullying, discrimination, stigma and ostracization.
    • Gender-neutral restrooms should be compulsory in educational institutes and other places.
    • Parents too need to be sensitised, because the first point of misunderstanding and abuse often begins at home, with teenagers being forced to opt for “conversion” therapies.
    • Health professionals point out that even adults opting for sex reassignment surgeries need to get proper guidance like therapy pre and post operation.

    Back2Basics: Transgender Persons (Protection of Rights) Act, 2019: Key Features

    Defining Transperson

    • The act defines a transgender person as one whose gender does not match the gender assigned at birth.
    • It includes trans-men and trans-women, persons with intersex variations, gender-queers, and persons with socio-cultural identities, such as kinnar and hijra.

    Prohibition against discrimination

    • It prohibits the discrimination against a transgender person, including denial of service or unfair treatment in relation to education, employment, healthcare, access to, or enjoyment of goods, facilities, opportunities available to the public.
    • Every transgender person shall have a right to reside and be included in his household.
    • No government or private entity can discriminate against a transgender person in employment matters, including recruitment, and promotion.

    HRD measures

    • A transgender person may make an application to the District Magistrate for a certificate of identity, indicating the gender as ‘transgender’.
    • Educational institutions funded or recognised by the relevant government shall provide inclusive facilities for transgender persons, without discrimination.
    • The government must provide health facilities to transgender persons including separate HIV surveillance centres, and sex reassignment surgeries.

    Grievances redressal

    • The National Council for Transgender persons (NCT) chaired by Union Minister for Social Justice, will advise the central government as well as monitor the impact of policies with respect to transgender persons.
    • It will also redress the grievances of transgender persons.

    Legal Protection

    • The Bill imposes penalties for the offences against transgender persons like bonded labour, denial of use of public places, removal from household & village and physical, sexual, verbal, emotional or economic abuse.

     

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  • Bhang, Ganja, and criminality in the NDPS Act

    While granting bail to a man arrested on June 1 for possessing 29 kg of bhang and 400 g of ganja, Karnataka High Court recently observed that nowhere in the Narcotic Drugs and Psychotropic Substances (NDPS) Act is bhang referred to as a prohibited drink or prohibited drug.

    What is Bhang?

    • Bhang is the edible preparation made from the leaves of the cannabis plant, often incorporated into drinks such as thandai and lassi, along with various foods.
    • Bhang has been consumed in the Indian subcontinent for centuries, and is frequently consumed during the festivals of Holi and Mahashivratri.
    • Its widespread use caught the attention of Europeans, with Garcia da Orta, a Portuguese physician who arrived in Goa in the 16th century, noting that, “Bhang is so generally used and by such a number of people that there is no mystery about it”.

    Bhang and the law

    • Enacted in 1985, the NDPS Act is the main legislation that deals with drugs and their trafficking.
    • Various provisions of the Act punish production, manufacture, sale, possession, consumption, purchase, transport, and use of banned drugs, except for medical and scientific purposes.
    • The NDPS Act defines cannabis (hemp) as a narcotic drug based on the parts of the plant that come under its purview. The Act lists these parts as:
    1. Charas: “The separated resin, in whatever form, whether crude or purified, obtained from the cannabis plant and also includes concentrated preparation and resin known as hashish oil or liquid hashish.”
    2. Ganja: “The flowering or fruiting tops of the cannabis plant (excluding the seeds and leaves when not accompanied by the tops), by whatever name they be known or designated.”
    3. “Any mixture, with or without any neutral material, of any of the above forms of cannabis or any drink prepared therefrom.”
    • The Act, in its definition, excludes seeds and leaves “when not accompanied by the tops”.
    • Bhang, which is made with the leaves of the plant, is not mentioned in the NDPS Act.

    Cannabis and criminal liability

    • Section 20 of the NDPS Act lays out the punishment for the production, manufacture, sale, purchase, import and inter-state export of cannabis, as defined in the Act.
    • The prescribed punishment is based on the amount of drugs seized.
    • Contravention that involves a small quantity (100 g of charas/hashish or 1 kg of ganja), will result in rigorous imprisonment for a term that may extend to one year and/or a fine which may extend to Rs 10,000.
    • For a commercial quantity (1 kg charas/ hashish or 20 kg ganja), rigorous imprisonment of not less than 10 years, which may extend to 20 years, including a fine that is not less than Rs 1,00,000 but may extend to Rs 2,00,000.
    • Where the contravention involves quantity less than commercial, but greater than small quantity, rigorous imprisonment up to 10 years is prescribed, along with a fine which may extend to Rs 1,00,000.

    Also read:

    [Burning Issue] Substance Abuse in India

     

     

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  • National Digital Health Mission

    digital healthContext

    • The covid-19 pandemic has presented a watershed moment, bringing the world’s healthcare systems to a halt, forcing us to rethink existing healthcare delivery models and embrace the digital health transformation of the sector.

    Definition of digital health care

    • Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise.

    Digital Health: A Backgrounder

    • The National Health Policy 2017 had envisaged creation of a digital health technology eco-system aiming at developing an integrated health information system.
    • A Digital Health ID was proposed to reduce the risk of preventable medical errors and significantly increase the quality of care.
    • It recognised the need to establish a specialised ecosystem, called the National Digital Health Mission (NDHM).

    digital healthThe National Digital Health Mission

    • The NDHM is a digital health ecosystem under which every Indian citizen will now have unique health IDs, digitized health records with identifiers for doctors and health facilities.
    • The mission will significantly improve the efficiency, effectiveness, and transparency of health service delivery and will be a major step towards the achievement of the UN Sustainable Development Goal 3.8 of Universal Health Coverage, including financial risk protection.

    Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise.Significance of digital health

    • Prioritizing patients: Say, mortality from Covid-19 is significantly increased by comorbidities or the presence of other underlying conditions like hypertension or diabetes.With digital health records, doctors can prioritise patients based on their test results.
    • Portability of health records: Portability of records fairly eases in a patient with the first hospital visit, or her/his most frequently visited hospital. If she/he wishes to change a healthcare provider for cost or quality reasons, she can access her health records without carrying pieces of paper prescriptions and test reports. People will able to access their lab reports, x-rays and prescriptions irrespective of where they were generated, and share them with doctors or family members — with consent.
    • Easy facilitation: This initiative will allow patients to access healthcare facilities remotely through e-pharmacies, online appointments, teleconsultation, and other health benefits. Besides, as all the medical history of the patient is recorded in the Health ID card, it will help the doctor to understand the case better, and improved medication can be offered.
    • Technology impetus in policymaking: Meanwhile, it is also not just individuals who could emerge beneficiaries of the scheme. With large swathes of data being made available, the government too can form policies based on geographical, demographical, and risk-factor based monitoring of health.

    Critical point to remember

    In the case of lung cancer, only 18.5 % of patients survive five or more years once diagnosed. These are threats that data-led technology will help address.

    Major privacy issues involved

    • Informed Consent:The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
    • Data leakages issue:Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
    • Digital divide:Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
    • Data Migration:The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.

    Other challenges

    • Existing digitalization is yet incomplete:India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
    • Lack of healthcare facilities:The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
    • Lack of finance:With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.

    Conclusion

    • With an enabling ecosystem, supported by effective policies for digital healthcare and increased innovation, the promise of digital solutions in healthcare is immense. It’s not long before precision healthcare becomes central to the health and well-being of every citizen.

    Mains question

    Q. The covid-19 pandemic has presented a watershed moment, bringing the world’s healthcare systems to a halt, forcing us to rethink existing healthcare delivery models. In this context discuss challenges and opportunities of digital health ecosystem in India.

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  • Equitable education and health care needed for better future

    Equitable health and educationContext

    • To create the foundation for the next century, we need to invest in equitable education and health care in the next 25 years not just for the elite, but for all.

    What is current status of education?

    • Expenditure on Education: The expenses on education as a percentage to GDP, India lags behind some developed/ developing nations.
    • Infrastructure deficit: Dilapidated structures, single-room schools, lack of drinking water facilities, separate toilets and other educational infrastructure is a grave problem.
    • Student-teacher ratio: Another challenge for improving the Indian education system is to improve the student teacher ratio.

    What is current status of healthcare?

    • Weak delivery: Current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
    • Unpreparedness: Public health experts believe that India is ill-equipped to handle emergencies.
    • Technical glitches in urban areas: It is not prepared to tackle health epidemics, particularly given its urban congestion.

    A systemic approach to reforming education system in the country needs

    • Dynamic pedagogy: Academic interventions involve the adoption of grade competence framework instead of just syllabus completion.
    • Directional efforts: Effective delivery of remedial education for weaker students like after-school coaching, audio-video based education.
    • Administrative reforms: that enable and incentivize teachers to perform better through data-driven insights, training, and recognition. Example: Performance based increments in Salary.

    equitable education and healthA systemic approach to reforming healthcare system in the country needs

    • Universal health coverage: Access to healthcare in India is not equitable—the rich and the middle class would survive the COVID-19 or any other crisis but not the poor.
    • Increasing healthcare professionals in numbers: India has handled the COVID-19 pandemic exceptionally well. However, India is in dire need of more medical staff and amenities.
    • Revamping medical education: If the government wants to stay successful in fighting the COVID-19 pandemic, it needs to rapidly build medical institutions and increase the number of doctors.
    • Cross-subsidization of health-care: How the poor managed without, or even with, any government insurance scheme is a big question. They can make up for the loss by cross-subsidizing treatments of patients with premium insurance policies.

    Recent initiatives

    • PLI scheme: In view of these challenges, the government announced various policies like PLI scheme for domestic manufacturing of active pharmaceutical ingredients (APIs).
    • National Digital Health Mission: It also announced the National Digital Health Mission.

    Way forward

    • India’s healthcare system is too small for such a large population.
    • There seems to be a long battle ahead. The public healthcare system cannot be improved overnight.
    • The country needs all hands on deck during and after this crisis—both public and private sectors must work together and deliver universal health coverage for all citizens.

    Conclusion

    • Providing expanded access to high quality education and healthcare supports—particularly for those young people who today lack such access—will not only expand economic opportunity for those individuals, but will also likely do more to strengthen the overall state economy.

    Mains question

    Q. To create the foundation for the next century, we need to invest in education and health in the next 25 years not just for the elite, but for all. Critically examine

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  • Anganwadi scheme

    Context

    • The economic fallout of COVID-19 makes the necessity of quality public welfare services more pressing than ever.
    • The Integrated Child Development Services (ICDS) programme is one such scheme.

    What is ICDS?

    • ICDS caters to the nutrition, health and pre-education needs of children till six years of age as well as the health and nutrition of women and adolescent girls.

    What is anganwadi scheme?

    • The scheme was started in 1975 and aims at the holistic development of children and empowerment of mother.
    • It is a Centrally-Sponsored scheme. The scheme primarily runs through the Anganwadi centre. The scheme is under the Ministry of Women and Child Development.

    Need for focus on early childhood care and education (ECCE)

    • Low enrolment: The National Family Health Survey-5 (NFHS-5) finds only 13.6 per cent of children enrolled in pre-primary schools.
    • Weakest link: With its overriding focus on health and nutrition, ECCE has hitherto been the weakest link of the anganwadi system.
    • Low awareness: Unfortunately, due to a lack of parental awareness compounded by the daily stresses of poverty, disadvantaged households are unable to provide an early learning environment.

    Data to remember

    According to government data, the country has 13.77 lakh Anganwadi centres (AWCs).

    A meaningful ECCE programme in anganwadis

    • Activity-based framework which reflect local context: To design and put in place a meaningful activity-based ECCE framework that recognises the ground realities with autonomy to reflect the local context and setting.
    • Remove non-ICDS work: Routine tasks of anganwadi workers can be reduced and non-ICDS work, such as surveys, removed altogether.
    • Extend Anganwadi time: Anganwadi hours can be extended by at least three hours by providing staff with an increase in their present remuneration, with the additional time devoted for ECCE.
    • Change in policy mindset: ICDS needs a change in policy mindset, both at central and state levels, by prioritising and monitoring ECCE.
    • Engagement with parents: Anganwadi workers must be re-oriented to closely engage with parents, as they play a crucial role in the cognitive development of young children.

     

    Case study / value addition

    In Andhra Pradesh and Telangana, anganwadi centres have been geotagged to improve service delivery.

    Gujarat has digitised the supply chain of take-home rations and real-time data is being used to minimise stockouts at the anganwadi centres.

    Way forward

    • Government must act on the three imperatives. First, while infrastructure development and capacity building of the anganwadi remains the key to improving the programme, the standards of all its services need to be upscaled.
    • Second, states have much to learn from each other’s experiences.
    • Third, anganwadi centres must cater to the needs of the community and the programme’s workers.

    Conclusion

    • Nearly 1.4 million anganwadis of the Integrated Child Development Services (ICDS) across India must provide ECCE for the millions of young children in low-income households.

    Mains question

    Q. Some educationists have suggested that owing to the high workload of anganwadi workers, ECCE in anganwadis would remain a non-starter. Critically examine this statement and give dynamic suggestions to improve EECE in anganwadis.

     

     

     

  • Drugs shortage haunts HIV-positive community

    People living with HIV are facing an acute shortage of life-saving drugs, say protesters who have been camping outside the National AIDS Control Organisation (NACO) office.

    What is NACO?

    • The NACO established in 1992 is a division of India’s Ministry of Health and Family Welfare.
    • It provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies.
    • It is the nodal organisation for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India.

    Functions of NACO

    • Along with drug control authorities and NACO provides joint surveillance of Blood Bank licensing, Blood Donation activities and Transfusion Transmitted infection testing and reporting.
    • NACO also undertakes HIV estimations biennially (every 2 years) in collaboration with the Indian Council of Medical Research (ICMR) – National Institute of Medical Statistics (NIMS).
    • The first round of HIV estimation in India was done in 1998, while the last round was done in 2017.

    Why in news?

    • Activists allege rationing of medicines, arbitrary change in the drug regimen and even complete deprivation of life-saving paediatric drugs.
    • They fear that treatment will be interrupted, leading to drug resistance and deaths from AIDS.

    NACO stand

    • The protesters noted that the NACO, in its public communication, had claimed that 95% of the recipients had not faced any shortage.
    • Going by the figure, 5% of 14.5 lakh, or 72,500 people, are being affected by the current shortage and stock-out.
    • The impact is severe and far-reaching.

    What drugs are protestors talking about?

    • Protestors are for a stock-out of ART (antiretroviral) drugs such as Dolutegravir 50 mg, Lopinavir/Ritonavir (adult and child doses), and Abacavir in several states.

    What is ART?

    • The medicines that treat HIV are called antiretroviral drugs.
    • There are more than two dozen of them, and they fall into seven main types.
    • Each drug fights the virus in your body in a slightly different way.
    • Research shows that a combination, or “cocktail,” of drugs is the best way to control HIV and lower the chances that the virus will become resistant to treatment.

    Back2Basics: HIV/AIDS

    • HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases.
    • First identified in 1981, HIV is the cause of one of humanity’s deadliest and most persistent epidemics.
    • It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex, or through sharing injection drug equipment.
    • If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).
    • The human body can’t get rid of HIV and no effective HIV cure exists.

    Treating HIV

    • However, by taking HIV medicine (called antiretroviral therapy or ART), people with HIV can live long and healthy lives and prevent transmitting HIV to their sexual partners.
    • In addition, there are effective methods to prevent getting HIV through sex or drug use, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

     

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