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Subject: Health

  • MTP Act 2021

    Context

    The issue of abortion is in the news again, internationally.

    Criminal law provisions related to termination of pregnancy

    • Under the general criminal law of the country, i.e. the Indian Penal Code, voluntarily causing a woman with child to miscarry is an offence attracting a jail term of up to three years or fine or both, unless it was done in good faith where the purpose was to save the life of the pregnant woman.
    • A pregnant woman causing herself to miscarry is also an offender under this provision apart from the person causing the miscarriage, which in most cases would be a medical practitioner.

    Background of the MTP Act

    • In 1971, after a lot of deliberation, the Medical Termination of Pregnancy (MTP) Act was enacted.
    • This law is an exception to the IPC provisions above.
    • Who, when, where, why and by whom? The law sets out the rules — of when, who, where, why and by whom — for accessing an MTP.
    •  This law has been amended twice since, the most recent set of amendments being in the year 2021 which has, to some extent, expanded the scope of the law.
    • The law does not recognise and/or acknowledge the right of a pregnant person to decide on the discontinuation of a pregnancy.
    • The law provides for a set of reasons based on which an MTP can be accessed.

    Reasons allowed for MTP

    • Reasons: The continuation of the pregnancy would involve a risk to the life of the pregnant woman or result in grave injury to her physical or mental health.
    • The law explains that if the pregnancy is as a result of rape or failure of contraceptive used by the pregnant woman or her partner to limit the number of children or to prevent a pregnancy, the anguish caused by the continuation of such a pregnancy would be considered to be a grave injury to the mental health of the pregnant woman.
    • The other reason for seeking an MTP is the substantial risk that if the child was born, it would suffer from any serious physical or mental abnormality.
    •  A pregnant person cannot ask for a termination of pregnancy without fitting in one of the reasons set out in the law.
    • Gestational age of pregnancy: The other set of limitations that the law provides is the gestational age of the pregnancy.
    • The pregnancy can be terminated for any of the above reasons, on the opinion of a single registered medical practitioner up to 20 weeks of the gestational age.
    • From 20 weeks up to 24 weeks, the opinion of two registered medical practitioners is required.
    • Any decision for termination of pregnancy beyond 24 weeks gestational age, only on the ground of foetal abnormalities can be taken by a Medical Board as set up in each State, as per the law.
    • The law, as an exception to all that is stated above, also provides that where it is immediately necessary to save the life of the pregnant woman, the pregnancy can be terminated at any time by a single registered medical practitioner.

    Issues with the MTP Act provisions

    • While India legalised access to abortion in certain circumstances much before most of the world did the same, unfortunately, even in 2020 we decided to remain in the logic of 1971.
    • Right to health and right to life: By the time the amendments to the MTP Act were tabled before the Lok Sabha in 2020, a number of cases came before the courts.
    • In these cases, the courts had articulated the right of a pregnant woman to decide on the continuation of her pregnancy as a part of her right to health and right to life, and therefore non-negotiable.
    • Violation of right to privacy: In right to privacy judgment of the Supreme Court of India it was held that the decision making by a pregnant person on whether to continue a pregnancy or not is part of such a person’s right to privacy as well and, therefore, the right to life.
    • The standards set out in this judgment were also not incorporated in the amendments being drafted.
    • Not in sync with central laws: The new law is not in sync with other central laws such as the laws on persons with disabilities, on mental health and on transgender persons, to name a few.
    • In conflict with other laws: The amendments also did not make any attempts to iron out the conflations between the MTP Act and the Protection of Children from Sexual Offences (POCSO) Act or the Drugs and Cosmetics Act, to name a few.

    Conclusion

    While access to abortion has been available under the legal regime in the country, there is a long road ahead before it is recognised as a right of a person having the capacity to become pregnant to decide, unconditionally, whether a pregnancy is to be continued or not.

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  • Highlights of the National Family Health Survey (NFHS) 5 Part: II

    The Total Fertility Rate (TFR), the average number of children per woman, has further declined from 2.2 to 2.0 at the national level between National Family Health Survey (NFHS) 4 and 5.

    What is NFHS?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • The IIPS is the nodal agency, responsible for providing coordination and technical guidance for the NFHS.
    • NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children’s Fund (UNICEF).
    • The First National Family Health Survey (NFHS-1) was conducted in 1992-93.

    Objectives of the NFHS

    The survey provides state and national information for India on:

    • Fertility
    • Infant and child mortality
    • The practice of family planning
    • Maternal and child health
    • Reproductive health
    • Nutrition
    • Anaemia
    • Utilization and quality of health and family planning services

    Modifications in NFHS 5

    NFHS-5 includes new focal areas that will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention. The areas are:

    • Expanded domains of child immunization
    • Components of micro-nutrients to children
    • Menstrual hygiene
    • Frequency of alcohol and tobacco use
    • Additional components of non-communicable diseases (NCDs)
    • Expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above.

    Highlights of the NFHS 5 Part-II

    (a) Fertility Rate

    • There are only five States — Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) Manipur (2.17) —which are above replacement level of fertility of 2.1.

    (b) Institutional Births

    • The institutional births increased from 79% to 89% across India and in rural areas around 87% births being delivered in institutions and the same is 94% in urban areas.
    • As per results of the NFHS-5, more than three-fourths (77%) children aged between 12 and 23 months were fully immunised, compared with 62% in NFHS-4.
    • The level of stunting among children under five years has marginally declined from 38% to 36% in the country since the last four years.
    • Stunting is higher among children in rural areas (37%) than urban areas (30%) in 2019-21.

    (c) Decision making

    • The extent to which married women usually participate in three household decisions (about health care for herself; making major household purchases; visit to her family or relatives) indicates that their participation in decision-making is high, ranging from 80% in Ladakh to 99% in Nagaland and Mizoram.
    • Rural (77%) and urban (81%) differences are found to be marginal.
    • The prevalence of women having a bank or savings account has increased from 53% to 79% in the last four years.

    (d) Rise in obesity

    • Compared with NFHS-4, the prevalence of overweight or obesity has increased in most States/UTs in NFHS-5.
    • At the national level, it increased from 21% to 24% among women and 19% to 23% among men.
    • More than a third of women in Kerala, Andaman and Nicobar Islands, AP, Goa, Sikkim, Manipur, Delhi, Tamil Nadu, Puducherry, Punjab, Chandigarh and Lakshadweep (34-46 %) are overweight or obese.

     

    Also read

    National Family Health Survey- 5 Part: I

     

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  • Civil Registration System Report, 2020

    The Civil Registration System (CRS) report 2020 was released at least a month before its schedule.

    What is Civil Registration System (CRS)?

    • The CRS collates data on all births and deaths registered with local authorities across India.
    • The CRS report is released by the Registrar-General of India.
    • It releases its report around 18 months after a year ends.

    Significance of the 2020 Report

    • The 2020 report was released at least a month before schedule.
    • Such data can be of significance during a pandemic as possible covid-19 deaths may not have been categorized as such in official records.
    • The CRS can help us reach an estimate by using the “excess deaths” approach.
    • It is the difference between the total number of deaths registered in a pandemic year and the number of deaths that normally take place in a year.

    Why was the data released ahead of schedule?

    • India and the WHO are locked in a tussle over the latter’s excess death estimates that would give a sense of pandemic-linked fatalities globally in 2020-21.
    • India has reportedly stalled WHO’s efforts to release the data, claiming flawed methodology.
    • WHO is set to release its estimates today, a possible reason that India released CRS data early.

    Why is India contesting the WHO approach?

    • One key objection by India is that WHO has classified it as a Tier 2 country and hence used a different modelling process to estimate excess deaths from that used for Tier 1 countries.
    • WHO says all countries that made available their full all-cause mortality data for the pandemic period were classified as Tier 1.
    • India is in Tier 2 because it didn’t share official data with WHO.
    • Hence, alternative data and modelling methods had to be adopted, adjusting for factors such as income levels, covid-19 reporting rates, and test positivity rates.

    What does the 2020 data show?

    (a) Covid deaths

    • The CRS report for 2020 has recorded deaths of 8.12 million Indians, 6.2% more than 2019.
    • Normally, an unusual increase in deaths would be linked to the pandemic. However, in India, not all deaths are registered.
    • Thus, a rise could simply be because of more families getting deaths registered.
    • The CRS for 2021, which saw more Covid deaths, may not be out until next year.

    (b) Improvements in sex ratio

    • Highest Sex Ratio at Birth (SRB) based on registered events has been reported by Ladakh (1,104) followed by Arunachal Pradesh (1,011), A&N Islands (984), Tripura (974), and Kerala (969).
    • The lowest sex ratio was reported by Manipur (880), followed by Dadra and Nagar Haveli and Daman and Diu (898), Gujarat (909), Haryana (916) and Madhya Pradesh (921).

     

     

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  • Autism Support Network to give Specialised Care in Rural India

    The Centre for Autism and Other Disabilities Rehabilitation Research and Education (CADRRE), a not-for-profit organization will launch “Pay Autention — a different mind is a gifted mind”, India’s first bridgital autism support network.

    Pay ‘Autention’

    • The initiative shall pave the way for small towns and rural India to access specialised care and support and help create an auxiliary network of champions for the differently-abled.
    • This platform shall also enable mentoring, skilling and meaningful livelihoods for people with autism.
    • In the first phase, the initiative will primarily focus on supporting children with autism, and subsequently, in the second stage, it will focus on young adults, empowering them with life skills and career readiness.
    • The content is designed and delivered in collaboration with specialists from CADRRE who have expertise in training children with autism.
    • The project aims to create a network of grassroots champions, enable early identification, first-level care, teach social skills, ways to ease activities of daily living, hold workshops for sensory and motor development.
    • It also focuses on art and craft, dance, music therapy, physical and mental fitness, communication skills and enable support for academics.

    What is Autism?

    • Autism, also called autism spectrum disorder (ASD), is a complicated condition that includes problems with communication and behaviour.
    • It can involve a wide range of symptoms and skills.
    • ASD can be a minor problem or a disability that needs full-time care in a special facility.
    • People with autism have trouble with communication. They have trouble understanding what other people think and feel.
    • This makes it hard for them to express themselves, either with words or through gestures, facial expressions, and touch.
    • People with autism might have problems with learning. Their skills might develop unevenly.
    • For example, they could have trouble communicating but be unusually good at art, music, math, or memory.

    What are the signs of Autism?

    Symptoms of autism usually appear before a child turns 3. Some people show signs from birth. Common symptoms of autism include:

    • A lack of eye contact
    • A narrow range of interests or intense interest in certain topics
    • Doing something over and over, like repeating words or phrases, rocking back and forth, or flipping a lever
    • High sensitivity to sounds, touches, smells, or sights that seem ordinary to other people
    • Not looking at or listening to other people
    • Not looking at things when another person points at them
    • Not wanting to be held or cuddled
    • Problems understanding or using speech, gestures, facial expressions, or tone of voice
    • Talking in a sing-song, flat, or robotic voice
    • Trouble adapting to changes in routine

    What causes Autism?

    • Exactly why autism happens isn’t clear. It could stem from problems in parts of your brain that interpret sensory input and process language.
    • Autism is four times more common in boys than in girls. It can happen in people of any race, ethnicity, or social background.
    • Family income, lifestyle, or educational level doesn’t affect a child’s risk of autism. But there are some risk factors:
    1. Autism runs in families, so certain combinations of genes may increase a child’s risk.
    2. A child with an older parent has a higher risk of autism.
    3. Pregnant women who are exposed to certain drugs or chemicals, like alcohol or anti-seizure medications, are more likely to have autistic children
    4. Other risk factors include maternal metabolic conditions such as diabetes and obesity.

    Prevalence of Autism in India

    • Prevalence and incidence statistics about autism in India is 1 in 500 or 0.20% or more than 2,160,000 people.
    • According to a study, an estimated three million people live with autistic spectrum disorder (ASD) on the Indian subcontinent.

     

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  • Settling India’s COVID-19 mortality data

    Context

    Over the last year, the World Health Organization (WHO) has been busy, in an unprecedented effort, to calculate the global death toll from COVID-19.

    Revision of Covid-19 death toll by WHO

    • Globally from an estimated six million reported deaths, WHO now estimates these deaths to be closer to almost triple the number.
    • The new estimates also take into account formerly uncounted deaths, but also deaths resulting from the impact of COVID-19.
    • For example, millions who could not access care, i.e., diagnosis or treatment due to COVID-19 restrictions or from COVID-19 cases overwhelming health services.
    • India’s stand: India is in serious disagreement with the WHO-prepared COVID-19 mortality estimates.
    • The argument being made by India’s health establishment through a public clarification is that this is an overestimation, and the methodology employed is incorrect.

    India’s Covid response

    • India’s COVID-19 response has been replete with delays and denials.
    • For instance, for the longest time that India’s COVID-19 number rose, the health establishment continued to insist that community transmission was not under way.
    • It took months and several lakh cases before they agreed that COVID-19 was finally in community transmission.
    • The devastation of the second wave showed how unprepared we were to combat the deadly Delta variant.
    •  By the time the wave subsided, India’s population was devastated, and helpless, seeing dignity neither in disease nor in death.

    Conclusion

    The figures ratchet up not only issues of administrative but also moral accountability for governments that they have been previously side stepped.

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  • Nutrition status and TB risk

    Context

    Historical importance of good nutrition was ignored by the modern therapist who tried to control TB initially with streptomycin injection, isoniazid and para-aminosalisylic acid. In the ecstasy of finding antibiotics killing the germs, the social determinants of disease were ignored.

    Lack of patient-centric TB treatment

    • With more drug arsenals such as rifampicin, ethambutol, pyrazinamide, the fight against TB bacteria continued, which became multidrug resistant.
    • The regimes and the mode of delivery of drugs were changed to plug the loopholes of non-compliance of patients.
    • Blister packs of a multi-drug regime were provided at the doorstep, and the directly observed treatment/therapy (DOT) mechanism set up.
    • Many of the poor discontinued blister-packaged free drugs thinking that these were “hot and strong” drugs not suited for the hunger pains they experienced every night.

    Role of nutrition in dealing with TB

    • India has around 2.8 million active cases. It is a disease of the poor.
    • And the poor are three times less likely to go for treatment and four times less likely to complete their treatment for TB, according to WHO, in 2002.
    • The fact is that 90% of Indians exposed to TB remain dormant if their nutritional status and thereby the immune system, is good. 
    • When the infected person is immunocompromised, TB as a disease manifests itself in 10% of the infected.
    • The 2019 Global TB report identified malnutrition as the single-most associated risk factor for the development of TB, accounting for more cases than four other risks, i.e., smoking, the harmful use of alcohol, diabetes and HIV.
    • The work and the findings of a team at the Jan Swasthya Sahayog hospital at Ganiyari, Bilaspur in Chhattisgarh established the association of poor nutritional status with a higher risk of TB.

    Way forward

    • Chhattisgarh initiated the supply of groundnut, moong dhal and soya oil, and from April 2018, under the Nikshay Poshan Yojana of the National Health Mission.
    • All States began extending cash support of ₹500 per month to TB patients to buy food. This amount needs to be raised.
    • Nutrition education and counselling support: Without simultaneous nutrition education and counselling support, this cash transfer will not have the desired outcome.

    Conclusion

    Food is a guaranteed right for life under the Constitution for all citizens, more so for TB patients. Thus, the goals of reducing the incidence of TB in India and of reducing TB mortality cannot be reached without addressing undernutrition.

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  • E-DAR portal to speed up Accident Compensation Claims

    The Ministry of Roads, Transport and Highways (MoRTH) has developed the portal named ‘e-DAR’ (e-Detailed Accident Report).

    Why such move?

    • Road accidents continue to be a leading cause of death, disabilities and hospitalization in the country despite our commitment and efforts.
    • India ranks first in the number of road accident deaths across the 199 countries and accounts for almost 11% of the accident related deaths in the World.

    E-DAR portal

    • It is designed in consultation with insurance companies to provide instant information on road accidents with a few clicks and help accelerate accident compensation claims, bringing relief to victims’ families.
    • Digitalised Detailed Accident Reports (DAR) will be uploaded on the portal for easy access.
    • The web portal will be linked to the Integrated Road Accident Database (iRAD).
    • From iRAD, applications to more than 90% of the datasets would be pushed directly to the e-DAR.
    • Stakeholders like the police, road authorities, hospitals, etc., are required to enter very minimal information for the e-DAR forms.
    • Thus, e-DAR would be an extension and e-version of iRAD.

    Its working

    • The portal would be linked to other government portals like Vaahan and would get access to information on driving licence details and registration of vehicles.
    • For the benefit of investigating officers, the portal would provide geo tagging of the exact accident spot along with the site map.
    • This would notify the investigating officer on his distance from the spot of the incident in the event the portal is accessed from any other location.
    • Details like photos, video of the accident spot, damaged vehicles, injured victims, eye-witnesses, etc., would be uploaded immediately on the portal.
    • Apart from the state police, an engineer from the Public Works Department or the local body will receive an alert on his mobile device and the official concerned will then examine the accident site.

    Check on fake claims

    • The e-DAR portal would conduct multiple checks against fake claims by conducting a sweeping search of vehicles involved in the accident, the date of accident, and the First Information Report number.

    Various moves to curb road accidents

    • Several initiatives have been taken by the MoRTH which continues to implement a multi-pronged road safety strategy.
    • It is based on Education, Engineering, Enforcement and Emergency Care consisting inter-alia of setting up Driver training schools, creating awareness, strengthening automobile safety standards, improving road infrastructure, carrying out road safety audit etc.
    • High priority has been accorded to rectification of black spots.
    • A major initiative of the Ministry in the field of Road Safety has been the passing of the Motor Vehicle Amendment Act, 2019.
    • It focuses on road safety include, inter-alia, stiff hike in penalties for traffic violations and electronic monitoring of the same, enhanced penalties for juvenile driving, cashless treatment during the golden hour etc.

     

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  • The impact of the CUET is likely to be harsher on disadvantaged sections

    Context

    The introduction of the Common University Entrance Test (CUET) can be seen as a step in the direction of aligning India with international standards.

    About CUET

    • The UGC’s rationale for introducing the test is to address the disparity in the allocation of marks by different examination boards, and provide a “level playing field” to students from different sections of society and diverse regions.
    • The CUET has been envisaged as a corrective.
    •  Of the 48 central universities, 45 seem to have the requirements to institute the test.
    • The CUET is going to decide the fate of approximately 1.3 crore students for roughly 5.4 lakh undergraduate seats in 45 central universities.

    Issues with the CUET

    • Students to contend with two examinations: The marks obtained in the board examination will remain vital for admission to state and private universities as well as job applications.
    • The students will now have to contend with two examinations.
    • Impetus to coaching classes: Many educationists argue that the new examination is likely to give an impetus to coaching classes.
    •  Coaching and private tuition will flourish without much concern for quality in the preparation of the study material.
    • Not all State Boards prescribe NCERT textbooks: The CUET syllabus will be based on NCERT (under the Ministry of Education) textbooks even though not all state boards prescribe these books.
    • The coaching industry stands to take advantage of this situation and students will have a hard time navigating two sets of textbooks.
    • The impact is likely to be harsher on disadvantaged sections of the society for whom access to higher education is seen as the only route to upward mobility.

    Way forward

    • The Gross Enrolment Ratio (GER) is constantly increasing for higher secondary education (51.4 per cent according to UDISE, 2019-20) and higher education (27.1 per cent to AISHE, 2019-20).
    • The figures indicate that higher education has acquired a mass base in the country.
    • This has important implications for a knowledge-based economy and society.
    • Maintaining the momentum of GER would require more teachers, schools and higher education institutions of quality and slow down the rush for a few but highly sought after universities and colleges.

    Conclusion

    The new examination would put additional pressure on both students and teachers at a time when they are trying to overcome the exactions of the pandemic. It appears to diverge from the objective of the National Education Policy-2020 — equitable access to good quality higher education for all students.

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  • [pib] Fortification of Rice

    The Cabinet Committee on Economic Affairs has approved supply of fortified rice in all States and Union Territories (UTs) by 2024 in a phased manner.

    What is the news?

    1. National Food Security Act (NFSA)
    2. Integrated Child Development Services (ICDS)
    3. Pradhan Mantri Poshan Shakti Nirman-PM POSHAN [erstwhile Mid-Day Meal Scheme (MDM)] and
    4. Other Welfare Schemes (OWS)

    Phases of implementation

    The following three phases are envisaged for full implementation of the initiative:

    1. Phase-I: Covering ICDS and PM POSHAN in India all over by March, 2022 which is under implementation.
    2. Phase-II: Phase I above plus TPDS and OWS in all Aspirational and High Burden Districts on stunting (total 291 districts) by March 2023.
    3. Phase-III: Phase II above plus covering the remaining districts of the country by March 2024.

    What is Fortification?

    • The Food Safety and Standards Authority of India (FSSAI) has explicitly defined fortification.
    • It involves deliberate increasing of the content of essential micronutrients in a food so as to improve the nutritional quality of food and to provide public health benefit with minimal risk to health.

    Types of food fortification

    Food fortification can also be categorized according to the stage of addition:

    1. Commercial and industrial fortification (wheat flour, cornmeal, cooking oils)
    2. Biofortification (breeding crops to increase their nutritional value, which can include both conventional selective breeding, and genetic engineering)
    3. Home fortification (example: vitamin D drops)

    How is fortification done for rice?

    • Various technologies are available to add micronutrients to regular rice, such as coating, dusting, and ‘extrusion’.
    • The last mentioned involves the production of fortified rice kernels (FRKs) from a mixture using an ‘extruder’ machine.
    • It is considered to be the best technology for India.
    • The fortified rice kernels are blended with regular rice to produce fortified rice.

    How does the extrusion technology to produce FRK work?

    • Dry rice flour is mixed with a premix of micronutrients, and water is added to this mixture.
    • The mixture is passed through a twin-screw extruder with heating zones, which produces kernels similar in shape and size to rice.
    • These kernels are dried, cooled, and packaged for use. FRK has a shelf life of at least 12 months.
    • As per guidelines issued by the Ministry of Consumer Affairs, Food and Public Distribution, the shape and size of the fortified rice kernel should “resemble the normal milled rice as closely as possible”.
    • According to the guidelines, the length and breadth of the grain should be 5 mm and 2.2 mm respectively.

    But why does rice have to be fortified in the first place?

    • India has very high levels of malnutrition among women and children.
    • According to the Food Ministry, every second woman in the country is anaemic and every third child is stunted.
    • Fortification of food is considered to be one of the most suitable methods to combat malnutrition.
    • Rice is one of India’s staple foods, consumed by about two-thirds of the population. Per capita rice consumption in India is 6.8 kg per month.
    • Therefore, fortifying rice with micronutrients is an option to supplement the diet of the poor.

    What are the standards for fortification?

    • Under the Ministry’s guidelines, 10 g of FRK must be blended with 1 kg of regular rice.
    • According to FSSAI norms, 1 kg of fortified rice will contain the following: iron (28 mg-42.5 mg), folic acid (75-125 microgram), and vitamin B-12 (0.75-1.25 microgram).
    • Rice may also be fortified with zinc (10 mg-15 mg), vitamin A (500-750 microgram RE), vitamin B-1 (1 mg-1.5 mg), vitamin B-2 (1.25 mg-1.75 mg), vitamin B-3 (12.5 mg-20 mg) and vitamin B-6 (1.5 mg-2.5 mg) per kg.

    Does fortified rice have to be cooked differently?

    • The cooking of fortified rice does not require any special procedure.
    • The rice needs to be cleaned and washed in the normal way before cooking.
    • After cooking, fortified rice retains the same physical properties and micronutrient levels as it had before cooking.

    What is India’s capacity for fortification?

    • At the time of the PM’s announcement last year, nearly 2,700 rice mills had installed blending units for the production of fortified rice.
    • India’s blending capacity now stands at 13.67 lakh tonnes in 14 key states, according to figures provided by the Ministry.
    • FRK production had increased rapidly from 7,250 tonnes to 60,000 tonnes within 2 years.

    How can a beneficiary distinguish between fortified rice and regular rice?

    • Fortified rice will be packed in jute bags with the logo (‘+F’) and the line “Fortified with Iron, Folic Acid, and Vitamin B12”.

    Advantages offered

    • Health: Fortified staple foods will contain natural or near-natural levels of micro-nutrients, which may not necessarily be the case with supplements.
    • Taste: It provides nutrition without any change in the characteristics of food or the course of our meals.
    • Nutrition: If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittently supplement.
    • Economy: The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 percent of the total food value.
    • Society: It upholds everyone’s right to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger

    Issues with fortified food

    • Against nature: Fortification and enrichment upset nature’s packaging. Our body does not absorb individual nutrients added to processed foods as efficiently compared to nutrients naturally occurring.
    • Bioavailability: Supplements added to foods are less bioavailable. Bioavailability refers to the proportion of a nutrient your body is able to absorb and use.
    • Immunity issues: They lack immune-boosting substances.
    • Over-nutrition: Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micro-nutrients, treatment failure, and increased mortality risk.

    Back2Basics: Public Distribution System (PDS)

    • The PDS is an Indian food Security System established under the Ministry of Consumer Affairs, Food, and Public Distribution.
    • PDS evolved as a system of management of scarcity through the distribution of food grains at affordable prices.
    • PDS is operated under the joint responsibility of the Central and State Governments.
    • The Central Government, through the Food Corporation of India (FCI), has assumed the responsibility for procurement, storage, transportation, and bulk allocation of food grains to the State Governments.
    • The operational responsibilities including allocation within the State, identification of eligible families, issue of Ration Cards and supervision of the functioning of FPSs etc., rest with the State Governments.
    • Under the PDS, presently the commodities namely wheat, rice, sugar, and kerosene are being allocated to the States/UTs for distribution.
    •  Some states/UTs also distribute additional items of mass consumption through PDS outlets such as pulses, edible oils, iodized salt, spices, etc.

    Mid-Day Meal Scheme

    • The Midday Meal Scheme is a school meal program in India designed to better the nutritional standing of school-age children nationwide.
    • It is a wholesome freshly-cooked lunch served to children in government and government-aided schools in India.
    • It supplies free lunches on working days for children in primary and upper primary classes in government, government-aided, local body, and alternate innovative education centers, Madarsa and Maqtabs.
    • The program has undergone many changes since its launch in 1995.
    • The Midday Meal Scheme is covered by the National Food Security Act, 2013.

    The scheme aims to:

    1. avoid classroom hunger
    2. increase school enrolment
    3. increase school attendance
    4. improve socialization among castes
    5. address malnutrition
    6. empower women through employment

     

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  • Fighting TB with lessons learnt during Covid pandemic

    Context

    On World TB day, we need to ask how best we can leverage the lessons learnt from Covid-19 to help gain a new momentum in TB control.

    Comparing the impact of Covid-19 and TB

    • In the first year of the Covid-19 pandemic, 1.8 million people were reported to have succumbed to the virus.
    • In the decade between 2010-20, 1.5-2 million individuals died every year because of tuberculosis.
    • The difference in responses to the two pandemics can only be explained by the differences in the profiles of those who get infected.
    • TB disproportionately affects people in low-income nations, the poor and the vulnerable.
    • The increased burden on healthcare to manage Covid has led to a serious setback in TB control.

    Using lessons from Covid-19 for TB control

    • To leverage the lessons learnt from Covid-19 to control TB, we need to focus on the epidemiological triad: Agent, host and the environment.
    • Test, treat and track has been a strategy successfully employed for Covid.
    • Scaling up testing: We need to aggressively scale up testing with innovative strategies such as active surveillance, bidirectional screening for respiratory tract infections using the most sensitive molecular diagnostics, and contact tracing.
    • Vaccine: The biggest victory against Covid has been the speed with which vaccines were developed, scaled up and deployed.
    • We need to replicate the same for tuberculosis, lobbying for funding from governments and industry to develop a successful vaccine for TB.
    • Social security programs for the prevention of risk: Malnutrition, poverty and immuno-compromising conditions such as diabetes are some of the factors strongly associated with TB.
    • Social security programmes that work towards prevention of modifiable risk factors would possibly pay richer dividends than an exclusive focus on “medicalising” the disease.
    • Environmental factors: Environmental factors which have been neglected include ventilation of indoor spaces, educating individuals to avoid crowds when possible, and to encourage voluntary masking, especially in ill-ventilated and closed spaces.
    • Investment and actions: Covid has been a stellar example of how investments and actions can be swift, and public education can transform behaviour.
    • Similar aspirations for TB can help turn this crisis into an opportunity to re-imagine our overburdened and underfunded systems.
    • Involvement of private sector: We need to actively engage the private sector, build bridges and partnerships as we did in the case of Covid.

    Way forward

    • The country needs to invest in state-of-the-art technologies, build capacity, expand its health workforce and strengthen its primary care facilities.
    • It also needs to consider telemedicine and remote support as important aspects of health services.
    • We need to build an open and collaborative forum where all stakeholders, especially affected communities and independent experts, take a lead role.

    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.

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