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Subject: Health

  • A cardinal omission in the COVID-19 package

    Context

    On July 8, 2021, the Union government announced the “India COVID-19 Emergency Response and Health Systems Preparedness Package: Phase II”. But it lacks provision for the medical workforce.

    Objectives of the package

    • The stated purpose of the package is to boost health infrastructure and prepare for a possible third wave of COVID-19.
    • There is plan to increase COVID-19 beds, improve the oxygen availability and supply, create buffer stocks of essential medicines; purchase equipment and strengthen paediatric beds.

    What is lacking in the package?

    • Workforce shortage: The package barely has any attention on improving the availability of health human resources.
    • As reported in rural health statistics and the national health profile there are vacancies for staff in government health facilities, which range from 30% to 80% depending upon the sub-group of medical officers, specialist doctors to nurses, laboratory technicians, pharmacists and radiographers, amongst others.
    • Interstate variation: In addition, there are wide inter-State variations, with States that have poor health indicators with the highest vacancies.

    Way forward

    • Package for filling the existing vacancies: The COVID-19 package II needs to be urgently supplemented by another plan and a similar financial package (with shared Union and State government funding) to fill the existing vacancies of health staff at all levels. 
    • An objective approach to assess the mid-term health human resource needs could be the Indian Public Health Standards (IPHS).
    • IPHS prescribes the human resources and infrastructure needed to make various types of government health facilities functional.
    • The pandemic should be used as an opportunity to prepare India’s health system for the future.
    • Scrutiny of the progress on policy decision: The progress on key policy decisions, for the last few years, to strengthen India’s health system, including those in India’s national health policy of 2017, need to be objectively scrutinised.
    • These two sets of policy decisions should be reviewed and progress monitored, through a meeting of the Central Council of Health and Family Welfare, of which the Health Ministers of the States are members.

    Conclusion

    India’s health system will not benefit from ad hoc and a patchwork of one or other small packages. It essentially needs some transformational changes.

  • How China eliminated malaria and the road ahead for India

    Recently, El Salvador and China were declared malaria-free by the WHO.

    What is Malaria?

    • Malaria is a disease caused by a parasite called plasmodium vivax, p. filarium.
    • The parasite is spread to humans through the bites of infected mosquitoes.
    • People who have malaria usually feel very sick with a high fever and shaking chills.
    • While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.

    How many countries have successfully eliminated malaria?

    • Since 1900, 127 countries have registered malaria elimination. This is definitely not an easy task.
    • It needs proper planning and a strategic action plan based on the local situations.
    • All these countries followed the existing tools and strategies to achieve the malaria elimination goal.
    • The main focus was on surveillance.
    How did China eliminate malaria?
    • China followed some specific strategies, namely strong surveillance following the ‘1-3-7’system: malaria diagnosis within 1 day, 3 days for case investigation and by day 7 for public health responses.
    • Molecular Malaria Surveillance for drug resistance and genome-based approaches to distinguish between indigenous and imported cases was conducted.
    • All borders to the neighboring countries were thoroughly screened to prevent the entry of unwanted malaria into the country.

    What is the current scenario of malaria in India?

    • As per the Global Malaria Report 2020 by the World Health Organization (WHO) India shared 2% of the total global malaria cases in 2019.
    • India has a great history of malaria control.
    • The highest incidence of malaria occurred in the 1950s, with an estimated 75 million cases with 0.8 million deaths per year.
    • The launch of National Malaria Control Programme in 1953 and the National Malaria Eradication Programme in 1958 made it possible to bring down malaria cases to 100,000 with no reported deaths by 1961.
    • This is a great achievement been made so far.

    Unexpected resurgence

    • But from a nearing stage of elimination, malaria resurged to approximately 6.4 million cases in 1976.
    • Since then, confirmed cases have decreased to 1.6 million cases, approximately 1100 deaths in 2009 to less than 0.4 million cases and below 80 deaths in 2019.
    • India accounted for 88% of malaria cases and 86% of all malaria deaths in the WHO South-East Asia Region in 2019.
    • It is the only country outside Africa among the world’s 11 `high burden to high impact’ countries.

    Road ahead for India

    Collaboration:

    • India is a signatory to National Framework for Malaria Elimination (NFME) 2016-2030 aiming for malaria elimination by 2030.
    • This framework has been outlined with a vision to eliminate the disease from the country which would contribute to improved health with quality of life and poverty alleviation.
    • China collaborated with Harvard University and the Massachusetts Institute of Technology, USA for Molecular Malaria Surveillance.
    • In India, there are very dedicated expert scientists who can take up such assignments.

    Diagnosis:

    • India stands at a very crucial stage. The present challenge is the detection of asymptomatic cases in most endemic areas.
    • Molecular Malaria Surveillance must be used to find out the drug-resistant variants and genetic-relatedness studies to find out the imported or indigenous cases.
    • The surveillance must be strengthened and using smart digital surveillance devices would be an important step. Real-time and organic surveillance is needed even in remote areas.

    Monitoring:

    • The results of each malaria case can be registered in a central dashboard at the National Vector Borne Disease Control Programme, as it is done for COVID-19 cases by Indian Council of Medical Research.
    • All intervention activities must strictly be monitored.
    • Vector biology, site of an actual vector mosquito bite, host shifting behaviour, feeding time, feeding behaviour and insecticide resistance studies need to be carried out to support the elimination efforts.

  • Mental health care in India

    Context

    Recently, a High Court suggested that homeless persons with health conditions be branded with a permanent tattoo, when vaccinated against COVID-19.

    Issue

    • In many countries, persons with severe mental health conditions live in shackles in their homes, in overcrowded hospitals, and even in prison.
    • On the other hand, many persons with mental health issues live and even die alone on the streets.
    • Three losses dominate the mental health systems narrative: dignity, agency and personhood.
    • Issues with the laws: Far-sighted changes in policy and laws have often not taken root and many laws fail to meet international human rights standards.
    • Many also do not account for cultural, social and political contexts resulting in moral rhetoric that doesn’t change the scenario of inadequate care.
    • There is also the social legacy of the asylum, and of psychiatry and mental illness itself, that guides our imagination in how care is organised.

    Way forward: A responsive care system

    • We must understand mental health conditions for what they are and for how they are associated with disadvantage.
    • These situations are linked, but not always so, therefore, not all distress can be medicalised.
    • Adopt WHO guidelines: Follow the Guidance on Community Mental Health Services recently launched by the World Health Organization.
    • The Guidance, which includes three models from India, addresses the issue from ‘the same side’ as the mental health service user and focuses on the co-production of knowledge and on good practices.
    • Drawn from 22 countries, these models balance care and support with rights and participation.
    • 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.
    • Small emergency care and recovery centres for those who need crisis support instead of larger hospitals, and long-term inclusive living options in an environment that values diversity and celebrates social mixing, will reframe the archaic narrative of how mental health care is to be provided.

    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.

  • Ed-tech in India

    The article suggests a policy formulation for future of the learning with the adoption of technology.

    Learning crisis facing and finding solutions through technology

    • India was facing a learning crisis, even before the Covid-19 pandemic, with one in two children lacking basic reading proficiency at the age of 10.
    • The pandemic worsened it with the physical closure of 15.5 lakh schools that has affected more than 248 million students for over a year.
    • With the Fourth Industrial Revolution — the imperative now is to reimagine education and align it with the unprecedented technological transformation.
    • The pandemic offers a critical, yet stark reminder of the impending need to weave technology into education.

    Is India prepared for integrating technology in learning?

    • India’s new National Education Policy (NEP) 2020envisions the establishment of an autonomous body, the National Education Technology Forum (NETF).
    • The NETF will spearhead efforts towards providing a strategic thrust to the deployment and use of technology.
    • India is well-poised to take this leap forward with increasing access to tech-based infrastructure, electricity, and affordable internet connectivity.
    • Flagship programmes such as Digital India and the Ministry of Education’s initiatives, including the Digital Infrastructure for School Education (DIKSHA), open-source learning platform and UDISE+  will help in this direction.
    • However, we must remember that technology cannot substitute schools or replace teachers.
    • It’s not “teachers versus technology”; the solution is in “teachers and technology”.
    • In fact, tech solutions are impactful only when embraced and effectively leveraged by teachers.

    Four key elements for ed-tech policy architecture

    • A comprehensive ed-tech policy architecture must focus on four key elements:
    • Access: Providing access to learning, especially to disadvantaged groups.
    • Enable: Enabling processes of teaching, learning, and evaluation.
    • Teacher training: Facilitating teacher training and continuous professional development.
    • Governance: Improving governance systems including planning, management, and monitoring processes.

    Ed-tech ecosystem in India

    • With over 4,500 start-ups and a current valuation of around $700 million, the ed-tech market is geared for exponential growth.
    • There are, in fact, several examples of grassroots innovation.
    • The Hamara Vidhyalaya in Namsai district, Arunachal Pradesh, is fostering tech-based performance assessments.
    • Assam’s online career guidance portal is strengthening school-to-work and higher-education transition for students in grades 9 to 12.
    • Samarth in Gujarat is facilitating the online professional development of lakhs of teachers in collaboration with IIM-Ahmedabad.
    • Jharkhand’s DigiSATH is spearheading behaviour change by establishing stronger parent-teacher-student linkages.
    • Himachal Pradesh’s HarGhar Pathshala is providing digital education for children with special needs.

    Way forward

    1) Short term policy formulation

    • In the immediate term, there must be a mechanism to thoroughly map the ed-tech landscape, especially their scale, reach, and impact.
    • The policy formulation and planning process must strive to:
    • 1) Enable convergence across schemes– education, skills, digital governance, and finance.
    • 2) Foster integration of solutions through public-private partnerships, factor in voices of all stakeholders.
    • 3) Bolster cooperative federalism across all levels of government.
    • Special attention must be paid to address the digital divide at two levels: access and skills.
    • Thematic areas of the policy should feature infrastructure and connectivity; high-quality software and content; and global standards for outcome-based evaluation, real-time assessments, and systems monitoring.

    2) Long-term policy measures

    • In the longer term, as policy translates to practice at local levels a repository of the best-in-class technology solutions, good practices and lessons from successful implementation must be curated.
    • The NITI Aayog’s India Knowledge Hub and the Ministry of Education’s DIKSHA and ShaGun platforms can facilitate and amplify such learning.

    Conclusion

    With NEP 2020 having set the ball rolling, a transformative ed-tech policy architecture is the need of the hour to effectively maximise student learning.

  • NITI Aayog releases study on ‘Not-for-Profit’ hospital model

    NITI Aayog has released a comprehensive study on the not-for-profit hospital model in the country, in a step towards closing the information gap on such institutions and facilitating robust policymaking in this area.

    ‘Not-for-Profit’ hospitals

    • The “Not-for-Profit” Hospital Sector has the reputation of providing affordable and accessible healthcare for many years.
    • This sector provides not only curative healthcare, but also preventive healthcare, and links healthcare with social reform, community engagement, and education.
    • They utilize the resources and grants provided to them by the Government to provide cost-effective healthcare to the population without being overly concerned about profits.
    • However, this sector remains largely understudied, with a lack of awareness about its services in the public domain.

    Significance for India

    • As per the NITI Aayog’s report, the not-for-profit hospitals account for only 1.1% of treated ailments as of June 2018.
    • The report further revealed that for-profit hospitals account for 55.3% of in-patients, while not-for-profit hospitals account for only 2.7% of in-patients in the country.
    • The cumulative cost of care at not-for-profit hospitals is lesser than for-profit hospitals by about one-fourth in the in-patient department.
    • This is reckoned by the package component of cost, which is approximately 20% lower, the doctor’s or surgeon’s charges, which are approximately 36% lower and the major aspect being the bed charges, which are approximately 44% lower than the for-profit hospitals.

    NITI Aayog’s approach

    • Categorization of the prominent not-for-profit hospitals based on the premise of services and their ownership
    • Understanding the business model of the hospitals i.e. the financial viability, and their dependence on donations and grants
    • Understanding the challenges faced by these hospitals
    • Formulation of recommendations for policy interventions to promote the sector

    Categories of such hospitals

    Using the above-mentioned approach and secondary research, the following four categories were defined for the not-for-profit hospitals:

    1. Faith-based Hospitals
    2. Community-based Hospitals
    3. Cooperative Hospitals
    4. Private Trust Hospitals

    Why need such hospitals?

    • There has been relatively low investment in the expansion of the health sector in the private domain.
    • The not-for-profit hospital sector provides not only curative but also preventive healthcare.
    • It links healthcare with social reform, community engagement, and education.
    • It uses government resources and grants to provide cost-effective healthcare to people without being concerned about profits.

  • Centre must make way for states in Covid fight

    The States are better equipped to deal with the health emergencies and the Centre needs to augment them in their efforts. The article deals with this issue.

    Role of the States in health crisis

    • Covid-19 pandemic is a national crisis calling for concerted efforts by both, the Government of India (GoI) and state governments.
    • Health is a state subject, and the states have been pioneering many health programmes on their own, some with support and funding from the GoI, for a very long time.
    • The number of employees in the health wing of the GoI is negligible as compared to that in any state government.
    • The GoI must help them, motivate them to do better and assist them in their task.
    • Also, the GoI must and can play a major role is in vaccination.

    Role of the Central government

    • It must try to augment supplies by encouraging companies to produce more and through imports/gifts.
    •  However, whatever it procures must be allotted to states in proportion to their eligible population.
    • State governments must be involved in this policy.
    • The vaccination policy may be left to the state governments based on the allocation. 
    • The GoI must also augment supplies of critical medical goods through imports and donations from friendly nations in view of their acute shortage.
    • It must distribute them to the needy states transparently and equitably.

    Steps that need to be taken

    • Lockdowns need to be lifted in a calibrated manner depending on local conditions.
    • Lockdowns are not the solution, they just buy breathing time which can be used by governments to ramp up capacity.
    • State governments must set up efficient and well-functioning control rooms and telemedicine centres to guide people on home treatment and timely admission to hospitals.
    • The private sector can also be fully involved in these efforts.
    • Bed capacity must be increased in both private and public sectors, with all necessary requirements such as oxygen, medicines, and health workers.
    • It is also important to put in place a standard guidance protocol for health workers and control rooms to guide patients through the disease.
    •  Enforcement of masks and distancing in public places must go on till the country is fully vaccinated.
    • The measures suggested above require hard work and efficient management by state governments, by a team of reputed professionals and civil servants.
    • Daily briefing by a professional, not a politician, is the need of the hour at both the Centre and state level, giving some confidence and assurance to the public.

    Consider the question “In dealing with the health crisis the Union Government and the State governments are better placed for certain roles.  In light of this, examine the important role of the States in dealing with the Covid pandemic and how the Union government can complement it.”

    Conclusion

    The central government must realise that states are on the forefront in this war, and therefore, play a supporting and proactive role. It has only a minor, behind-the-scenes role in the health sector.

  • Challenges in Vaccinating All

    Reoriented vaccine policy

    • The foremost challenge in vaccination in India has been a supply deficit.
    • Announcing a reoriented vaccine policy recently, the Prime Minister announced a coherent path forward.
    • Starting from June 21, the Union government will take charge of 75 per cent of the total procurement, and provide vaccines to states at no cost.
    • The government has reserved 30 crore vaccines with Hyderabad-based Biological-E by facilitating an advance payment of Rs 1,500 crore.
    • Fortnightly updates on the supply of vaccines to states are being taken to ensure transparency and efficiency in planning.

    Dealing with two complex challenges

    • Two other complex challenges that need immediate focus are vaccine hesitancy and the much-discussed digital divide in the country.

    1) Challenge of vaccine hesitancy

    • Contextualised and curated approaches are crucial.
    • The WHO has put forth the BeSD (behavioural and social drivers) vaccination model, which emphasises “motivation” as the vanguard of human psychology during a vaccination drive.
    • Vaccination coverage could be increased by incentivising and motivating citizens.
    • Unfortunately, in India, misinformation, disinformation and misplaced beliefs have led to fears about the potential harmful effects of vaccines.
    • The diversity of India necessitates community engagement at the local level to counter this narrative of misinformation.
    • A successful information campaign requires dissemination through mediums that invoke trust.
    • Local languages and dialects should be used to engage people via local radio, television channels and regional newspapers.
    • Another network that can be leveraged at the district level is that of the ASHA workers and the auxiliary nurse-midwives.
    • These are trusted local figures.

    2) Bridging the digital divide

    • It is important to introduce solutions that bridge the digital divide.
    • A toll-free helpline number 1075 has been activated for those without internet.
    • Similarly, districts can explore missed-call campaigns, which could ensure that minimal infrastructure is being optimised for processing high-volume user requests.
    • Even though the reported adverse events following immunisation stands at only 0.012 per cent, dedicated representatives can provide vaccine-related pre- and post-counselling to individuals.

    Way forward

    Startups could help bridge digital divide

    • The devastating effects of the second wave in rural areas have prompted fintech startups to enable vaccine registration.
    • PayNearby has helped over 8 lakh citizens register through its network of agents called “digital pradhans”, who are present in kirana, ration, mobile and hardware stores, frequented regularly by rural users. 

    Use points of contact for publicising benefits of vaccine and registration

    • Almost 81 crore beneficiaries, 75 per cent of whom are in rural areas, procure ration from 5,46,165 fair price shops across India.
    • There are over 11 lakh business correspondent outlets in India working mostly in rural areas to advance the mission of financial inclusion.
    • A network of around 1,54,965 post offices (as on March 2017) exists in India of which 1,39,067 are in the rural areas.
    • Such points of contact can be leveraged as dedicated units for publicising the benefits of Covid vaccines and as physical locations for vaccine registration

    Direct engagement with citizens

    • The Prime Minister recently described district officials as “field commanders” in our efforts against Covid.
    • This ambit should move beyond just the district bureaucracy to the extensive network of public services. 
    • A stellar example of direct engagement also stems from the success of the Swachh Bharat Abhiyan.
    • Direct engagement with citizens contributed greatly to the operational success of previous immunisation campaigns like the pulse polio programme.

    Consider the question “What are the factors responsible for vaccine hesitency? Suggest the ways to deal with it.”

    Conclusion

    Thinking local and utilising established networks to create culturally resonant messages is the need of the hour to reduce vaccine hesitancy, bridge the digital divide and achieve vaccine saturation.

     

  • South Asia’s healthcare burden

    The article contrasts the public healthcare system in South Asian countries with that of their Southeast Asian peers and highlights the shortcomings.

    Subpar public healthcare system

    • Super spreader events, a fragile health infrastructure neglected for decades, citizens not following health protocols, and logistical mismanagement were the factors responsible for the destruction in the second Covid-19 wave.
    • What has exacerbated the situation is a subpar public healthcare system running on a meagre contribution of a little over 1% of India’s Gross Domestic Product (GDP).
    • While the private medical sector is booming, the public healthcare sector has been operating at a pitiful 0.08 doctors per 1,000 people, World Health Organization’s (WHO) prescribed standard ois1:1000.
    • India has only half a bed available for every 1,000 people, which is a deficient figure even for normal days.
    • Bangladesh and Pakistan fare no better, with a bed to patient ratio of 0.8 and 0.6, respectively, and a doctor availability of less than one for every 1,000 people.
    • While ideally, out-of-pocket expenditure should not surpass 15% to 20% of the total health expenditure, for India, Bangladesh and Pakistan, this figure stands at an appalling 62.67%, 73.87% and 56.24%, respectively.

    Lack of investment in healthcare

    • Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
    • While India has the world’s third-largest military expenditure, its health budget is the fourth-lowest.
    • Indian government in this year’s budget highlighted an increase of 137% in health and well-being expenditure, a closer look reveals a mismatch between facts and figures.
    • In Pakistan, even amidst the pandemic, the defence budget was increased while the spending on health remained around $151 million.
    • Not too far behind is Bangladesh, with decades of underfunding culminating in a crumbling public healthcare system.
    • Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
    • A quick look at pre-pandemic sectoral allocations explains the chronically low status of human development indicators in the three countries.

    Learning from Southeast Asia

    • Southeast Asia has prioritised investments in healthcare systems while broadening equitable access through universal health coverage schemes.
    • Vietnam’s preventive measures focused on investments in disease surveillance and emergency response mechanisms.
    • Even countries like Laos and Cambodia are making a constant effort towards improving the healthcare ecosystem.
    • All have done much better than their South Asian peers.

    Conclusion

    Learning from the devastation unleashed by the pandemic, South Asian countries must step up investment in their public healthcare sectors to make them sustainable, up to date and pro-poor; most importantly, the system should not turn its back on citizens.

  • Operation Pangea XIV

    More than 1.10 lakh web links, including websites and online marketplaces, have been taken down in the operation Pangea XIV.

    Operation Pangea XIV

    • Code-named “Operation Pangea XIV”, the exercise was coordinated by Interpol.
    • It involved the police, customs, and health regulatory authorities of 92 countries against the sale of fake and illicit medicines and medical products.
    • Indian agencies also participated in the operation, said an official of the Central Bureau of Investigation that is the nodal body for the Interpol in the country.
    • It showed that criminals were continuing to cash in on the huge demand for personal protection and hygiene products due to the COVID-19 pandemic.

  • [pib] SAGE (Senior-care Ageing Growth Engine) Initiative

    The Ministry of Social Justice and Empowerment has launched the SAGE (Seniorcare Aging Growth Engine) initiative and SAGE portal for elderly persons.

    SAGE Initiative

    • The SAGE will be a “one-stop access” of elderly care products and services by credible start-ups.
    • The start-ups will be selected on the basis of innovative products and services.
    • Their products should be able to provide across sectors such as health, housing, care centers, apart from technological access linked to finances, food and wealth management, and legal guidance.
    • The start-ups who have applied will be selected by an independent screening committee of experts.
    • A fund of upto Rs.1 crore as one-time equity will be granted to each selected start-up.

    Why need such initiative?

    • India’s elderly population is on the rise as per surveys.
    • The share of elders, as a percentage of the total population in the country, is expected to increase from around 7.5% in 2001 to almost 12.5% by 2026, and surpass 19.5% by 2050.
    • There is an urgent need to create a more robust eldercare ecosystem in India, especially in the post-COVID phase.