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Subject: Health

  • [pib] Digital platform ‘CO-WIN’

    A New Digital platform ‘CO-WIN’ is being used for COVID-19 Vaccine Delivery.

    Q.India’s first mass adult vaccination drive against COVID-19 is a difficult task. Explain.

    CO-WIN

    • This user friendly mobile app for recording vaccine data is working as a beneficiary management platform having various modules.
    • The platform will be used for recording vaccine data and will form a database of healthcare workers too.
    • The app will have separate modules for administrator, registration, vaccination, beneficiary acknowledgement and reports.
    • Once people start to register for the app, the platform will upload bulk data on co-morbidity provided by local authorities.
    • In the process of forming database of Healthcare Workers, which is in an advanced stage across all States/UTs, data is presently being uploaded on the Co-WIN platform.

    Prioritized group

    Prioritized Population Groups include:

    1. Healthcare Workers in both Government and Private Healthcare facilities
    2. Frontline Workers including personnel from state and central police department, armed forces, home guard, civil defence organizations, disaster management volunteers and municipal workers and
    3. Prioritized Age Group, which includes those aged above 50 years & those with co-morbidities

    (Note: This is not the sequence, but categorization.)

  • India’s Population with Disabilities

    December 3 is marked by the UN as International Day of Persons with Disabilities in a bid to promote a more inclusive and accessible world for the differently-abled and to raise awareness for their rights.

    Try this question from our AWE initiative:

    What are the legal provisions and policy initiatives in India for the welfare of persons with disabilities? What are the challenges faced by persons with disabilities in India? 10 marks

    Disability in India

    • About 2.2% of India’s population lives with some kind of physical or mental disability, as per the National Statistics Office report on disability released last year.

    How are the disabled identified?

    • Until the 2011 census, there were questions on seven kinds of disabilities in the questionnaire.
    • This list of disabilities was expanded to 21 when the Rights of People with Disabilities was introduced in 2016.
    • Accordingly, the 2019 report included questions to identify people with temporary loss of ability as well as neurological and blood disorders in addition.
    • The earlier definition included mental retardation and permanent inability to move, speak, hear and see.
    • Significantly, the revised definition recognizes deformities and injuries of acid attack victims as disabilities, entitling them to various relief measures.

    Who are disabled and in what way?

    • Rural men had the highest prevalence of disability in India, according to the NSO report.
    • A higher proportion of men were disabled in India compared with women, and disability was more prevalent in rural areas than in urban areas.
    • Inability to move without assistance was the most common disability. More men experienced locomotor disability than women.
    • These numbers were self-reported. In other words, the respondents were asked if they experienced any difficulty in performing tasks like moving, talking, etc.

    Are these measures in line with those from other surveys?

    • The 2011 census estimated that the number of people with disabilities in India is close to 2.68 crore (or 2.2% of the population) — that is more than the entire population of Australia.
    • This number was based on the older definition of disability, yet the proportion of disabled people in the population is not different from the 2019 NSO report, which used the expanded definition of disability.
    • Other metrics for evaluating disability have provided different estimates.
    • A group of doctors from AIIMS found that alternate questionnaires like the Rapid Assessment of Disability have resulted in a prevalence ranging from 1.6%-43.3%.

    How can the range be so wide?

    • The proportion of population facing disability becomes bigger as one move from a narrow definition to a broader one.
    • For instance, if one defines disability as the difficulty in accessing public services for all kinds of reasons, even social or economic, then the proportion goes up.

    Why is it important to map disabled people?

    • Like other disadvantaged groups, the disabled in India are entitled to some benefits, ranging from reservation in educational institutes to concessions on railway tickets.
    • To claim these benefits, they have to furnish certificates as proof of disability.
    • At the macro level, data on the prevalence and type of disability is useful while making allocations for welfare schemes.

  • [pib] E-Sanjeevani Telemedicine Service

    In a landmark achievement, eSanjeevani, Health Ministry’s national telemedicine initiative today completed 9 lakh consultations.

    Although telemedicine brings with it many benefits, there are some downsides to it as well. Discuss.

    What is E-Sanjeevani?

    • Ministry of Health & Family Welfare has launched two variants of eSanjeevani namely – doctor to doctor (eSanjeevani AB-HWC) in the hub and spoke model and patient to doctor (eSanjeevaniOPD).
    • E-Sanjeevani OPD (out-patient department) is a telemedicine variant for the public to seek health services remotely; it was rolled out on 13th of April 2020 during the first lockdown in the country.
    • It enables virtual meetings between the patients and doctors & specialists from geographically dispersed locations, through video conferencing that occurs in real-time.
    • At the end of these remote consultations, eSanjeevani generates electronic prescriptions which can be used for sourcing medicines.
    • Andhra Pradesh was the first state to roll out eSanjeevani AB-HWC services in November 2019.

    Benefits of telemedicine

    Telemedicine benefits patients in the following ways:

    • Transportation: Patients can avoid spending gas money or wasting time in traffic with video consultations.
    • No missing work: Today, individuals can schedule a consultation during a work break or even after work hours.
    • Childcare/Eldercare Challenges: Those who struggle to find care options can use telemedicine solutions.

  • What is the Emergency Use Authorization (EUA) for Drugmakers?

    The US drugmaker Moderna said it was applying for emergency use authorisation for its vaccine in India.

    Practice question for Mains:

    Q. What is Vaccine Nationalism? Discuss various ethical issues involved and its impact on vulnerable populations across the globe.

    Emergency Use Authorisation (EUA)

    • Vaccines and medicines, and even diagnostic tests and medical devices, require the approval of a regulatory authority before they can be administered.
    • In India, the regulatory authority is the Central Drugs Standard Control Organisation (CDSCO).
    • The approval is granted after an assessment of their safety and effectiveness, based on data from trials. In fact, approval from the regulator is required at every stage of these trials.
    • This is a long process, designed to ensure that medicine or vaccine is absolutely safe and effective.
    • The fastest approval for any vaccine until now — the mumps vaccine in the 1960s — took about four-and-a-half years after it was developed.

    Exceptions for emergency

    • In emergency situations, like the current one, regulatory authorities around the world have developed mechanisms to grant interim approvals.
    • However, there should sufficient evidence to suggest a medical product is safe and effective.
    • Final approval is granted only after completion of the trials and analysis of full data; until then, EUA allows the medicine or the vaccine to be used on the public.

    What is the process of getting a EUA in India?

    • India’s drug regulations do not have provisions for a EUA, and the process for receiving one is not clearly defined or consistent.
    • Despite this, CDSCO has been granting emergency or restricted emergency approvals to Covid-19 drugs during this pandemic — for remdesivir and favipiravir in June, and itolizumab in July.

    Associated risks

    • The public has to be informed that a product has only been granted a EUA and not full approval.
    • In the case of a Covid-19 vaccine, for example, people have to be informed about the known and potential benefits and risks.

    Not a compulsion

    • There has been an ongoing debate over whether people have the option of refusing to take the vaccine.
    • Incidentally, no country has made vaccination compulsory for its people.
    • Initially, all vaccines are likely to be deployed on emergency use authorizations only. Final approval from may take several months, or years.

  • Swasthya Sathi Health Insurance Scheme

    West Bengal CM has recently extended the Swasthya Sathi health insurance scheme to cover the entire population of the state.

    Do you know?

    Delhi, Telangana, Odisha and West Bengal have not implemented the Ayushman Bharat Scheme.

    Swasthya Sathi

    • The scheme was launched in West Bengal in 2016.
    • It is a basic health cover for secondary and tertiary care up to Rs five lakh per annum per family.
    • It is quite popular among rural and economically deprived sections of the state’s population.

    Highlights of the expanded scheme

    • Every family, every citizen irrespective of the age group will be included in this scheme
    • This is a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family
    • The scheme is completely funded by the state government
    • To cover the entire population of the state, each and every family will be given one smart card to avail the benefits under this scheme, where they will get cashless treatment
    • All state-run and private hospitals are going to come under the Swasthya Sathi
    • The card will be issued to the female guardians of families

  • Is allowing Ayurvedic doctors to perform surgery legally and medically tenable?

    The Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry has allowed postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.

    Debate over Ayurvedic surgeries

    • The Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy.
    • The debate revolves Ayurveda doctors allowing  ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures.
    • The AYUSH Ministry has clarified that the ‘Shalya’ and ‘Shalakya’ postgraduates were already learning these procedures in their (surgical) departments in Ayurvedic medical colleges as per their training curriculum.

    Broader issue

    • The broader issue is the feasiblity of short-term training equip them to conduct surgeries and if this dilutes the medicine standards in India.
    •  As such, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course.
    • Whether the surgeries conducted in Ayurvedic medical colleges and hospitals have the same standards and outcomes as allopathic institutions requires explication and detailed formal enquiry, in the interest of patient safety.

    Why such a move?

    • The shortage and unwillingness of allopathic doctors, including surgeons, to serve in rural areas is now a chronic issue.
    • The government has tried to address this by mechanisms such as rural bonds, a quota for those who have served in rural service in postgraduate seats.
    • However, it would probably still continue to fall short of enough trained specialists in rural areas.

    Are there any restrictions on Ayurveda practitioners?

    •  As of now, no such restriction exists that limits non-allopathic doctors, including those doing Ayurvedic surgical postgraduation, to rural areas.
    • They have the same rights as allopathic graduates and postgraduates to practise in any setting of their choice.

    Is it sensible to allow Ayurvedic surgeons to only assist allopathic surgeons, rather than perform surgeries themselves?

    • The AYUSH streams are recognised systems of medicine, and as such are allowed to independently practise medicine.
    • They have medical colleges with both undergraduate and postgraduate training, which include surgical disciplines for some systems, such as Ayurveda.
    • There is, however, a difference in approach in the systems of medicine, and hence models, which allow for cross-pathy.

    Various risks associated

    • An apprenticeship model for Ayurvedic surgeons working with allopathic surgeons might fall into a regulatory grey zone.
    • It might require re-training Ayurvedic practitioners in the science of surgical approaches in modern medicine.
    • Even then, there might be a limit to what they are allowed to do. Any such experiment can put patient safety in peril, and hence, will need careful oversight and evaluation.

    Can this lead to substandard care?

    • Many patients prefer to receive treatment exclusively from AYUSH providers, while some approach this form of treatment as a complement to the existing allopathic treatment they are receiving.
    • For invasive procedures, like surgery, the risk element can be high.

    A matter of rights

    • Patients have a right to know and understand who their surgeon would be, what system of medicine they belong to, and their expertise and level of training.
    • There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals.

    Way forward

    • We need to explore creative ways of addressing this gap by evidence-based approaches, such as task-sharing, supported by efficient and quality referral mechanisms.
    • The advent of mid-level healthcare providers, such as Community Health Providers in many States, is also an opportunity to shift some elements of healthcare (preventive, promotive, and limited curative) to these providers, while ensuring clarity of role and career progression.

  • Electronic Vaccine Intelligence Network

    The government is using eVIN – Electronic Vaccine Intelligence Network in association with the United Nations Development Program (UNDP) to identify primary beneficiaries and vaccine distribution networks.

    Try this question from CSP 2016:

    Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

    (a) Immunization of children and pregnant women

    (b) Construction of smart cities across the country

    (c) India’s own search for the Earth-like planets in outer space

    (d) New Educational Policy

    What is eVIN?

    • E-VIN is an indigenously developed technology that digitizes vaccine stocks and monitors the temperature of the cold chain through a smartphone application.
    • It was first launched across 12 states in 2015 to support better vaccine logistics management at cold chain points.
    • It supports the central government’s Universal Immunization Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points across states and UTs.

    Components of eVIN

    • eVIN combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real-time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country.
    • At present, 23,507 cold chain points across 585 districts of 22 States and 2 UTs routinely use the eVIN technology for efficient vaccine logistics management.

    Benefits of eVIN

    • It has helped create a big data architecture that generates actionable analytics encouraging data-driven decision-making and consumption-based planning.
    • It helps in maintaining optimum stocks of vaccines leading to cost savings. Vaccine availability at all times has increased to 99% in most health centres in India.
    • While instances of stock-outs have reduced by 80%, the time taken to replenish stocks has also decreased by more than half, on an average.
    • This has ensured that every child who reaches the immunization session site is immunized, and not turned back due to unavailability of vaccines.

  • National Digital Health Mission

    The National Digital Health Mission will soon be ready for a nationwide roll-out, confirmed the Chairman of National Health Authority and CEO of Ayushman Bharat.

    Must read:

    [Burning Issue] Rolling-out of National Digital Health Mission

    National Digital Health Mission

    • Our PM has launched the National Digital Health Mission on 15th August 2020.
    • The mission aims to create an integrated healthcare system linking practitioners with the patients digitally by giving them access to real-time health records.
    • It is a complete digital health ecosystem. The digital platform will be launched with four key features — health ID, personal health records, Digi Doctor and health facility registry.
    • At a later stage, it will also include e-pharmacy and telemedicine services, regulatory guidelines for which are being framed.

    Its implementation

    • The NDHM is implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare.
    • The National Health Authority (NHA), is also the implementing agency for Ayushman Bharat.

  • Distribution of Fortified Rice under ICDS

    In a bid to combat chronic anaemia and undernutrition, the government is planning to distribute fortified rice through the Integrated Child Development Services and Mid-Day Meal schemes across the country.

    What is Fortified Rice?

    • Rice can be fortified by adding a micronutrient powder to the rice that adheres to the grains or spraying of the surface of ordinary rice grains with a vitamin and mineral mix to form a protective coating.
    • Rice can also be extruded and shaped into partially precooked grain-like structures resembling rice grains, which can then be blended with natural polished rice.
    • Rice kernels can be fortified with several micronutrients, such as iron, folic acid and other B-complex vitamins, vitamin A and zinc.
    • These fortified kernels are then mixed with normal rice in a 1:100 ratio, and distributed for consumption.

    Note: Biofortification is the process by which the nutritional quality of food crops is improved through agronomic practices, conventional plant breeding, or modern biotechnology. It differs from conventional fortification in that Biofortification aims to increase nutrient levels in crops during plant growth rather than through manual means during the processing of the crops.

    What was the earlier initiative?

    • The centrally-sponsored pilot scheme was approved in February 2019 for a three-year period from 2019-20 onwards.
    • However, only five States — Andhra Pradesh, Gujarat, Maharashtra, Tamil Nadu and Chhattisgarh — have started the distribution of fortified rice in their identified pilot districts.

    Need for expansion

    • Currently, there are only 15,000 tonnes of these kernels available per year in the country.
    • To cover PDS, anganwadis and mid-day meals in the 112 aspirational districts, annual supply capacity would need to be increased to about 1.3 lakh tonnes.
    • To cover PDS across the country, 3.5 lakh tonnes of fortified kernels would be needed.

    Regulating fortification

    • FSSAI has formulated a comprehensive regulation on fortification of foods namely ‘Food Safety and Standards (Fortification of Foods) Regulations, 2016’.
    • These regulations set the standards for food fortification and encourage the production, manufacture, distribution, sale and consumption of fortified foods.
    • The regulations also provide for the specific role of FSSAI in promotion for food fortification and to make fortification mandatory.
    • WHO recommends fortification of rice with iron, vitamin A and folic acid as a public health strategy to improve the iron status of population wherever rice is a staple food.

    Back2Basics: Integrated Child Development Services (ICDS)

    • The ICDS aims to provide food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
    • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.
    • The tenth FYP also linked ICDS to Anganwadi centres established mainly in rural areas and staffed with frontline workers.
    • The ICDS provide for anganwadis or day-care centres which deliver a package of six services including:
    1. Immunization
    2. Supplementary nutrition
    3. Health checkup
    4. Referral services
    5. Pre-school education (Non-Formal)
    6. Nutrition and Health information

    Implementation

    • For nutritional purposes, ICDS provides 500 kilocalories (with 12-15 grams of protein) every day to every child below 6 years of age.
    • For adolescent girls, it is up to 500-kilo calories with up to 25 grams of protein every day.
    • The services of Immunisation, Health Check-up and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare.

  • What is ‘Infodemic’ Management?

    Managing the “infodemic” has been a serious challenge during the COVID-19 pandemic, says a Chief Scientist at World Health Organization (WHO).

    Try this question for mains:

    Q.‘Infodemic’ management these days has become a greater challenge than the actual course of pandemic management. Discuss.

    Defining Infodemic

    • Infodemic implies too much information, including false or misleading information, particularly on social media.
    • It has led to confusion, risk-taking and ultimately mistrust towards governments and the public health response.

    WHO framework for infodemics

    • The WHO has a framework for managing the coronavirus infodemic.
    • Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic.
    • From the perspective of being the first “infodemiolgist” who originally coined the term almost two decades ago, the author posts four pillars of infodemic management:
    1. Information monitoring (infoveillance)
    2. Building eHealth Literacy and science literacy capacity
    3. Encouraging knowledge refinement and quality improvement processes such as fact-checking and peer-review
    4. Accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences