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Subject: Health

  • Ayushman Sahakar Scheme

    The Agriculture Ministry has rolled out the Ayushman Sahakar Scheme to assist cooperatives in the creation of healthcare infrastructure in the country.

    Can you find the peculiarity of this scheme? Yes. It’s the Agriculture and not the Health Ministry.

    Ayushman Sahakar Scheme

    • The scheme is formulated by the National Cooperative Development Corporation (NCDC), the apex autonomous development finance institution under the Ministry of Agriculture and Farmers Welfare.
    • The scheme would give a boost to the provision of healthcare services by cooperatives.
    • It specifically covers establishment, modernization, expansion, repairs, renovation of hospital and healthcare and education infrastructure.

    Why need such a scheme?

    • There is a huge need for medical and nursing education in rural areas. But the problem is a lack of infrastructure.
    • Co-ops find it difficult to access credit for such projects as banks may not give them loans for non-agricultural purposes.

    Financing the scheme

    • NCDC would extend term loans to prospective cooperatives to the tune of Rs 10000 Crore in the coming years.
    • Any Cooperative Society with a suitable provision in its byelaws to undertake healthcare-related activities would be able to access the NCDC fund.
    • NCDC assistance will flow either through the State Governments/ UT Administrations or directly to the eligible cooperatives.
    • Apart from working capital and margin money to meet operational requirements, the scheme will also provide interest subvention of 1% to women majority cooperatives.

  • AIDS & India

    The article highlights the achievement in the fight against AIDS. Most significant are the achievements in the prevention of transmission from mother-to-child.

    Significant gains

    • As per recently released 2019 HIV estimates by the National AIDS Control Organization (NACO)/Ministry of Health and Family Welfare with the technical support of UNAIDS there has been a 66.1% reduction in new HIV infections among children and a 65.3% reduction in AIDS-related deaths in India over a nine-year period.
    • The number of pregnant women living with HIV has reduced from 31,000 in 2010 to 20,000 in 2019.
    • Overall, antenatal coverage has expanded, and HIV testing has increased over time and within target range.
    • Treatment coverage has also expanded.

    Progress in preventing mother to child transmission

    • Under the leadership of NACO, a ‘Fast-Tracking of EMTCT (elimination of mother-to-child transmission) strategy-cum-action plan’ was outlined by June 2019.
    • The plan entailed mobilisation and reinforcement of all national, State and partners’ collective efforts to achieve the EMTCT goal.
    • Additionally, in March 2020, we began efforts to minimise challenges posed by the COVID-19 pandemic.
    • From 2010 to 2019, India made important progress in reducing the HIV impact on children through prevention of mother-to-child transmission of HIV.
    • This was done through education and communication programmes; increased access to HIV services with innovative delivery mechanisms for HIV testing; counselling and care; and treatment and follow-ups.
    • India made HIV testing for all pregnant women free and HIV treatment is offered the same way nationwide without cost to pregnant mothers living with HIV through the national ‘treat all’ policy.
    • For two years UNICEF has worked with the World Health Organization and NACO to identify high burden districts (in terms of density of pregnant women living with HIV) as the last mile towards disease elimination.
    • Since 2002, when the EMTCT of HIV programmes were launched in India, a series of policy, programmatic and implementation strategies were rolled out so that all pregnant women can access free HIV testing and free treatment regimens for life to prevent HIV transmission from mothers to babies.
    • This has been made possible in government health centres and grass-root level workers through village health and nutrition days and other grass-roots events under the National Health Mission.
    • Indeed, the approach being promoted by UNICEF in focusing attention and resources in high burden districts is supported by the HIV strategic information division of NACO and UNAIDS to better understand the locations and populations most HIV affected, so that technical support and HIV services can be directed towards these areas.

    Conclusion

    Using data-driven and decision-making approaches it is certain that AIDS will no longer be a public health threat for children in India by the end of 2030, if not before.

  • Highlights of the Global Hunger Report, 2020

    India has the highest prevalence of wasted children under five years in the world, which reflects acute undernutrition, according to the Global Hunger Index 2020.

    Note the parameters over which the GHI is based and their weightage composition.

    Global Hunger Index (GHI)

    • The GHI has been brought out almost every year by Welthungerhilfe lately in partnerships with Concern Worldwide since 2000; this year’s report is the 14th one.
    • The reason for mapping hunger is to ensure that the world achieves “Zero Hunger by 2030” — one of the SDGs laid out by the UN.
    • A low score gets a country a higher ranking and implies better performance.
    • It is for this reason that GHI scores are not calculated for certain high-income countries.
    • Each country’s data are standardised on a 100-point scale and a final score is calculated after giving 33.33% weight each to components 1 and 4, and giving 16.66% weight each to components 2 and 3.

    For each country in the list, the GHI looks at four indicators:

    1. Undernourishment (which reflects inadequate food availability): calculated by the share of the population that is undernourished (that is, whose caloric intake is insufficient)
    2. Child Wasting (which reflects acute undernutrition): calculated by the share of children under the age of five who are wasted (that is, those who have low weight for their height)
    3. Child Stunting (which reflects chronic undernutrition): calculated by the share of children under the age of five who are stunted (that is, those who have low height for their age)
    4. Child Mortality (which reflects both inadequate nutrition and unhealthy environment): calculated by the mortality rate of children under the age of five.

    India’s performance this year

    • In the 2020 Global Hunger Index, India ranks 94th out of the 107 countries with sufficient data to calculate 2020 GHI scores.
    • With a score of 27.2, India has a level of hunger that is serious.
    • The situation has worsened in the 2015-19 period, when the prevalence of child wasting was 17.3%, in comparison to 2010-14, when it was 15.1%.
    • India fares worst in child wasting (low weight for height, reflecting acute undernutrition) and child stunting (low height for age, reflecting chronic undernutrition), which together make up a third of the total score.

    Useful comparative data

    • Overall, India ranks 94 out of 107 countries in the Index, lower than neighbours such as Bangladesh (75) and Pakistan (88).
    • In the region of the south, east and south-eastern Asia, the only countries which fare worse than India are Timor-Leste, Afghanistan and North Korea.

  • [pib] Thalassemia Bal Sewa Yojna

    Union Health Ministry has launched the second phase of “Thalassemia Bal Sewa Yojna” for underprivileged Thalassemic patients.

    Thalassemia Bal Sewa Yojna

    • This scheme was launched in 2017 under the Coal India CSR funded Hematopoietic Stem Cell Transplantation (HSCT) program.
    • It aims to provide a one-time cure opportunity for Haemoglobinopathies like Thalassaemia and Sickle Cell Disease for patients who have a matched family donor.
    • The initiative was targeted to provide financial assistance to a total of 200 patients by providing a package cost not exceeding Rs. 10 lakhs per HSCT.

    What is Thalassemia?

    • Thalassemia is an inherited blood disorder characterized by less oxygen-carrying protein (haemoglobin) and fewer red blood cells in the body than normal.
    • When there isn’t enough haemoglobin, the body’s red blood cells don’t function properly and they last shorter periods of time, so there are fewer healthy red blood cells travelling in the bloodstream.
    • Symptoms include fatigue, weakness, paleness and slow growth.
    • Mild forms may not need treatment. Severe forms may require blood transfusions or a donor stem-cell transplant.

  • E-VIN network to handle COVID-19 vaccine supply

    The eVIN network, which can track the latest vaccine stock position; the temperature at storage facility; geo-tag health centres; and maintain facility-level dashboard, is being repurposed for the delivery of the COVID-19 vaccine.

    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 network?

    • The eVIN is an innovative technological solution aimed at strengthening immunization supply chain systems across the country.
    • This is being implemented under the National Health Mission (NHM) by the Ministry of Health and Family Welfare.
    • It aims to provide real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in the country.
    • This system has been used during the COVID pandemic for ensuring the continuation of the essential immunization services and protecting our children and pregnant mothers against vaccine-preventable diseases.

    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.

  • Assisted Reproductive Technology Bill needs a thorough review

    There are several issues with the Assisted Reproductive Technology Bill and these issues need consideration before the passage of the Bill.

    What the Bill aims to achieve

    • Union Health Minister introduced the Assisted Reproductive Technology (Regulation) Bill, 2020 (Bill) in the Lok Sabha.
    • Its aim is to regulate ART banks and clinics, allow safe and ethical practice of ARTs and protect women and children from exploitation.
    • The Bill was introduced to supplement the Surrogacy (Regulation) Bill, 2019 (SRB), which awaits consideration by the Rajya Sabha after review by two parliamentary committees.

    Concerns with the Bill

    1)  Exclusion in the access of ART

    • .The Bill allows for a married heterosexual couple and a woman above the age of marriage to use ARTs.
    • It excludes single men, cohabiting heterosexual couples and LGBTQI individuals and couples from accessing ARTs.
    • This violates Article 14 of the Constitution and the right to privacy jurisprudence of Puttaswamy, where the Supreme Court held that “ the liberty of procreation, the choice of a family life” concerned all individuals irrespective of their social status and were aspects of privacy.
    • In Navtej Johar case, Justice Chandrachud exhorted the state to take positive steps for equal protection for same-sex couples.
    • Unlike the SRB, there is no prohibition on foreign citizens accessing ARTs.
    • Foreigners can access ART but not Indian citizens in loving relationships.
    • This fails to reflect the true spirit of the Constitution.

    2) Consent

    • The ART Bill does little to protect the egg donor.
    • Harvesting of eggs is an invasive process which, if performed incorrectly, can result in death.
    • The Bill requires an egg donor’s written consent but does not provide for her counselling or the ability to withdraw her consent before or during the procedure.
    • She receives no compensation or reimbursement of expenses for loss of salary, time and effort.
    • Failing to pay for bodily services constitutes unfree labour, which is prohibited by Article 23 of the Constitution.
    • The commissioning parties only need to obtain an insurance policy in her name for medical complications or death; no amount or duration is specified.
    • The egg donor’s interests are subordinated in a Bill proposed in her name.
    • The Bill restricts egg donation to a married woman with a child (at least three years old).

    3) Threat of eugenics

    • The Bill requires pre-implantation genetic testing.
    • If the embryo suffers from “pre-existing, heritable, life-threatening or genetic diseases”, it can be donated for research with the commissioning parties’ permission.
    • These disorders need specification or the Bill risks promoting an impermissible programme of eugenics.

    4) Overlap with Surrogacy Regulation

    • There is considerable overlap between ART and SRB sectors. Yet the Bills do not work in tandem.
    • Core ART processes are left undefined; several of these are defined in the SRB.
    • Definitions of commissioning “couple”, “infertility”, “ART clinics” and “banks” need to be synchronised between the Bills.
    • A single woman cannot commission surrogacy but can access ART.
    • The Bill designates surrogacy boards under the SRB to function as advisory bodies for ART, which is desirable.
    • However, both Bills set up multiple bodies for registration which will result in duplication or lack of regulation (e.g. surrogacy clinic is not required to report surrogacy to National Registry).
    • Also, the same offending behaviours under both Bills are punished differently + punishments under the SRB are greater.
    • Offences under the Bill are bailable but not under the SRB.
    • Finally, records have to be maintained for 10 years under the Bill but for 25 years under the SRB.
    • The same actions taken by a surrogacy clinic and ART clinic  attract varied regulation.

    Other concerns

    • Children born from ART do not have the right to know their parentage, which is crucial to their best interests and protected under previous drafts.
    • There is no distinction between ART banks and ART clinics, given that gamete donation is not compensated, economically viability of ART Banks raises a question.
    • In previous drafts, gametes could not be gifted between known friends and relatives if this is not changed, gamete shortage is likely.
    •  The Bill’s prohibition on the sale, transfer, or use of gametes and embryos is poorly worded and will confuse foreign and domestic parents relying on donated gametes.
    • Unusually, the Bill requires all bodies to be bound by the directions of central and state governments in the national interest, friendly relations with foreign states, public order, decency or morality — being broadly phrased, it undermines their independence.

    Way forward

    • The Bill to maintain a grievance cell but clinics must instead have ethics committees.
    • Mandated counselling services should also be independent of the clinic.
    • The poor enforcement of the PCPNDT Act, 1994, demonstrates that enhanced punishments do not secure compliance — lawyers and judges also lack medical expertise.
    • Patients already sue fertility clinics in consumer redressal fora, which is preferable to criminal courts.

    Conclusion

    The Bill raises several constitutional, medico-legal, ethical and regulatory concerns, affecting millions and must be thoroughly reviewed before passage.

  • [pib] Coalition of Epidemic Preparedness for Innovation (CEPI)

    Translational Health Science And Technology Institute (THSTI), an autonomous institute of the Department of Biotechnology, has now been recognized by Coalition of Epidemic Preparedness for Innovation (CEPI) as one of the Global Network of Laboratories for centralized assessment of COVID 19 Vaccines.

    Note: CEPI is neither a WHO subsidiary nor a UN body .

    Coalition of Epidemic Preparedness for Innovation (CEPI)

    • The CEPI is a foundation that takes donations to finance independent research projects to develop vaccines against emerging infectious diseases (EID).
    • It is focused on the WHO’s “blueprint priority diseases.
    • These diseases include the Middle East respiratory syndrome-related coronavirus (MERS-CoV), the SARS coronavirus 2 the Nipah virus, the Lassa fever virus, and the Rift Valley fever virus, as well as the Chikungunya virus and the hypothetical, unknown pathogen “Disease X”.
    • CEPI investment also requires “equitable access” to the vaccines during outbreaks.
    • CEPI was conceived in 2015 and formally launched in 2017 at the World Economic Forum (WEF) in Davos, Switzerland.

  • Swachh Bharat Puraskar (PIB)

    What are Swachh Bharat Puruskar ?

    • he Swachh Bharat (2020) Awards were conferred to the best performing States/UTs, districts, blocks, GPs and others in various categories marking six years of the Swachh Bharat Mission (SBM) launch.
    • The awards were given by Department of Drinking Water and Sanitation (DDWS).
    • Top Awards were conferred upon Gujarat, Uttar Pradesh, Haryana, Telangana, Tamil Nadu, Madhya Pradesh, Punjab& others.
    • Gujarat was felicitated with the first prize in the state category; Tirunelveli, Tamil Nadu as best district; Khachrod, Ujjain, Madhya Pradesh as best block; and Chinnaur, (Salem) as the best Gram Panchayat for Swachh Sundar Samudayik Shauchalaya (SSSS) campaign organized from 1st Nov 2019 to 30th April 2020.
    • For the week-long Gandagi Se Mukt campaign launched by Prime Minister, Shri Narendra Modi on 8th August 2020, Telangana received the top award for maximum Shramdaan participation.

     

  • Obesity in India

    Adults in urban India consume much more fat than those in rural areas, found the latest survey by the Indian Council of Medical Research and National Institute of Nutrition.

    Do you know?

    Over-nutrition is also a form of malnutrition.

    ‘What India Eats’ Survey

    • Adults in India’s urban centres consumed 51.6 grammes fat per day per head on an average. The volume was 36 g in rural areas, according to the survey report What India Eats.
    • The report categorised fat into two groups:
    1. Visible or added fat, comprising oils and fat in preparing food, in fried food and those derived from meat and poultry
    2. Invisible fat, including fat/oils from rice, pulses, nuts and oilseeds

    Urban-Rural data

    • 84 per cent of the rural population secured their energy (E) per day requirement from total fats/oils, or visible / added fats.
    • On the other hand, less than 20 per cent of the urban population derived their E / day from this category.
    • In urban areas of the country, northern India had the highest intake of added fat with 45.9 g / day.
    • Southern India reported the lowest per capita consumption of added fat/oils with 22.9 g / day in this segment of the population.
    • In the urban region of north India, fat intake (67.3 g) was among the highest; and overweight, obesity and abdominal obesity were highest when compared to other regions.

  • Dealing with the problems of medical education

    The article discusses the issues with medical education in India and how it affects the principle of equality.

    Role of private entities

    • Due to demand for high-quality medical care on the one hand and constraints on public resources on the other, private entities have been permitted to establish medical educational institutions to supplement government efforts.
    • In the field of health care, there is a continuing shortage of health-care personnel.
    • The infrastructure required for high-quality modern medical education is expensive.
    • The three stated objectives of medical education has been — providing health-care personnel in all parts of the country, ensuring quality and improving equity.
    • None of the three stated objectives of medical education has been achieved by the private sector.
    • Though they are supposed to be not-for-profit, taking advantage of the poor regulatory apparatus and the ability to both tweak and create rules, these private entities, with very few exceptions, completely commercialised education.

    Demand for regulation and equity

    • There have been attempts to regulate fees, sometimes by governments and sometimes by courts.
    •  These efforts have not been fruitful.
    • The executive, primarily the Medical Council of India, has proven unequal to the task of ensuring that private institutions comply with regulations.
    •  When the courts are approached, which issues are seen as important depends on the Bench.
    • It was in this situation that led to the introduction of the National Eligibility-cum-Entrance Test (Undergraduate), or NEET-UG, as a single all-India gateway for admission to medical colleges.
    •  Challenged in courts, after an initial setback, the NEET scheme has been upheld.

    How NEET affected equity

    • NEET may have improved the quality of candidates admitted to private institutions to some extent, but it seems to have further worsened equity.
    • Under any scheme of admission, the number of students from government schools who are able to get admission to a medical college is very low.
    • With NEET, the number has become lower.
    • The high fees of private medical colleges have always been an impossible hurdle for students from government schools, whatever the method used for admission.

    Way forward

    • The basic cause of inequity in admission to higher educational institutions is the absence of a high quality school system accessible to all.
    • Allowing government medical colleges to admit students based on marks in Standard XII and using NEET scores for admission to private colleges will be more equitable right now.

    Conclusion

    Only a resolute government, determined to ensure that economic policy facilitates quality and equity in education, can do it.