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Subject: Health

  • Assisted Reproductive Technology (Regulation) Bill, 2020

    The Centre moved to standardize protocols of the growing fertility industry and introduced the Assisted Reproductive Technology (Regulation) Bill, 2020, in Lok Sabha on the first day of the monsoon session of Parliament.

    Try this question for mains:

    Q. What is Assisted Reproductive Technology? Discuss the salient features of ART Regulation Bill, 2020?

    Features of the ART Regulation Bill, 2020

    (1) Defining ART

    • The Bill defines ART to include all techniques that seek to obtain a pregnancy by handling the sperm or the oocytes (immature egg cell) outside the human body and transferring the gamete or the embryo into the reproductive system of a woman.
    • Examples of ART services include gamete (sperm or oocyte) donation, in-vitro-fertilisation (fertilising an egg in the lab), and gestational surrogacy (the child is not biologically related to surrogate mother).
    • ART services will be provided through: (i) ART clinics, which offer ART related treatments and procedures, and (ii) ART banks, which store and supply gametes.

    (2) Regulation of ART clinics and banks

    • The Bill provides that every ART clinic and the bank must be registered under the National Registry of Banks and Clinics of India.
    • The National Registry will be established under the Bill and will act as a central database with details of all ART clinics and banks in the country.
    • State governments will appoint registration authorities for facilitating the registration process.
    • Clinics and banks will be registered only if they adhere to certain standards (specialised manpower, physical infrastructure, and diagnostic facilities).
    • The registration will be valid for five years and can be renewed for a further five years. Registration may be cancelled or suspended if the entity contravenes the provisions of the Bill.

    (3) Conditions for gamete donation and supply

    • Screening of gamete donors, collection and storage of semen, and provision of oocyte donor can only be done by a registered ART bank.
    • A bank can obtain semen from males between 21 and 55 years of age, and oocytes from females between 23 and 35 years of age.
    • An oocyte donor should be an ever-married woman having at least one alive child of her own (minimum three years of age).
    • The woman can donate oocyte only once in her life and not more than seven oocytes can be retrieved from her.
    • A bank cannot supply gamete of a single donor to more than one commissioning couple (couple seeking services).

    (4) Conditions for offering ART services

    • ART procedures can only be carried out with the written informed consent of both the party seeking ART services as well as the donor.
    • The party seeking ART services will be required to provide insurance coverage in the favour of the oocytes donor (for any loss, damage, or death of the donor).
    • A clinic is prohibited from offering to provide a child of pre-determined sex. The Bill also requires checking for genetic diseases before the embryo implantation.

    (5) Rights of a child born through ART 

    • A child born through ART will be deemed to be a biological child of the commissioning couple and will be entitled to the rights and privileges available to a natural child of the commissioning couple.
    • A donor will not have any parental rights over the child.

    (6) National and State Boards

    • The Bill provides that the National and State Boards for Surrogacy constituted under the Surrogacy (Regulation) Bill, 2019 will act as the National and State Board respectively for the regulation of ART services.
    • Key powers and functions of the National Board include:
    1. advising the central government on ART related policy matters,
    2. reviewing and monitoring the implementation of the Bill,
    3. formulating code of conduct and standards for ART clinics and banks, and
    4. overseeing various bodies to be constituted under the Bill
    • The State Boards will coordinate enforcement of the policies and guidelines for ART as per the recommendations, policies, and regulations of the National Board.

    (7) Offences and penalties

    • Offences under the Bill include:

    (i) abandoning, or exploiting children born through ART, (ii) selling, purchasing, trading, or importing human embryos or gametes, (iii) using intermediates to obtain donors, (iv) exploiting commissioning couple, woman, or the gamete donor in any form, and (v) transferring the human embryo into a male or an animal.

    • These offences will be punishable with a fine between five and ten lakh rupees for the first contravention.
    • For subsequent contraventions, these offences will be punishable with imprisonment for a term between eight and 12 years, and a fine between 10 and 20 lakh rupees.
    • Any clinic or bank advertising or offering sex-selective ART will be punishable with imprisonment between five and ten years, or fine between Rs 10 lakh and Rs 25 lakh, or both.
    • No court will take cognizance of offences under the Bill, except on a complaint made by the National or State Board or any officer authorised by the Boards.

    With inputs from PRS: https://www.prsindia.org/billtrack/assisted-reproductive-technology-regulation-bill-2020

  • Uniting South Asian region to combat Covid

    The article analyses how South Asia is dealing with the pandemic and the need for coordinated action by the countries across the region.

    Varying response across the region

    • Governments in South Asian countries have responded in varying degrees to counter the health and economic crises.
    • India resumed its economic activities on a limited scale following a strict lockdown.
    • Bangladesh, Nepal, Pakistan and Sri Lanka did the same after an extended lockdown.
    • Bhutan and the Maldives have managed to largely contain community transmission and avoid prolonged lockdowns due to a higher testing rate.
    • This is consistent with the hypothesis that countries that have conducted more tests have been more successful in containing the pandemic.

    Low mortality in the region

    • Unlike other regions, South Asian countries are experiencing a lower mortality rate despite having a higher infection rate.
    • However, epidemiological studies and the World Health Organization’s reviews have been sceptical about the data reliability.

    Effectiveness of state responses

    • India, Pakistan, Bangladesh, and the Maldives have unveiled stimulus packages.
    • The rest of the countries are yet to announce any concrete support for their low income and lower-middle income population still suffering from the economic fallout of the crisis.
    • In late March, India announced a $22.5 billion relief package to ensure food security and cash transfers to save the livelihoods of an estimated 800 million people living in poverty.
    • The Reserve Bank of India (RBI) slashed the repo and reverse repo rate to create liquidity for businesses.
    • In early April, Bangladesh announced a stimulus package worth about $8 billion in addition to an earlier $595 million incentive package for export-oriented industries.
    • Although countries like India and Bangladesh announced financial and material stimulus packages, distribution concerns remain unaddressed.

    United response by SAAR

    • The region need to look beyond narrow geopolitical rivalry and come together to work towards a well-coordinated response mechanism.
    • A SAARC COVID-19 fund was created following Indian Prime Minister Narendra Modi’s call to South Asian leaders.
    • Bbut governments are yet to decide on its modus operandi.
    • The region could leverage its existing institutional framework under the umbrella of SAARC to effectively respond to the crisis.
    • For instance, SAARC Food Banks could be activated to tackle the imminent regional food crisis, and the SAARC Finance Forum can be activated to formulate a regional economic policy response.

    Conclusion

    Faced with an unprecedented crisis, this is the right time for the leaders of the region to come together and take on the challenge collectively.

  • Crisis in education in rural India and NEP

    The article analyses the missing focus on the rural youth in the National Education Policy 2020 and its implications.

    Education in rural India and NEP

    • Poor quality education marks and mars the lives of rural citizens.
    • The NEP fails to address the growing school differentiation in which government schools are now primarily attended by children of disadvantaged castes and Adivasi groups.
    • The mushrooming of private schools caters to the aspirations of the more advantaged castes and classes.
    • The NEP overlooks the complexity of contemporary rural India, which is marked by a sharp deceleration of its economy, extant forms of distress, and widespread poverty.
    • Rural candidates are finding it increasingly difficult to gain entry into professional education.
    • The lack of fit between their degrees and the job market means that several lakhs of them find themselves both “unemployable” and unemployed.

    What the NEP misses

    • NEP overlooks the general adverse integration of the rural into the larger macroeconomy and into poor quality mass higher education.
    • The report calls for the “establishment of large, multi-discipline universities and colleges” and places emphasis on online and distance learning (ODL).
    • However, correspondence courses and distance education degrees have become a source of revenue generation for universities.
    • The possibility of forging and promoting environmental studies for local ecological restoration and conservation are missing.
    • Emphasis on local health and healing traditions from the vast repertoire of medical knowledge is missing.
    • Vernacular architectural traditions and craftsmanship to use local resources find no mention at all in the NEP.

    Neoliberal ideas in NEP

    • The NEP moots the possibility of establishing “Special Education Zones” in disadvantaged areas and in “aspirational districts”.
    • But the report provides no details as to how such SEZs will function and who will be the beneficiaries of such institutions.

    Conclusion

    The NEP fails to cater to the needs of rural India’s marginalised majority, who in so many ways are rendered into being subjects rather than citizens.

  • Making malnutrition free India by 2030

    The article analyses the problem of malnutrition in India and suggests the pathways to achieve the malnutrition free India by 2030.

    Severity of the nourishment problem in India

    • There were  189.2 million undernourished people (28 per cent of the world) in India in 2017-19, as per the combined report of FAO, IFAD, UNICEF, WFP and WHO (FAO, et.al. 2020) on “The state of Food Security and Nutrition in the World”.
    •  India accounts for 28 per cent (40.3 million) of the world’s stunted children (low height-for-age) under five years of age, and 43 per cent (20.1 million) of the world’s wasted children (low weight-for-height) in 2019.
    • In India, the problem has been more severe amongst children below the age of five years.
    • As per the National Family Health Survey (NFHS, 2015-16), the proportion of underweight and stunted children was as high as 35.8 per cent and 38.4 per cent respectively.
    • In several districts of Bihar, Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and even Gujarat, the proportion of underweight children was more than 40 per cent.

    Aims of the National Nutrition Mission (NNM)

    • Ending all forms of malnutrition by 2030 is also the target of Sustainable Development Goal (SDG-2) of Zero Hunger.
    • Towards this end, NNM aims to reduce stunting, underweight and low birth weight each by 2 per cent per annum.
    • It aims to reduce anaemia among children, adolescent girls and women, each by 3 per cent per annum by 2022.
    • However, the Global Burden of Disease Study 1990–2017 has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022.

    Understanding the key determinants and deciding policy response

    1) Mothers’ education

    • Mothers’ education, particularly higher education, has the strongest inverse association with under-nutrition.
    • Women’s education has a multiplier effect not only on household food security but also on the child’s feeding practice and the sanitation facility.
    • Despite India’s considerable improvement in female literacy, only 13.7 per cent of women have received higher education (NFHS, 2015-16).
    • Therefore, programmes that promote women’s higher education such as liberal scholarships for women need to be accorded a much higher priority.

    2) Sanitation and access to safe drinking water

    • The second key determinant of child under-nutrition is the wealth index, which subsumes access to sanitation facilities and safe drinking water.
    • WASH initiatives, that is, safe drinking water, sanitation and hygiene, are critical for improving child nutritional outcomes.
    • In this context, the Swachh Bharat Abhiyan aims to eliminate open defecation and bring about behavioural changes in hygiene and sanitation practices.
    • In five years of the Abhiyan, as per government records, rural sanitation coverage has gone from 38.7 per cent in 2014 to 100 per cent in 2019, while the sanitation coverage in urban cites has gone up to 99 per cent by September 2020.
    • This remarkable achievement of the Swachh Bharat Abhiyan, subject to third-party evaluations, is expected to have a multiplier effect on nutritional outcomes.

    3) Leveraging agricultural policies

    • We should leverage agricultural policies and programmes to be more “nutrition-sensitive” and reinforcing diet diversification towards a nutrient-rich diet.
    • Food-based safety nets in India are biased in favour of staples: rice and wheat.
    • They need to provide a more diversified food basket, including coarse grains, millets, pulses and bio-fortified staples.
    • Bio-fortification is very cost-effective in improving the diet of households and the nutritional status of children.
    • The Harvest-Plus programme of CGIAR can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops.

    4) Promotion of exclusive breastfeeding, complementary foods, diversified diet

    • The promotion of exclusive breastfeeding and the introduction of complementary foods and a diversified diet after the first six months is essential to meet the nutritional needs of infants and ensure appropriate growth and cognitive development of children.

    5) Access to prenatal and postnatal care

    • Access and utilisation of prenatal and postnatal health care services also play a significant role in curbing undernutrition among children.
    • Aanganwadi workers and community participation can bring significant improvements in child-caring practices.

    Consider the question “Assess the severity the problem of malnutrition in India and suggest the measure to achieve the goal of malnutrition free India by 2030”

    Conclusion

    To contribute towards the holistic nourishment of children and a malnutrition free India by 2030, the government needs to address the multi-dimensional determinants of malnutrition on an urgent basis.

  • Changing India’s health delivery landscape through NDHM

    The National Digital Health Mission promises to transform the Indian healthcare system with the aid of technology. The article highlights the key aspects of the mission.

    Building integrated digital health infrastructure through NDHM

    • NDHM is based on the principles of health for all, inclusivity, accessibility, affordability, education, empowerment, wellness, portability, privacy and security by design.
    • NDHM will build the backbone necessary to create an integrated digital health infrastructure.
    • With its key building blocks HealthID, DigiDoctor, Health Facility Registry, Personal Health Records, Telemedicine, and e-Pharmacy, the mission will bring together disparate stakeholders and radically strengthen and, thus change India’s healthcare delivery landscape.
    • NDHM is also a purposeful step towards the achievement of the United Nations’ Sustainable Development Goal of Universal Health Coverage.

    Importance of digital intervention in health service

    • Digital interventions significantly enhance the outcomes of every health service delivery programme.
    • Importance of digital intervention is demonstrated in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana scheme.
    • Under PM-JAY, 1.2 crore cashless secondary and tertiary care treatments have been provided using an indigenously developed state-of-the-art IT platform.
    • The Arogya Setu mobile app deploys ICT innovations for contract tracing.

    Principal highlight of NDHM

    1) Voluntary in nature

    • HealthID is entirely voluntary for citizens.
    • Its absence will not mean denial of healthcare to a citizen.
    • They can choose to generate their Health Account or ID using their Aadhaar card or digitally authenticable mobile number and by using their basic address-related details and email ID.
    • The use of Aadhaar, therefore, is not mandatory.

    2) Data sharing based on consent

    • Providing access to and sharing of personal health records is a prerogative of the HealthID holder.
    • The consent of the health data owner is required to access this information or a part of it.The consent can be withdrawn anytime.
    • The personal health record will enable citizens to store and access their health data, provide them with more comprehensive information and empower them with control over their private health records.

    3) Compliance with laws and fundamental rights

    • NDHM has been built within a universe of fundamental rights and legislation such as the Aadhaar Act and the IT Act 2008 as well as the Personal Data Protection Bill 2019.
    • This project is also informed by the entire gamut of Supreme Court judgments and core democratic principles of cooperative federalism.
    • The Mission gets its strategic and technical foundation from the National Digital Health Blueprint, the architectural framework of which keeps the overall vision of NHP 2017 at its core and ensures security and privacy by design.

    4) Reaching out to the unconnected population

    •  NHDM is a digital mission led by technology powered by the internet.
    • So, to reach out to and empower the large number of “unconnected” masses specialised systems are being built and off-line modules that will be designed to reach out to the “unconnected”.

    5) Partnership with all key stakeholders

    • The design of NDHM has been built on the principle of partnership with all key stakeholders — doctors, health service providers, technology solution providers and above all citizens.
    • Without their belief, trust, adoption, and stewardship, this mission will not achieve its desired result.

    Consider the question “Examine the key aspects of the National Digital Heath Mission and how it could help transform the Indian healthcare landscape?”

    Conclusion

    NDHM is a mission whose time has come because health is the first step towards self-reliance and only a healthy nation can become Atma Nirbhar.

  • How marriage age and women’s health are linked?

    PM had announced a panel to fight malnutrition in young women and ensure they get married at the right age. Take a look at how the two are linked:

    How prevalent is underage marriage?

    • Data show that the majority of women in India marry after the age of 21.
    • Chart 1 shows the mean age of women at marriage is 22.1 years, and more than 21 in all states. This does not mean that child marriages have disappeared.
    • The latest National Family Health Survey (NFHS-4) found that about 26.8% of women aged 20-24 (Chart 2) were married before adulthood (age 18).

    Try this question for mains:

    Q. Discuss how marriage age and women’s health are linked with each other?

    How does the age of marriage correlate with health?

    • Preventing early marriage can reduce the maternal mortality ratio and infant mortality ratio.
    • At present, the maternal mortality ratio — the number of maternal deaths for every 100,000 children born — is 145.
    • India’s IMR shows that 30 of every 1,000 children born in a year die before the age of one.
    • Young mothers are more susceptible to anaemia. More than half the women of reproductive age (15-49 years) in India are anaemic.

    What delayed marriage can alter?

    • Poverty, limited access to education and economic prospects, and security concerns are the known reasons for early marriage.
    • If the main causes of early marriage are not addressed, a law will not be enough to delay marriage among girls.

    What do the data show?

    • Women in the poorest 20% of the population married much younger than their peers from the wealthiest 20% (Chart 5).
    • The average age at marriage of women with no schooling was 17.6, considerably lower than that for women educated beyond class 12 (Chart 6).
    • Almost 40% of girls aged 15-18 do not attend school, as per a report of the National Commission for Protection of Child Rights.
    • Nearly 65% of these girls are engaged in non-remunerative work.
    • That is why many believe that merely tweaking the official age of marriage may discriminate against the poorer, less-educated and marginalised women.

  • Reversing health sector neglect with a reform agenda

    The article analyses the issues India could face in implementing the universal health coverage.

    Context

    • Both India and the U.S. leads the Covid cases in the world and also lack effective universal health coverage (UHC).

    What explains the lack of UHC in both the countries

    • The lack of UHC is due to multiple long-standing factors and historical reasons that have put a damper on the UHC agenda.
    • This long legacy has two important and inter-related implications when it comes to health-care reform.
    • 1) Certain foundational aspects of these health systems that have been adopted over decades tend to dictate the terms of further evolution and lead to a number of compromises.
    • 2) The long legacy itself comprises a path-dependent trajectory that precludes far-reaching health-care reform.
    • This applies both to AB-PM-JAY and NDHM.

    India’s attempt at UHC: Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana

    • The government has looked poised to employ Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance as the tool for achieving UHC.
    • Taking the health insurance route to UHC driven by private players, rather than strengthening the public provisioning of health care, is reflective of the non-negotiability of private health care in India.
    • Covering the remaining population under the AB-PM-JAY presents massive fiscal and design challenges.
    • Turning it into a contributory scheme based on premium collections would be a costly and daunting undertaking, given the huge informal sector and possible adverse selection problems.
    • Distributing benefits among various beneficiary groups, and a formalisation and consolidation of practices in a likely situation of covering outpatient care, are formidable additional challenges.
    • One possible advantage for India over the U.S. could be a relative ease of integrating fragmented schemes into a unified system. The AB-PM-JAY has this ability.

    Issues with AB-PM-JAY

    1) Universal insurance will not be universal access

    • In India, almost two-third corporate hospital are located in cities.
    • So, such maldistribution of health-care facilities and low budgetary appropriations for insurance could mean that universal insurance does not translate to universal access to services.
    • So far, insurance-based incentives to drive private players into the rural countryside have been largely unsuccessful.

    2) Lack of regulatory robustness

    • AB-PM-JAY is without enough regulatory robustness to handle everything from malpractices to monopolistic tendencies.
    • This could have major cost, equity, and quality implications.

    National Digital Health Mission (NDHM)

    • Integration and improved management of patient and health facility information are sought through NDHM.
    • But in the absence of robust ground-level documentation practices and its prerequisites, it would do little more than helping some private players and adding to administrative complexity and costs.

    Consider the question “What are the challenges India faces in the implementation of universal health coverage? Suggest the measures to achieve it.”

    Conclusion

    Upheavals offer a window for reforms. We cannot afford to be complacent and think that the pandemic will automatically change the Indian health-care landscape. It will require mobilising concerted action from all quarters.

  • Tribes in news: Bondas

    The COVID-19 pandemic has reached the Bondas, a PVTGs community residing in the hill ranges of Malkangiri district in Odisha.

    Try this PYQ:

    Consider the following statements about Particularly Vulnerable Tribal Groups (PVTGs) in India:

    1. PVTGs reside in 18 States and one Union Territory.
    2. A stagnant or declining population is one of the criteria for determining PVTG status.
    3. There are 95 PVTGs officially notified in the country so far.
    4. Irular and Konda Reddi tribes are included in the list of PVTGs.

    Which of the statements given above are correct?(CSP 2019)

    (a) 1, 2 and 3

    (b) 2, 3 and 4

    (c) 1, 2 and 4

    (d) 1, 3 and 4

    Who are the Bondas?

    • The Bondas are Munda ethnic group who live in the isolated hill regions of the Malkangiri district of southwestern Odisha near the junction of the three states of Odisha, Chhattisgarh, and Andhra Pradesh.
    • They are a scheduled tribe of India and are also known as the Remo (meaning “people” in the Bonda language).
    • The tribe is one of the oldest and most primitive in mainland India; their culture has changed little for more than a thousand years.
    • Their isolation and known aggressiveness continue to preserve their culture despite the pressures of an expanding Indian population.

    Back2Basics: Particularly Vulnerable Tribal Groups (PVTGs)

    • There are certain tribal communities who have declining or stagnant population, low level of literacy, pre-agricultural level of technology and are economically backward.
    • They generally inhabit remote localities having poor infrastructure and administrative support.
    • These groups are among the most vulnerable section of our society as they are few in numbers, have not attained any significant level of social and economic development.
    • 75 such groups have been identified and categorized as Particularly Vulnerable Tribal Groups (PVTGs).

  • Increasing the age of marriage for girls and related issues

    The article analyses the issues with objectives of increasing the age of marriage for girls.

    Poverty of mother: Important factor

    • Raising the age of marriage is the could be the way to improve the health and nutritional status of mothers and their infants.
    • An article published in the journal The Lancet Child and Adolescent Health analyses data on stunting in children and thinness in mothers in the latest round of the National Family Health Survey 4 (2015-16).
    •  The authors examine the strength of the association between many different causal factors.
    •  As it turns out, the poverty of the mother plays the greatest role of all by far.
    • Instead of early pregnancy causing malnourishment, they may both be the consequences of poverty.
    • The best way to go about breaking such a cycle would be to pick the factors perpetuating it, it would be the poverty of the mother in this case.

    Declining fertility rate in India

    • India’s fertility rates have been declining to well below replacement levels in many States, including those with higher levels of child marriage.
    • This could be the reason for the shift from fuelling fears about booming populations to expressing concern for the undernourishment of children.
    • So, the problem of “populations explosion” is not the real problem as the demographic data suggests.

    Concern

    • The change in the marriage age will leave the vast majority of Indian women who marry before they are 21 without the legal protections.

    Conclusion

    The proposal and the objective to be achieved through raising the age of marriage needs reconsideration for the reasons cited above.

  • What is the National Health ID System?

    In his address to the nation on Independence Day, the PM has launched the National Digital Health Mission which rolls out a national health ID for every Indian.

    Try this question for mains:

    Q.What is the National Health ID System? How will it benefit transforming healthcare facilities in India?

    National Health ID System

    • This system finds its roots in a 2018 NITI Aayog proposal to create a centralised mechanism to uniquely identify every participating user in the National Health Stack.
    • It will be a repository of all health-related information of a person.
    • According to the National Health Authority (NHA), every patient who wishes to have their health records available digitally must start by creating a Health ID.
    • Each Health ID will be linked to a health data consent manager — such as National Digital Health Mission (NDHM).
    • The Health ID is created by using a person’s basic details and mobile number or Aadhaar number.
    • This will make it unique to the person, who will have the option to link all of their health records to this ID.

    What was the original proposal for the health ID?

    • The National Health Policy 2017 had envisaged creation of a digital health technology eco-system aiming at developing an integrated health information system.
    • In the context of this, the central government’s think-tank NITI Aayog, in June 2018, floated a consultation of a digital backbone for India’s health system — National Health Stack.
    • As part of its consultation, NITI Aayog proposed a Digital Health ID to greatly reduce the risk of preventable medical errors and significantly increase the quality of care.

    Stakeholders in the national health ID

    • As envisaged, various healthcare providers — such as hospitals, laboratories, insurance companies, online pharmacies, telemedicine firms — will be expected to participate in the health ID system.

    Back2Basics:

    https://www.civilsdaily.com/news/national-digital-health-mission-ndhm/