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Subject: Health

  • COVID Isolation Coaches and their deployment

    The Union govt. has declared that 500 COVID isolation coaches would be deployed in Delhi. So far, over 5,000 coaches have been converted into COVID isolation coaches across India.

    Practice question for mains:

    Q. Health infrastructure in India is hardly capable of handling any  pandemic. Critically comment.

    What are these COVID Isolation Coaches?

    • In March, Railways was sounded out by the PMO and the government’s multi-ministerial outbreak-containment apparatus that train coaches could also be used as a last resort to keep isolated patients.
    • So far, 5,321 non-AC sleeper class coaches of ICF variety (older design) have been converted by the 16 zonal railways through their workshops spread across India.
    • These are developed as COVID Care Level 1 centres—as per the Health Ministry classification of COVID facilities—where suspected cases or those with mild symptoms are to be kept.
    • Suspected and confirmed cases will be kept in separate coaches.

    How were these coaches selected?

    • Early into the pandemic, health experts were of the view that air-conditioned environments might aid the spread of the virus.
    • Well-ventilated, airy environments were thought to be safer. India’s decision to use non-AC coaches for isolation has to be viewed in that context.
    • As per targets given to the 16 zonal railways, 5,000 older coaches, surplus to Railways’ operational needs, were marked for conversion.

    What were the challenges faced?

    • The summer heat in the coach was always a matter of discussion.
    • Several ideas were discussed, including erecting shamianas over the coaches or painting the roof with “solar reflective” paints.
    • Another question was how to dispose of toilet waste if the coaches were in remote areas and whether such waste was potentially infectious.
    • It was agreed that since chlorine tablets are placed in the chambers of the bio toilets, the risk was neutralised.
    • In any case, bio-enzymes in the toilet tanks take care of human waste.
    • Another question was the placement. The batteries of the coaches need to be charged and the water needs to be replenished. Not all areas in India might have such facilities.
    • The idea was that being mobile units, they could be dispatched to any part of the country to pick up patients and come back to their bases.

    Deployment of such train

    • Each isolation train will be tied to the nearest hospital.
    • The Centre will not deploy these coaches at will; states will have to request for them.
    • At least 10 coaches, or one train, will have to be deployed in one place. States can request for more.
    • Besides the 500 being deployed in Delhi, Telangana has requested for 60 coaches in three locations, and UP has requested in 24 locations.
    • Many states are said to be informally enquiring about the coaches in zones.

  • AarogyaPath Platform for the Healthcare Supply Chain

    AarogyaPath Platform has been recently launched to provide real-time availability of critical healthcare supplies.

    Possible prelims question:

    Q. The AarogyaPath platform recently seen in news is related to:

    Options:  a) Tracking of COVID patients/ b) Emergency ambulances service/c)  Supply-chain solutions of healthcare facilities/ d)E-com portal for generic medicines 


    Aarogyapath platform

    • The information platform named AarogyaPath with a vision of providing a path which leads one on a journey towards Aarogya (healthy life) has been developed by the CSIR.
    • During the present national health emergency arising out of the COVID-19 pandemic, wherein there is a severe disruption in the supply chain, the ability to produce and deliver the critical items may be compromised due to a variety of reasons.
    • The platform would serve manufacturers, suppliers and customers.
    • CSIR expects AarogyaPath to become the national healthcare information platform of choice in the years to come.
    • It would fill a critical gap in last-mile delivery of patient care within India through improved availability and affordability of healthcare supplies.

    Its significance

    • This platform provides single-point availability of key healthcare goods that can be helpful to customers in tackling a number of routinely experienced issues.
    • These issues include dependence on limited suppliers, time-consuming processes to identify good quality products, limited access to suppliers who can supply standardized products at reasonable prices within desired timelines, lack of awareness about the latest product launches, etc.
    • It also helps manufacturers and suppliers to reach a wide network of customers efficiently, overcoming gaps in connectivity between them and potential demand centres like nearby pathological laboratories, medical stores, hospitals, etc.
    • It will also create opportunities for business expansion due to an expanded slate of buyers and visibility of new requirements for products.
    • Over time, analytics from this platform is expected to generate early signals to manufacturers on overcapacity as well as on looming shortages.

  • Digital surveillance for Covid could do more harm than good

    Two issues are examined in detail in this article. The first is about the lack of legal framework in India. And the second which is related to the first is the deployment of technology and its benefit and issues it raises. The nature of private-friendly technology to track the disease is also elaborated.

    Disease surveillance and individual rights

    • Concerns about the impact of disease surveillance on individual rights—including privacy—are not new.
    • Globally, previous epidemics have led to an increasing acceptance that public health initiatives must also respect freedom and privacy to the greatest extent possible.
    • Lessons from history and other jurisdictions show that a rights-friendly response to the pandemic is possible and must be strived for.
    • Canada amended its Quarantine Act in 2005 to give legislative powers to powers state may exercise and also placed some limits on these powers.
    • Similarly, in 2015, South Korea also amended the Infectious Diseases Control and Prevention Act, 2009, giving power to state as well as an individual.
    • In 2017, the World Health Organization (WHO) published its guidelines on “Ethical Issues in Public Health Surveillance” (WHO 2017).
    • These guidelines require states to ensure that there is no unauthorised access or disclosure of information collected.
    • It also requires states to take stock of how much data is rightfully required by various agencies of the government before access is granted.
    •  However, India does not appear to have factored this into its response to the COVID-19 pandemic.
    • Rather, what we are witnessing is a push to develop and adopt ad hoc technology-based solutions without a clear understanding of their limitations and harms.

    How the absence of legal framework could be problematic?

    •  During an epidemic (or a pandemic), state agencies may act in a way that significantly impacts people’s fundamental rights to liberty, free movement, and privacy.
    • Authorities may have to compel individuals to undergo testing, mandatory isolation and/or enforce quarantine measures, and trace all of their interactions in case they test positive for the infection.
    • With such grave implications for civil liberties, a legal framework is essential to bring certainty and accountability to government functioning.
    • It will have checks and balances in place and will state the rights and remedies of those affected by the wrongful exercise of powers.
    • A 2015 report by WHO’s International Health Regulations has highlighted this fact.
    • International Health Regulations are currently the only global regulations on public health, which are binding on India.

    Let’s look into this WHO’s report

    •  WHO’s International Health Regulations-2015 observed the absence of appropriate legislation that would enable the Indian government to mobilise its different wings in the case of an imminent outbreak (WHO 2015).
    • The report noted that this legal gap is exacerbated when coordination is required with states.
    • This is presumably because health is a domain over which states have exclusive powers.
    • The report also noted that India lacks a standard operating procedure (SOP) to clarify when existing legislative provisions could be invoked, and who could be directed to respond to the outbreak.
    • However, in nearly five years since this report was published, there is still no sign of a legal regime to describe the powers of the state and its functions during such times.

    Acts used in India to control pandemic and issues with them

    • In the absence of such an SOP, states in India have resorted to invoking the Epidemic Diseases Act, 1897.
    • This act is pre-independence legislation that confers extremely wide powers on states without any procedural safeguards.
    • In order to exercise powers under this statute, most states have framed regulations under it, conferring upon themselves the power to impose and enforce quarantine and to collect vast amounts of personal information.
    • These regulations are vaguely worded and contain no limitations or safeguards.
    • Similarly, on 24 March 2020, the central government invoked the Disaster Management Act, 2005, which allowed it to issue binding guidelines to states.
    • [The central government’s entire response to COVID-19 has been through these guidelines, including its imposition of a strict nationwide lockdown for over two months.
    • The result has been the issuance of top-down orders,  even though much of the economic and infrastructural burden has fallen directly on state governments.

    Adoption of technology and issues with it

    • There has been the alarming increase in the adoption of digital technology, with the supposed objective of overcoming existing infrastructural gaps.
    • India spends approximately 1.28% of its GDP on health.
    • Such technologies are often rolled out with neither understanding their limitations, nor properly examining their potential to harm.
    • More worryingly, an over-reliance on technology also makes the state complacent.
    • Technological interventions tend to become the default, replacing efforts to understand and address the underlying causes of the problem.

    Arogya Setu and other digital interventions in India

    • Arogya Setu is a contact-tracing application.
    • States have also taken to widespread deployment of drones in several cities to enforce quarantine measures as well as the lockdown itself.
    • More recently, BECIL, a public sector undertaking, issued expressions of interest to invite bids for a “personnel tracking GPS solution” as well as a “COVID-19 patient tracking tool”
    • The first envisages a wearable device to track health workers’ location and to store the data on a  centralised government server.
    • The second proposes the collation of information from government databases and from telecom and internet data to identify “locations, associations and behaviour” of patients/persons suspected of being infected.
    • However, evidence suggests that these interventions may only end up ramping up surveillance without achieving any of their stated objectives.

    Limitations of digital surveillance and possible harm

    • Such apps are inherently limited:
    • 1) Their success depends on self-reporting by confirmed infectious persons, which in turn depends on large-scale testing.
    • Given India’s abysmally low testing rate, self-reporting too will predictably below.
    • 2)In view of India’s low smartphone penetration, it is likely that the app will be ineffective for a large part of the population.
    • 3)Such apps assess risk based on Bluetooth signals, which may result in false positives as the signals are capable of transmitting across walls or ceilings,  therefore alerting people in adjoining houses or cars, even in the absence of physical contact.
    • In addition to these limitations, such technological tools also vastly expand the government’s surveillance architecture.

    Issues with Aarogya Setu and use of Drones

    • Aarogya Setu collects a large amount of personal information from users when they sign up, and constantly builds on this by collecting location and Bluetooth data in real-time.
    • This allows the app to create a social graph of a person’s interactions.
    • Neither the app nor the Data Access and Knowledge Sharing Protocol—which was subsequently issued—provide for a fixed period of time after which the collected data will be destroyed.
    • The protocol also reveals that the app’s functionality is not limited to contact tracing, but that the data gathered through it will be used to inform government decision making on almost all aspects related to COVID-19.
    • The government recently relied on the data generated by the app to identify new hotspots.
    • But the inherent limitations of the app referred to above make these decisions highly suspect.
    • This is in addition to some states in India promoting their own applications for contact tracing and geofencing, which raise similar concerns.
    • The use of hired drones by the police for surveillance also raises several concerns.
    • These drones are being deployed without any legal basis or transparency on how the recorded footage will be used or retained.
    • A number of troubling scenarios are possible—the data may be used to surveil and target specific locations or communities that are already subjected to discrimination and harassment.
    • It may also be retained and used later for purposes unrelated to disease surveillance.
    • Reports suggest that this data is already being shared freely amongst various entities of the government without people’s knowledge or consent.

    Way forward

    • No doubt, public health interests may require some restrictions to the right to privacy—as was expressly recognised by the court itself.
    • However, any restriction must necessarily pursue a legitimate aim, be based in law, and be a necessary and proportionate means to achieve said aim.
    • This means that the state must first identify the goals it seeks to achieve rather than first creating surveillance mechanisms and then continuously shifting the goalposts.
    • If multiple ways exist to achieve an objective, the state is obliged to adopt the least restrictive one.
    • The legal regime for public health, such as in Canada and South Korea, is therefore essential to ensure that public safety is not used as an excuse to unnecessarily restrict constitutionally guaranteed freedoms.
    • The state needs to be transparent about the digital tools it adopts, which would only go towards increasing public trust and ensure better adoption of the technology.
    • Individuals should be informed if their information has been collected and used by the government for surveillance or research purposes, giving them an opportunity to challenge the government’s acts if they feel such powers are wrongly exercised.
    • If surveillance is legitimately warranted to deal with a public health emergency, then it must be subject to a sunset clause.
    • Data that is no longer required must be deleted.
    • And clear protocols need to be created to determine who can access the data in case it has to be retained for research or medical purposes.

    Consider the question “A pandemic admittedly requires the extensive gathering of data and surveillance to understand disease trends, infrastructural constraints, and to frame prevention and mitigation strategies. Howerver, the technology adopted to achieve this aim must be privacy-friendly. Comment.

    Conclusion

    Our past experiences can and should inform our decision on the similar deployment of surveillance technology for public health. Such technology must not be excessively invasive and should always have the legal framework which could help the citizens challenge its applications in a given situation.

  • Tracking the epidemic

    This article suggests the innovative indicators for the classification of areas. Also, the need for decentralisation of science and governance is stressed. So, how could decentralisation help? What should form the basis of indicators at the local level? Such questions are answered in this article.

    States are better placed to deliver on public health

    • They are, of course, better placed to deliver on public health and welfare. They are also generally more accountable.
    • According to the recent ICMR serological sample study conducted in mid-May, barely 1 per cent of non-metropolitan India was infected.
    • Thus, as the infection spreads and eventually stabilises, there is a lot of heavy lifting that the states must do.

    The measure of prevention and containment zone

    • After lockdown,  the message of prevention and the device called containment zones are the only ways left to manage the epidemic.
    • This includes allied activities: The demarcation of the boundary, testing, treatment, tracing and quarantine.
    • Hidden inside this box of practices are the answers to questions such as: Why is Karnataka doing better than Maharashtra in terms of mortality?

    What went wrong with colour-coded zones at district levels?

    • The older colour-coded zone label, introduced by the Centre on April 14, was at the district scale.
    • That quickly became a collective punishment with little measurable benefits.
    • One consequence was that districts were unhappy with the return of migrants simply because that could change their colour.
    • The second problem was that the red-ness of a region was equated with the need for lockdowns, since that was the only visible instrument.

    Let’s explore the ward and community level base strategy

    • Well designed metrics at the ward and community scale will help the science develop.
    • They can guide the people and the administration and allow the states to compare practices and learn from each other.

    Let us see what can be achieved within this framework: Focusing on measurement

    1. Classified should include socio-economic and demographic factors

    • Any area classification must include key socio-economic and demographic determinants, for example, the density of the area, number of people in dwellings with one room or less, or the fraction of people using community toilets.
    • As we know, much of the infection is spreading within dense clusters.
    • Such metrics would indicate vulnerable areas and the limits to reduction in contact rate through policing.
    • Here, decongestion measures such as out-migration may be required.
    • This will also serve as a guide to the future of the locality or ward.

    2. Designing indicator from data collected so far

    • An important document is the Specimen Referral Form (SRF) designed by the ICMR which must be filled to undertake the PCR Corona Test.
    •  In that, the possible patient backgrounds for recommending the test, are recorded.
    •  In that, symptomatic cases with no known contact are already a large fraction of those infected.
    • This and other fields in the SRF such as age, location and symptoms, would give us substantial insights into the dynamics and severity of the disease and the efficacy of our procedures.
    • This data should be made available immediately.

    3. Measuring the risk from migrants

    • The recent inclusion of migrants in the SRF is indeed welcome.
    • This, coupled with other quarantine data in the SRF, gives us the risk from migrants to the community at large.
    • Also welcome is the setting up of a National Migrant Information System (NMIS) on the NDMA database.
    • Hopefully, we may now know the fraction of migrants who have safely reached home and the state-wise status of those who haven’t and the reasons for the same.
    • In any case, the number of infected migrants, if suitably quarantined, must be subtracted from the total number of positive cases for that area/district, for they did not arise there and they are outside the infective load in the area.
    • This will help reduce the stigma on migrants and instead put more focus on quarantine arrangements for them.

    4. Measuring preparedness

    • Ensuring that our villages and towns are prepared to meet the disease is an important objective.
    • One metric to measure preparedness is the number of beds, doctors and ambulances per 1,000.
    • This may then be compared with the active cases in the region.
    • In fact, the adverse mortality in some areas is directly correlated with the local shortage of medical care.
    • For most districts in Maharashtra, shortages would start biting at about 200 cases per day.
    • An important addition would be village-level data on the running of the local quarantine, the functioning of the PDS and availability of drinking water.

    5. Measuring the prevalence and social distance

    • Coming to prevention, the importance of masks, distance and open ventilation is still not appreciated.
    • A simple statistical metric is to measure the prevalence of masks in an area.
    • This can be done by installing cameras in suitable locations and counting people with masks.
    • Social distance measures are also amenable to indicators.
    • For example, the fraction of buses which have installed a sheet between the driver and the passengers, or recording innovative ways of ticket vending.

    The popularity of the colour-coding based on such indicators may be effective in social mobilisation.

    Social comprehension and local solution

    • Mitigation and adaptation require social comprehension and local solutions.
    • These need scientific studies by regional institutions and partnerships with civil society.
    • Creating and supporting good metrics and providing data is an important step in that direction.
    • This will not only save lives, it will reduce fear and help re-start normal life.

    Decentralisation of science and governance

    • The epidemic has underlined that publicness and decentralisation of science and governance is the only way of creating knowledge and the professional ability to solve our own problems.
    • Without this, the post-corona Indian society would be an unhappy attempt at making the old arrangement work in a degraded reality of fearful and angry people.

    Consider the question “Corona pandemic and subsequent measures to contain it has highlighted the need for decentralisation of governance. Elaborate.”

    Conclusion

    We must learn to live with the virus, but we must also find joy. Only through constant engagement and adaptation will we overcome fear and forge a new society that will sustain both life and happiness.

  • [pib] Star Ratings of Garbage Free Cities

    The Ministry of Housing and Urban Affairs (MoHUA) has released the Star rating of garbage-free cities for the assessment year 2019-2020.

    Practice question for mains:

    Q. Discuss how the Swachh Bharat Mission has become a people’s movement in India. Also, discuss how it has managed to instill a behavioural change amongst the citizens.

    About Star Rating Protocol

    • The Star Rating Protocol was launched by the MoHUA in January 2018 to institutionalize a mechanism for cities to achieve Garbage Free status and to motivate cities to achieve higher degrees of cleanliness.
    • The protocol has been devised in a holistic manner including components such as the cleanliness of drains & water bodies, plastic waste management, managing construction & demolition waste, etc.
    • While the key thrust of this protocol is on Solid waste management(SWM), it also takes care of ensuring certain minimum standards of sanitation through a set of prerequisites defined in the framework.
    • The new protocol considers ward-wise geo-mapping, monitoring of SWM value chain through ICT interventions like Swachh Nagar App and zone-wise rating in cities with a population above 50 lakh.

    Performance of cities

    • Accordingly, as per the 2020 survey, 6 cities have been graded 5 stars, 65 Cities rated 3 Star and 70 Cities rated 1 Star.

    5 Star Cities

    ULB Name State Final Rating
    Ambikapur Chhattisgarh 5 Star
    Rajkot Gujarat 5 Star
    Surat Gujarat 5 Star
    Mysore Karnataka 5 Star
    Indore Madhya Pradesh 5 Star
    Navi Mumbai Maharashtra 5 Star

    Assessment under the protocol

    • To ensure that the Protocol has a SMART framework, the MoHUA has developed a three-stage assessment process.
    • In the first stage, ULBs populate their progress data on the portal along with supporting documents within a particular timeframe.
    • The second stage involves a desktop assessment by a third-party agency selected and appointed by MoHUA.
    • Claims of cities that clear the desktop assessment are then verified through independent field-level observations in the third stage.

    Significance

    • This certification is an acknowledgement of the clean status of Urban Local Bodies and strengthened SWM systems as well as a mark of trust and reliability akin to universally known standards.

    Back2Basics: Swachh Bharat Mission (SBM)

    • SBM is a nation-wide campaign in India for the period 2014 to 2019 that aims to clean up the streets, roads and infrastructure of India’s cities, towns, urban and rural areas.
    • The objectives of Swachh Bharat include eliminating open defecation through the construction of household-owned and community-owned toilets and establishing an accountable mechanism of monitoring toilet use.
    • Run by the GoI, the mission aims to achieve an “open-defecation free” (ODF) India by 2 October 2019, the 150th anniversary of the birth of Mahatma Gandhi by constructing 90 million toilets in rural India.
    • The mission will also contribute to India reaching Sustainable Development Goal 6 (SDG 6), established by the UN in 2015.
    • It is India’s largest cleanliness drive to date with three million government employees and students from all parts of India participating in 4,043 cities, towns, and rural areas.
    • The mission has two thrusts: Swachh Bharat Abhiyan (“gramin” or ‘rural’), which operates under the Ministry of Drinking Water and Sanitation; and Swachh Bharat Abhiyan (‘urban’), which operates under the Ministry of Housing and Urban Affairs.

  • Global Nutrition Report, 2020

    The Global Nutrition Report 2020 has stated that India is among 88 countries that are likely to miss global nutrition targets by 2025.

    UPSC may puzzle you by asking a prelim question like-

    With reference to the Global Nutrition Report, which of the following is/are a Global Nutrition Targets?

    Visit this link for more graphics related to India: https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/india/

    About the Global Nutrition Report

    • The GNR is a report card on the world’s nutrition—globally, regionally, and country by country—and on efforts to improve it.
    • It is an independently produced annual stock-take of the state of the world’s nutrition. It is a multi-stakeholder initiative, consisting of a Stakeholder Group, Independent Expert Group and Report Secretariat.
    • It was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013 and was first published in 2014.
    • The report tracks global nutrition targets on maternal, infant and young child nutrition and on diet-related Non-Communicable Diseases adopted by member states of the WHO as well as governments’ delivery against their commitments.

    India would miss the targets

    • According to the Global Nutrition Report 2020, India will miss targets for all four nutritional indicators for which there is data available, i.e.

    1) Stunting among under-5 children,

    2) Anaemia among women of reproductive age,

    3) Childhood overweight and

    4) Exclusive breastfeeding

    What are Global nutrition targets?

    • In 2012, the World Health Assembly identified six nutrition targets for maternal, infant and young child nutrition to be met by 2025. They are:

    1) Reducing stunting by 40% in children under 5 years age

    2) Reducing anaemia by 50% among women in the age group of 19-49 years

    3) Ensuring a 30% reduction in low-birth-weight

    4) Ensuring no increase in childhood overweight,

    5) Increasing the rate of exclusive breastfeeding in the first six months up to at least 50% and

    6) Reducing and maintaining childhood wasting to less than 5%.

    Data on Underweight children

    • Between 2000 and 2016, rates of underweight have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls.
    • However, this is still high compared to the average of 35.6% for boys and 31.8% for girls in Asia.
    • In addition, 37.9% of children fewer than 5 years are stunted and 20.8% are wasted, compared to the Asia average of 22.7% and 9.4% respectively.
    • One in two women of reproductive age is anaemic, while at the same time the rate of overweight and obesity continues to rise, affecting almost a fifth of the adults, at 21.6% of women and 17.8% of men.

    Data about India

    • Stunting and wasting among children

      • Data: 37.9% of children under 5 years are stunted and 20.8% are wasted, compared to the Asia average of 22.7% and 9.4% respectively. 
    •  Inequity:
        • India is identified as among the three worst countries, along with Nigeria and Indonesia, for steep within-country disparities in stunting, where the levels varied four-fold across communities.
        • For example, Stunting level in Uttar Pradesh is over 40% and their rate among individuals in the lowest income group is more than double those in the highest income group at 22.0% and 50.7%, respectively.
        • In addition, stunting prevalence is 10.1% higher in rural areas compared to urban areas.
    • Overweight and Obesity
      • Data: Rate of overweight and obesity continues to rise, affecting almost a fifth of the adults, at 21.6% of women and 17.8% of men.
      • Inequity: There are nearly double as many obese adult females than there are males (5.1% compared to 2.7%).
    • Anaemia
      • One in two women of reproductive age is anaemic.

    Inequities in Malnutrition

    • The report emphasises on the link between malnutrition and different forms of inequity, such as those based on geographic location, age, gender, ethnicity, education and wealth malnutrition in all its forms.
    • Inequity is a cause of malnutrition — both under-nutrition and overweight, obesity and other diet-related chronic diseases.
    • Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle, says the report.

  • What is the Sample Registration System (SRS)?

    The Registrar General of India released its Sample Registration System (SRS) bulletin based on data collected for 2018.

    Since we are talking about birth rates and death rates, how about revising Demographic Transition Model. Can you recall 4 distinctive stages of Indian Demographic history?

    Sample Registration System (SRS)

    • The SRS is a demographic survey for providing reliable annual estimates of infant mortality rate, birth rate, death rate and other fertility and mortality indicators at the national and sub-national levels.
    • Initiated on a pilot basis by the Registrar General of India in a few states in 1964-65, it became fully operational during 1969-70.
    • The field investigation consists of a continuous enumeration of births and deaths in selected sample units by resident part-time enumerators, generally Anganwadi workers and teachers; and an independent retrospective survey every six months by SRS supervisors.
    • The data obtained by these two independent functionaries are matched.

    Highlights of the data

    Birth and death rates

    • According to the data released the national birth rate in 2018 stood at 20, and death and infant mortality rates stood at 6.2 and 32, respectively.
    • The rates are calculated per one thousand of the population.
    • Madhya Pradesh has the worst infant mortality rate in the country while Nagaland has the best.
    • Chhattisgarh has the highest death rate, while Delhi has the lowest.
    • Bihar continues to remain at the top of the list in the birth rate while Andaman and Nicobar are at the bottom.

    Infant mortality

    • The data shows that against the national infant mortality rate (IMR) of 32, Madhya Pradesh has an IMR of 48 and Nagaland 4.
    • Bihar has the highest birth rate at 26.2 and Andaman and Nicobar Islands has a birth rate of 11.2.
    • Chhattisgarh has the highest death rate at 8 and Delhi, an almost entirely urban state, has a rate of 3.3, indicating better healthcare facilities.
    • As far as IMR is concerned, the present figure of 32 is about one-fourth as compared to 1971 (129).
    • In the last 10 years, IMR has witnessed a decline of about 35 per cent in rural areas and about 32 per cent in urban areas. T

    Birth rate

    • The birth rate is a crude measure of fertility of a population and a crucial determinant of population growth.
    • India’s birth rate has declined drastically over the last four decades from 36.9 in 1971 to 20.0 in 2018.
    • The rural-urban differential has also narrowed. However, the birth rate has continued to be higher in rural areas compared to urban areas in the last four decades.
    • There has been about an 11 per cent decline in the birth rate in the last decade, from 22.5 in 2009 to 20.0 in 2018. The corresponding decline in rural areas is 24.1 to 21.6, and in urban areas, it is 18.3 to 16.7.

  • Strategy for calibrated opening of economy

    The article discusses the performance of India so far and the strategy for reopening of the economy. Dividing the districts based on the number of cases and adopting a suitable approach for opening the economy there while keeping the spread of the virus in control is suggested in the article.

    India performing better

    • While the OECD countries are reeling under the COVID-19 impact, India is clearly ahead of the curve.
    • This is not merely in terms of the confirmed cases in the country but is also strongly reflected in very low mortality numbers (8.5 deaths per lakh population) compared to other nations (4,040 in the UK and 1,930 in the US).
    • While the first cases were reported in most hotspot countries and India around the same time (last week of January), today, the outbreak is far more manageable in India than in most other countries.
    • It was pragmatic for a resource-poor country to be pre-emptive and declare a national lockdown when the total number of cases were still low at 500.
    • The subsequent growth of the pandemic clearly shows a perceptible decline in the number of cases due to the lockdown.
    • Though stringent, this was much-needed and a timely policy intervention by the government.
    • It is important, however, to appreciate the high and growing opportunity costs that are involved during a lockdown.
    • We must brace ourselves for long-term pandemic management (18 to 24 months) with significant economic impact on our lives.

    Policy interventions by government and two major concerns

    • The immediate costs of the lockdown are borne by the most economically vulnerable people in society.
    • This perhaps was the rationale behind the first round of economic policy interventions announced by the finance minister within a few days of the lockdown.
    • They targeted front-loading of cash transfers through PM-Kisan, support to construction workers, self-help groups, food distribution through the public distribution system, among others.
    • Two major concerns: Beyond welfare concerns, there are significant growth concerns that are mounting with every day of economic inactivity in the country.
    • Companies are struggling to honour payroll and maintain their workforce against cancelling orders and declining demand for their goods and services.
    • These in turn will lead to greater delays and defaults in loan repayments, thereby further weakening the fragile banking sector and struggling credit markets.

    The RBI’s intervention and increasing damage to the economy

    • The Reserve Bank of India stepped in for some timely monetary interventions.
    • However, the longstanding climate of risk aversion within the banking sector will mean that transmission of these monetary interventions is unlikely to be timely or adequate.
    • All eyes are set expectantly in one direction.
    • Historically, when economies are faced with major calamities, governments step in to stabilise the environment and boost confidence within the business community.
    • We have seen this response from all major economies disrupted by COVID-19 over the last several weeks.
    • India will not be an exception to this as the government fine-tunes its strategy to support and kickstart our immobilised economy.
    • The opportunity cost of time, however, is ballooning with each passing day.
    • Just like the spread of the virus, we are up against the full force and power of compounding.
    • Mindful policy interventions, when timed well, can cut growing losses and the misfortune of many.

    How the states are performing against Covid-19?

    • While we have succeeded in slowing the growth of the virus at the national level, the true gains and pains are at the state and local level.
    • As the data reveals, currently we have three states that have made remarkable gains and “flattened the curve” of COVID cases.
    • These are Kerala, Haryana and Tamil Nadu where recoveries are growing and active cases are rapidly declining.
    • States like Karnataka and Telangana are improving their recovery rates consistently, despite fluctuations.
    • Every state and local administration has to keep eternal vigil and double down on containment and testing.
    • They have to aggressively improve their contact tracing efforts with the help of their police who are trained in debriefing, call record mapping and have more manpower than public health departments of local administrations.

    The article contains the policy and governance aspects which are important from Mains Paper-2, and economic issues such as the size of the package and opportunity cost of time involved are important from the Mains Paper-3 perspective. Take note of these issues.

    What should be the strategy?

    • Given the scale and variation in infection control across the country, our national strategy needs to be informed and calibrated.
    • Currently, there are more than 300 districts in the country which have reported zero COVID-19 cases.
    • This can be confirmed quickly with some random testing and the lockdown can be lifted effective immediately.
    • Then there are about 225 districts which have reported less than 10 cases each.
    • With adequate ring-fencing at the level of the block where these cases are reported, these districts too can afford to lift their lockdowns.
    • There are, however, approximately 30 districts across the country which have reported large numbers of confirmed cases and are identified as “hotspots”.
    • The lockdown in these places needs to continue with some relaxations for basic trade and essential services.
    • Not surprisingly, these “hotspots” are also important economic centres of the country.
    • The capacity of the local administration to develop and enforce appropriate strategies of containment, contact tracing and testing, should determine their decisions to ring-fence and isolate blocks while allowing other parts of the district/city to resume economic activity.

    Way forward

    • Given the uncertainty of the virus, we seem prepared for large hospitalisation and care if the need arises.
    • The efforts now must be to further contain the growth of the infection.
    • Acting against the power of compounding: If the current rate persists, we will reach over lakh cases within three weeks. That is the power of compounding we are against.
    • Public health support team: Beyond knowledge sharing across states and adopting successful containment strategies from each other, there is a role for the central government in providing “NSG-like” public health support teams to states that need them.
    • Economic package: On the economy front similarly, the central government’s timely economic package should flatten the curve of exponentially rising opportunity costs across the sectors.

    Conclusion

    Given the relative scale and virulence of the COVID-19 virus in India, the odds seem stacked in favour of a calibrated opening of the economy.

     

  • [pib] Year of Awareness on Science & Health (YASH) Program

    National Council for Science & Technology Communication (NCSTC) has launched a programme on health and risk communication ‘Year of Awareness on Science & Health (YASH)’ with focus on COVID-19.

    There are various initiatives named with Hindi acronyms. YASH is newer among them. It is very unlikely to frame a prelim question on it. Still, we should know it for the sake of general awareness.

    YASH Program

    • YASH is a comprehensive and effective science and health communication effort for promoting grass-root level appreciation and response to health.
    • The current pandemic scenario has posed concerns and challenges all around, where scientific awareness and health preparedness play a significant role to help combat the situation.
    • This requires translation and usage of authentic scientific information to convey the risks involved and facilitates communities to overcome the situation.
    • The programme will encompass the development of science, health, and risk communication software, publications, audio-visual, digital platforms, folk performances, trained communicators, especially in regional languages to cater to various cross-sections of the society in the country.
    • It would help to save and shaping the lives of people at large, as well as build confidence, inculcate a scientific temper and promote health consciousness among them.

    Activities under YASH

    • The programme is aimed at minimizing risks at all levels with the help of public communication and outreach activities.
    • It would promote public understanding of common minimum science for community care and health safety measures like personal sanitation and hygiene, physical distancing, maintaining desired collective behaviour and so on.
    • It also includes information dissemination mechanisms to reduce the fear of risks and build confidence with necessary understanding for adopting sustainable healthy lifestyles and nurturing scientific culture among masses and societies.

  • Spanish Plan for Phased Easing of Lockdown

    • Spain’s Prime Minister has presented a four-phase lockdown exit strategy for the country.
    • It’s imperative for India to learn from global examples for easing lockdown without doing away with health concerns.

    With the nearing end of nationwide lockdown, various exit strategies are being discussed for a smooth restart.

    Spain’s exit strategy

    • The opening up of the lockdown will begin with phase 0 throughout Spain, except for a few islands that will already be in phase 1 by then.
    • A week later, provinces will enter phase 1, which will last for two weeks and the remaining phases will also last for two weeks each.
    • In total, the de-escalation will take at least six weeks to be complete.

    Phase 0: The preparation phase

    • De-escalations in this phase include opening up of takeaway facilities at restaurants and opening up of some other establishments such as hair salons.
    • From May 2, individuals will be able to go out for a walk or to exercise alone or with people they stay with. In this phase, professional athletes will be able to access individual training sessions.
    • Children aged 14 years or younger have been allowed to go out for walks from April 26.

    Phase 1: The initial phase

    • Begins on May 11. Small businesses will be allowed to open under strict security measures.
    • For instance, gyms can open for people who want to train individually and by appointment.
    • Further, hotels and tourist accommodations will be allowed to open, excluding the common areas and with certain restrictions in place.
    • Places of worship will also be allowed to open, limiting their capacity to one-third. Owners of terrace bars can open their establishments but with 30 per cent capacity.
    • In this phase, some degree of social contact with a limited number of people may also be allowed, subject to what the conditions are then.

    Phase 2: The intermediate phase

    • Begins on May 25.Will include the resumption of hunting and sport fishing, and the opening of cinemas and auditorium theatres at one-third of their capacity.
    • Visits to monuments and cultural facilities, such as exhibition halls and conference rooms, will resume with one-third occupancy.
    • Cultural shows will be allowed with less than 50 people in closed spaces. In the outdoors, shows and events can be held with less than 400 people provided they are seated.
    • All places of worship will have to limit their capacity to 50 per cent.

    Phase 3: The advanced phase

    • Begins on June 8 and provided the situation is under control, general mobility will be made more flexible.
    • Wearing masks will be recommended when people venture outside, especially on public transport. In commercial settings, capacities will be restricted to 50 per cent.
    • Beaches may also open in this phase. The movement of people into other provinces or islands is restricted until the de-escalation process is complete.