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Subject: Health

  • [pib] ArogyaSetu App

     

    The Government of India has launched a mobile app ArogyaSetu developed in a public-private partnership to bring the people of India together in a resolute fight against COVID-19.

    AarogyaSetu App

    • The App enables people to assess themselves the risk of their catching the Corona Virus infection.
    • It will calculate this based on their interaction with others, using cutting edge Bluetooth technology, algorithms and artificial intelligence.
    • Once installed in a smartphone through an easy and user-friendly process, the app detects other devices with AarogyaSetu installed that come in the proximity of that phone.
    • The app can then calculate the risk of infection based on sophisticated parameters if any of these contacts has tested positive.
    • The personal data collected by the App is encrypted using state-of-the-art technology and stays secure on the phone till it is needed for facilitating medical intervention.

  • A pandemic in an unequal India

    Context

    The official strategies to deal with the virus place the responsibility on citizens, a majority without privilege, to fight the virus.

    The poor disproportionately affected

    • If the COVID-19 pandemic lashes India with severity, it will not be just the middle class who will be affected.
    • India’s impoverished millions are likely to overwhelmingly bear the brunt of the suffering which will ensue.
    • Inequality and impact of a pandemic: The privileged Indian has been comfortable for too long with some of the most unconscionable inequalities in the planet.
    • But with the pandemic, each of these fractures can decimate the survival probabilities and fragile livelihoods of the poor.

    Inadequate capacity of the health system  

    • Low investment in public health: India’s investments in public health are among the lowest in the world, and most cities lack any kind of public primary health services.
    • A Jan Swasthya Abhiyan estimate is that a district hospital serving a population of two million may have to serve 20,000 patients, but they are bereft of the beds, personnel and resources to do this. Few have a single ventilator.
    • The poor left with meagre services: India’s rich and middle-classes have opted out of public health completely, leaving the poor with unconscionably meagre services.
    • The irony is that a pandemic has been brought into India by people who can afford plane tickets, but while they will buy private health services, the virus will devastate the poor who they infect and who have little access to health care.

    No planning and preparation by the state

    • Official strategies placing responsibility on citizens: Most of the official strategies place the responsibility on the citizen, rather than the state, to fight the pandemic.
    • No preparation by the states: The state did too little in the months it got before the pandemic reached India for expanding greatly its health infrastructure for testing and treatment.
    • This includes planning operations for food and work; security for the poor; for safe transportation of the poor to their homes; and for special protection for the aged, the disabled, children without care and the destitute.

    What must be done?

    • 25 day’s minimum wage: For two months, every household in the informal economy, rural and urban, should be given the equivalent of 25 days’ minimum wages a month until the lockdown continues, and for two months beyond this.
    • Pensions must be doubled and home-delivered in cash.
    • There should be free water tankers supplying water in slum shanties throughout the working days.
    • Double the PDS entitlement: Governments must double PDS entitlements, which includes protein-rich pulses, and distribute these free at doorsteps.
    • Provide cooked and packed food: In addition, for homeless children and adults, and single migrants, it is urgent to supply cooked food to all who seek it, and to deliver packed food to the aged and the disabled in their homes using the services of community youth volunteers.
    • Ensure prisons are safe: To ensure jails are safer, all prison undertrial prisoners, except those charged with the gravest crimes, should be released.
    • Likewise, all those convicted for petty crimes. All residents of beggars’ homes, women’s rescue centres and detention centres should be freed forthwith.

    Way forward

    • Commit 3% of GDP on health: India must immediately commit 3% of its GDP for public spending on health services, with the focus on free and universal primary and secondary health care.
    • Nationalise private healthcare: Since the need is immediate, authorities should follow the example of Spain and New Zealand and nationalise private health care.
    • An ordinance should be passed immediately that no patient should be turned away or charged in any private hospital for diagnosis or treatment of symptoms which could be of COVID-19.

    Conclusion

    While one part of the population enjoys work and nutritional security, health insurance and housing of globally acceptable standards, others survive at the edge of unprotected and uncertain work, abysmal housing without clean water and sanitation, and no assured public health care. Can we resolve to correct this in post-COVID India? Can we at least now make the country more kind, just and equal?

  • Regulating the Private Health Sector to Eliminate COVID-19

    Context

    The current COVID-19 crisis that India is battling has brought into sharp focus the public health system’s inadequacy to cope with it.

    Contradictory scenario between public and private healthcare delivery

    • The contrast between public and private: Hospitals with state-of-the-art equipment rivalling five-star hotels in their facilities are mushrooming mostly in cities even as the overburdened public hospitals are valiantly fighting to cope. 
    • Dismal picture in rural areas: As far as the rural areas are concerned, the community health centres and primary health centres and sub-centres present an even more dismal picture in terms of availability of medicine stock, trained para-medical staff, and doctors and nurses.
    • However, it is not as if urban hospitals offer patients excellent care. A common and widely held general misperception is that the private healthcare system is better than the public one.
    • Why private is not always better? Complaints of non-transparent billing, demanding exorbitant sums in advance even in a medical emergency, and cutting corners in services are all too familiar, as are cases of the denial of services.
    • In semi-rural areas and towns, the private sector is not necessarily similar to hospitals in cities.
    • The private hospitals in these areas are small and have basic infrastructure and limited medical and non-medical staff. Unlike the cities, the power and water supply in these areas also constitute a problem to the functioning of these hospitals.

    Problems in the public healthcare system

    • Within the public sector health system, there are a number of trends again that add to the dismal picture.
    • A high number of patients: Doctors in the public hospitals deal with an overwhelming number of patients majorly from the poor and marginalised sections.
    • Issue of contractual staff: Health activists have also pointed out that the growing trend of contractual hiring of paramedical and allied staff leads to an insecurity among them, and thus affects overall caregiving to patients.
    • Consequently, the poor patients’ families, frustrated by the lack of infrastructure and services, turn their anger upon the doctors and nurses.
    • What are the implications? The constant vilification of the public hospital staff coupled with starving these hospitals of resources has led to the view that the private hospitals are “much better” despite their exorbitant rates.

    State-wise variation in healthcare

    • States subject: Health is a state subject, and it is well known that the health delivery systems are not uniform across states.
    • Kerala a role model: Kerala is often held up as a role model generally, and even now in the manner in which it has dealt with the COVID-19 crisis.
    • The dismal system in North India: As it is, certain states in North India have abysmal healthcare systems, and a couple does not have any testing facilities, the media has reported.

    Getting the private sector involved in COVID-19 testing

    • Undoubtedly, at present, the private sector must be involved in screening, tests and treatment for COVID-19.
    • The highly trained professionals in this sector can contribute enormously by helping scale up the testing efforts.
    • Importance of large-scale testing: In South Korea too, it was large-scale testing that was instrumental in reducing mortality rates.
    • The pricing issue: Services across sectors must not be priced differently at a time like this. The media has reported that there is a difference of opinion between the government and private sector on the price of COVID-19 tests flowing from the prices of test kits.
    • Need for the protocol: A clear and non-negotiable protocol for the private sector must be established regarding the present crisis and how the government is going to help financially and otherwise in dealing with it.

    Way forward

    • Regulate the testing, screening and treatment facilities: The experience with the government offering subsidies to hospitals, especially in urban areas in terms of land and other concessions, has not borne out desired objectives such as better care for the poor.
    • Taking a cue from this, the testing, screening, and treatment facilities must be regulated in terms of pricing and quality.
    • Focus on strengthening the public health system: The Supreme Court has held healthcare to be a fundamental right under Article 21. The biggest lesson of the current crisis is that political will must focus on strengthening the public health system.

    Conclusion

    The finance minister has announced a package of `1.7 lakh crore to deal with this catastrophic situation. This is welcome, but long-term resource allocation to invigorate the public health system must be a continual and parallel process.

  • PM-CARES Fund

    Our PM has called for donations to the newly instituted PM-CARES Fund which has been formed on popular demand to help fight the novel coronavirus.

    PM-CARES Fund

    • The fund will be a public charitable trust under the name of ‘Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund’.
    • The PM is Chairman of this trust and members include the Defence Minister, Home Minister and Finance Minister.
    • Contributions to the fund will qualify as corporate social responsibility (CSR) spending that companies are mandated to make.
    • The Fund accepts micro-donations as well.

  • [pib] National Teleconsultation Centre (CoNTeC)

    The Union Ministry of Health & Family Welfare has launched the National Teleconsultation Centre (CoNTeC).

     About CoNTeC

    • The CoNTeC is a Telemedicine Hub established by AIIMS, New Delhi, wherein expert doctors from various clinical domains will be available 24×7 to answer the multifaceted questions from specialists from all over the country.
    • It is a multi-modal telecommunications hub through which 2 way audio-video and text communications can be undertaken from any part of the country as well as the world at large.
    • The modes of communication will include simple mobile telephony as well as two way video communications, using WhatsApp, Skype and Google Duo.
    • The CoNTeC is also fully integrated with the National Medical College Network (NMCN) to conduct a full fledged Video Conference (VC) between the 50 Medical Colleges.

    How to Contact the CoNTeC?

    • A single mobile number (+91 9115444155) can be dialled from anywhere in the coutnry/world by COVID-19 treating doctors to reach the CoNTeC which has six lines that can be used simultaneously at present.
    • This number of lines can be increased in future if needed.
    • The incoming calls will be picked up by the CoNTeC Managers, who will then handover the call to the appropriate expert doctors from the clinical domains as desired by the calling specialists managing the COVID-19 cases anywhere in the country.
    • The Managers will guide the callers in establishing a two way video call using the WhatsApp, Skype or Google Duo as preferred by the caller.
    • The callers from the NMCN network can connect anytime using the Telemedicine infrastructure at their end.

  • Home and nation

    Context

    A 21-day lockdown is extraordinary. Government, people must come together to ensure that supply chains and social trust must not break.

    An unprecedented move

    • A 21-day nationwide lockdown: The way we conduct ourselves in these 21 days will be critical in our fight against the coronavirus.” With these words, Prime Minister announced a measure unprecedented in India’s 72-year-old history.
    • Never have the people of the country been asked to stay within the confines of their homes for this long a period, not even when the country has fought wars.
    • Yet extraordinary times demand extraordinary measures. As the PM underlined, “stringent social distancing and staying within the Lakshman Rekha of our homes is the only prevention against the coronavirus”, the only way to break its transmission cycle.

    Challenges and consequences

    • There will be social and economic consequences and the PM did not equivocate on the challenges. He spoke of the vulnerable sections, and, as in last week’s speech, emphasised the imperative to be compassionate.
    • He lauded the frontline workers, doctors, nurses and other healthcare workers, expressed gratitude to safai karamcharis and praised the private sector and civil society.
    • A reworked social compact — more compassionate — will be necessary to confront the challenges posed by the lockdown.
    • It is now up to civil society, government agencies, the healthcare and corporate sectors to take their cues from the PM’s speech and ensure that the burden of fighting the pandemic does not fall too heavily on those at the margins, the migrant and daily wage labourers, the rickshaw pullers and others for whom these 21 days could prove to be the toughest.
    • Centre and state to work together: The Centre and state governments will need to work together, setting aside their political differences, to ensure that there is no shortage of essential commodities and the supply chains are not broken.

    Measures to mitigate the impact

    • Earlier in the day, Finance Minister Nirmala Sitharaman had announced a slew of measures that could soften the blow of a 21-day lockdown.
    • The deadline for filing of income taxes for the financial year 2018-19 has been extended, as has the last date for filing GST returns.
    • Sitharaman also announced that the threshold for taking companies through the insolvency and bankruptcy proceedings has been increased from Rs 1 lakh to Rs 1 crore.
    • This will prevent creditors from taking small and medium-sized companies, who may be facing temporary cash flow management issues due to the lockdown, and hence are unable to meet their obligations, through the IBC process.
    • The Centre has also advised state governments to transfer funds to construction workers from the cess fund collected by the labour welfare boards.

    Conclusion

    As the PM said, “21 days is a long period”. It’s now up to the authorities and the people to own and implement his message — to ensure that not just supply chains, but also social trust, isn’t broken.

  • Legal Provisions Used By Law Enforcement Agencies To Control The Spread Of Coronavris

    To enforce a full lockdown to contain the spread of COVID-19, law enforcement agencies have taken the help of various legal provisions in CrPC and IPC.

    • The orders issued to curb the spread of the coronavirus have been framed under the Epidemic Diseases Act, 1897, which lays down punishment as per Section 188 of the Indian Penal Code, 1860.
    • Similarly, Sections 269 and 270 IPC are being invoked against persons who malignantly do any act which is likely to spread the infection of any disease dangerous to life.

      Sections 269 and 270 of the IPC

      • Sections 269 (negligent act likely to spread infection of disease dangerous to life) and 270 (malignant act likely to spread infection of disease dangerous to life) come under Chapter XIV of the IPC.
      • The chapter is named ‘Of Offences Affecting The Public Health, Safety, Convenience, Decency and Morals’.
      • While Section 269 provides for a jail term of six months and/or fine, Section 270 provides for a jail term of two years and/or fine.
      • In Section 270, the word ‘malignantly’ indicates a deliberate intention on the part of the accused.
      • During the coronavirus outbreak, penal provisions, such as Sections 188, 269 and 270 of the IPC, are being invoked to enforce the lockdown orders in various states.

      Earlier instances of invocation

      • Both Sections have been used for over a century to punish those disobeying orders issued for containing epidemics.
      • The Sections were similarly enforced by colonial authorities during outbreaks of diseases such as smallpox and bubonic plague.

    What is Section 188 of the Indian Penal Code?

    • Section 3 of the Epidemic Diseases Act, 1897, provides penalties for disobeying any regulation or order made under the Act.
    • These are according to Section 188 of the Indian Penal Code (disobedience to order duly promulgated by public servant).
    • It is not necessary that the offender should intend to produce harm, or contemplate his disobedience as likely to produce harm.
    • It is sufficient that he knows of the order which he disobeys, and that his disobedience produces, or is likely to produce, harm.

    What happens if you violate the lockdown orders? 

    Under Section 188, there two offences:

    1) Disobedience to an order lawfully promulgated by a public servant, If such disobedience causes obstruction, annoyance or injury to persons lawfully employed

    Punishment: Simple Imprisonment for 1 month or fine of Rs 200 or both

    2) If such disobedience causes danger to human life, health or safety, etc.

    Punishment: Simple Imprisonment for 6 months or fine of Rs 1000 or both

    According to the First Schedule of the Criminal Procedure Code (CrPC), 1973, both offences are cognizable, bailable, and can be tried by any magistrate.

    Triable By: Any Magis­trate

     

  • AYUSH Health-Wellness Centres

    What is the news: The Union Cabinet has approved the inclusion of AYUSH Health and Wellness Centre (AYUSH HWC) component of Ayushman Bharat in the National AYUSH Mission (NAM).

    • A total of 12,500 Ayush health and wellness centres throughout the country will be operationalised within a period of five years.
    • The implementation of the proposal will establish a holistic wellness model based on Ayush principles and practices focusing on preventive promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.

    Why such a move?

    • The move is aimed at establishing a holistic wellness model based on AYUSH principles and practices focusing on preventive, promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.
    • The National Health Policy 2017 has advocated mainstreaming the potential of AYUSH systems (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sows-rigpa and Homoeopathy) within a pluralistic system of Integrative healthcare.
    • The vision of the proposal is to establish a holistic wellness model based on AYUSH principles and practices, to empower masses for ‘self care’ to reduce the disease burden and out of pocket expenditure and to provide informed choice of the needy public.

    What is National AYUSH Mission (NAM)?

    • Department of AYUSH, Ministry of Health and Family Welfare, Government of India has launched National AYUSH Mission (NAM) during 12th Plan for im­plementing through States/UTs.
    • The basic objective of NAM is to promote AYUSH medical systems through cost effective AYUSH services, strengthening of educational systems, facilitate the enforcement of quality control of ASU &H drugs and sustainable availability of ASU & H raw-materials.
    • It envisages flexibility of implementation of the programmes which will lead to substantial participation of the State Governments/UT.
    • The NAM contemplates establishment of a National Mission as well as corresponding Missions in the State level.

  • Need for re-orientation

    Context

    State universities will have to deliver more to the State where they are located

    Status of the state universities in India

    • Significance of state universities: Out of about a thousand higher education institutions (HEIs) that are authorised to award degrees in India, about 400 are state public universities.
      • These state universities produce over 90% of our graduates (including those from the colleges affiliated to them) and contribute to about one-third of the research publications from this country.
    • Poor quality: That their quality and performance is poor in most cases is accepted as a given today.
      • It is evidenced by their poor performance in institutional rankings,
      • the poor employment status of their students,
      • rather poor quality of their publications,
      • negligible presence in national-level policy/decision-making bodies,
      • poor track record in receiving national awards and recognition, poor share in research funding and so on.
    • Stated reasons for poor performance– Commonly stated reasons for these observations include government/political interference in the management of the university, lack of autonomy, poor governance structures, corruption, poor quality of teachers, outdated curricula, plagiarism, poor infrastructure and facilities, overcrowding, evils of the “affiliation” system and poor linkages with alumni and industry.
      • Symptoms of the problem: While many of these observations are no doubt valid, they appear to be only the symptoms and consequences of some deeper malaise and not the underlying cause.

    Core causative factors for the poor state of state universities

    • Lack of support: State universities are not supported the way Central universities are supported by the Central government as well as given patronage by the section of society.
      • It is as though State-level players do not have much stake in the stability and performance of the State university system.
      • What could be the reason for lack of support? One reason why State-level players do not feel compelled to back the State university system more strongly could be that the latter does not commit itself to anything that may be of particular interest and value to the State where the university is located.
    • What could be the solution? In order to receive much more funding and support from the State system then, State universities would have to commit to delivering lots more to the State and its people where they are located.
      • New vision and programmes: They must come up with a new vision and programmes specifically addressing the needs of the State, its industry, economy and society, and on the basis of it make the State-level players commit to providing full ownership and support to them.

    Conclusion

    The initiative to start a larger dialogue on the future of our State universities would have to be taken primarily by the academic community of these institutions.

  • Get a step ahead of the virus

    Context

    The COVID-19 pandemic has repercussions beyond the biomedical sector — it impinges on industry, transport, finance, banking and education sectors. All of them must act in unison.

    Virus different from its nearest relative

    • Comparison with SARS and MERS: The rapid spread of the zoonotic (transmitted from animal-to-human) coronavirus infection in Wuhan in China — several hundreds every day — in December 2019 and January 2020 was a clear signal that COVID-19 is drastically different from its nearest relative viz.-
      • the Severe Acute Respiratory Syndrome (SARS) coronavirus,
      • and its distant relative, the Middle-East Respiratory Syndrome (MERS) coronavirus.
      • The former spread slowly among humans in 2002-2003. It was checked globally within nine months by screening passengers and quarantining travellers from infected countries.
      • There have been no cases since July 2003. MERS coronavirus is, by and large, an inefficient spreader — it has been confined to the Middle-East.
    • How COVID-19 is different? COVID-19 has assumed a pandemic form.
      • In less than three months, it has reached more than 180 countries and claimed more than 10,000 lives.
      • The disease has claimed more people in Italy than in the country of its origin.
      • Travel bans, screening travellers and quarantines are necessary to slow the spread of COVID-19.
      • However, there is a limit to the utility of these measures.
    • Community transmission: When the infection becomes widespread, screening procedures will become inefficient — the virus will spread stealthily.
      • Indigenous transmission — the virus spreading within communities — has begun in many countries.
      • This is typical of viruses that spread from human to human through the respiratory system.

    How India’s health management systems deals with the disease burden?

    • Medicine consists of three components —
      • universal healthcare,
      • public health, and
      • research to constantly contextualise solutions to local problems.
    • Reaction after falling ill: Many of us in India believe that disease is a matter of fate or karma and disease prevention is not always in human hands — we only react after falling ill.
    • No focus on prevention and control: Therapeutics and surgeries — healthcare interventions — are valued much, but not disease prevention and control.
    • Cultural beliefs matter: Attitudes and cultural beliefs do matter. If victims are somehow regarded as responsible for their maladies, universal healthcare is perceived as an optional service — not mandatory.

    Good reasons to change the attitude

    • There are good reasons for such thinking to change.
    • Every person who contracts a communicable disease stands the risk of spreading it to others.
    • Prevention of disease is states’ duty: At the same time, the state, too, is responsible for the spread of diseases by not mitigating the environmental and social risk factors or determinants. Prevention of disease is the state’s duty.
    • Investment in health and its implications: Healthy people create wealth. For example, every year, uncontrolled tuberculosis drains India’s economy of the equivalent of the GDP of roughly 2 million people.
      • Investment in health, therefore, can have implications for the country’s economy.
      • But Indians have never really demanded an effective public health system.
      • Healthcare has never become a political slogan. That’s one reason for the sorry state of India’s public health system.
    • Absence of effective public health system: The country does have international obligations to control TB, malaria and leprosy, and eliminate polio.
      • Ad hoc measures: In the absence of an effective public health system, the country has depended on fulfilling these obligations through ad hoc measures that are targeted towards one disease.
      • Need for robust health system: Robust public health systems are needed to prevent typhoid, cholera, dysentery, leptospirosis, brucellosis, water-born hepatitis and influenza.
    • Overburdened healthcare system with communicable disease: The absence of an effective preventive element means that healthcare services in the public sector are over-burdened with uncontrolled communicable diseases.
      • The entry of the private sector: This encourages private sector healthcare providers to step in, which brings in problems related to unregulated profits.
      • Questions are often raised over the quality of service.
      • COVID-19 could compound the systems problems: Moreover, uncontrolled communicable diseases vie with the non-communicable ones for the healthcare provider’s attention. The COVID-19 outbreak could compound the system’s problems.

    One step ahead of the virus

    • SARS and Nipah in Kerala: The SARS and Nipah virus outbreak in Kerala in 2018 were crises that required short bursts of professional activity. Our healthcare systems coped with them.
      • But endemic diseases, even influenza, that has a vaccine, require sustained interventions.
    • Test for the country’s healthcare system: Herein lies the test for the country’s healthcare system.
      • It has often been seen that the system is not able to sustain its initial momentum.
      • There is a possibility that COVID-19 could follow the path taken by the HINI influenza – after the epidemic died down, the disease became endemic.
      • The country’s healthcare system has to prepare for that. In other words, it has to be one step ahead of the virus.

    Way forward

    • Equipping district hospitals: Every district hospital must be equipped to diagnose infections caused by serious communicable diseases — these affect the lungs, brain, liver and kidneys.
      • The system should also ensure that healthcare personnel do not get infected.
    • Allocate 5% of GDP to health budget: The country needs to allocate 5 per cent of the GDP to the health budget to have a health management system that can take care of public health emergencies such as the COVID-19 outbreak — and its aftermath.
    • Unified control machinery: A unified command and control machinery, under the prime minister’s guidance, to control the spread of COVID-19 is overdue by at least six weeks in the country.
    • Define the tasks of various authorities: The tasks of the Directorate-General of Health Services, National Centre for Disease Control, Indian Council of Medical Research, National Health Mission and state health ministries must be clearly defined.
    • The mechanism for coordination: Most importantly, a mechanism for coordination between these agencies should be set up to deal with the COVID-19 threat.

    Conclusion

    The COVID-19 pandemic has repercussions beyond the biomedical sector — it impinges on industry, transport, finance, banking and education sectors. All of them must act in unison.