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Subject: Health

  • Clean house: On India’s septic tank desludging

    Why in the News?

    Recently, a social audit tabled in Parliament revealed 150 hazardous cleaning deaths in 2022–23, exposing unsafe outsourcing, poor implementation of safety laws, and inadequate funding under schemes like NAMASTE. Despite Supreme Court orders and successful models in states like Odisha and Tamil Nadu, enforcement and mechanisation remain critically lacking nationwide.

    Why has manual scavenging persisted despite laws and schemes like NAMASTE?

    • Weak Enforcement of Legal Provisions and Court Orders: Despite the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 and Supreme Court directions to cancel offending contracts and penalise principal employers, enforcement remains minimal. Eg: In 2024, Parliament revealed that 150 workers died in 2022–23 due to hazardous cleaning.
    • Poor Implementation and Underfunding of Schemes: Schemes like NAMASTE are hindered by insufficient financial support, poor outreach, and lack of protective equipment or training. Eg: Of the 57,758 workers involved in hazardous cleaning, only 16,791 received PPE kits, and a mere ₹14 crore had been released under NAMASTE—inadequate for mechanisation in even one major city.
    • Obscured Employer Liability through Subcontracting: The use of contractual and ‘loaned’ labour allows government and private employers to avoid responsibility for worker safety. Eg: A social audit tabled in Parliament found that out of 54 hazardous cleaning deaths, only five workers were on government payroll, while others were ‘loaned’ to private contractors, making accountability unclear.

    How have Odisha and Tamil Nadu offered viable alternatives to manual scavenging?

    • Odisha has ensured identified sanitation workers are equipped with PPE kits and have access to mechanised desludging vehicles, reducing the need for manual entry.
      Eg: Workers now use vacuum trucks for sewer cleaning instead of entering toxic manholes, improving safety and dignity.
    • Tamil Nadu has piloted robotic interventions to eliminate manual scavenging in urban areas.
      Eg: In Chennai, sewer robots have been deployed to clean over 5,000 manholes, showcasing how technology and political will can prevent hazardous practices.

    How does the lack of rural data hinder sanitation worker reforms?

    • Exclusion from Mechanisation Schemes: Without reliable data on rural sanitation workers, schemes like NAMASTE do not extend their benefits (e.g. robotic cleaning or desludging machines) to villages. Eg: In many gram panchayats of Bihar, manual pit cleaning is still done without equipment as workers remain unregistered and thus unaccounted for in policy rollouts.
    • No Health or Safety Monitoring: The lack of worker enumeration means occupational health risks go unnoticed, and safety training or PPE kitsare not distributed in rural regions. Eg: In Chhattisgarh’s rural blocks, no health cards or protective equipment have been distributed to sanitation workers, exposing them to toxic gases and infections.
    • Obstructs Legal Accountability and Compensation: If workers are not documented, accidental deaths are often unreported or misclassified, preventing compensation to families and accountability for employers. Eg: In a 2023 case in Madhya Pradesh, a worker died while cleaning a septic tank, but due to lack of registration, the case was recorded as a general accident, not as a violation of the Manual Scavenging Act.

    What are the steps taken by the Indian Government?

    • Legislation and Legal Ban: The Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 bans manual scavenging and mandates identification and rehabilitation of affected workers.
    • NAMASTE Scheme (2023): The National Action for Mechanised Sanitation Ecosystem (NAMASTE) scheme promotes mechanised cleaning, provides training, PPE kits, and financial support to sanitation workers.
    • Welfare and Skill Development Initiatives: The government has launched surveys, provided one-time cash assistance, health insurance under Ayushman Bharat, and livelihood loans to support entrepreneurship among workers.

    What reforms can ensure safety and rehabilitation for workers?

    • Mandatory Mechanisation and Licensing: Urban local bodies should mandate mechanised sewer cleaning, make it a licensed profession, and classify manual cleaning without valid certification as a cognisable offence. This will ensure accountability and eliminate unsafe practices.
    • Rehabilitation Through Financial and Social Support: Provide sanitation workers with housing, education scholarships, health cards, and loans to operate mechanised equipment. These should be linked to guaranteed municipal contracts, enabling long-term economic and social upliftment.

    Mains PYQ:

    [UPSC 2024] Poverty and malnutrition create a vicious cycle, adversely affecting human capital formation. What steps can be taken to break the cycle?

    Linkage: Manual scavenging represents an extreme form of poverty and human capital degradation. This article mentions that “Two-thirds of validated workers are also Dalits, yet rehabilitation packages rarely include housing or scholarships that might help families exit contemptible occupations”. This question allows for a discussion of how ending such hazardous labor and providing meaningful rehabilitation can break this vicious cycle.

  • [8th July 2025] The Hindu Op-ed: Fostering a commitment to stop maternal deaths

    PYQ Relevance:

    [UPSC 2020] In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss.

    Linkage: The article on maternal mortality highlights various deficiencies in healthcare delivery and infrastructure (e.g., lack of specialists, blood banks, operation theatres, and trained personnel) that contribute to maternal deaths, indicating the critical need for sound policies. This question is most directly relevant as it specifically names “maternal health care” as a crucial area for sound and adequate healthcare policies to enhance social development.

     

    Mentor’s Comment:  Despite progress, India still loses 93 mothers for every 1,00,000 births due to problems that could be prevented during childbirth. Although the number has come down from 103 (2017–19) to 93 (2019–21), there are still huge differences between states. For example, Kerala has brought the number down to 20, but in states like Madhya Pradesh (175) and Assam (167), the numbers are very high.

    Today’s editorial analyses the issues related to India’s Maternal Mortality Ratio. This topic is important for GS Paper I (Women-related Issues) and GS Paper II (Social Justice and Health) in the UPSC mains exam.

    _

    Let’s learn!

    Why in the News?

    India’s Maternal Mortality Ratio is going down, but some states still need to work on solving basic problems and improving their healthcare systems.

    What do MMR trends reveal about regional disparities in India?

    • Declining National MMR: India’s MMR dropped from 103 (2017–19) to 93 (2019–21), showing slow but consistent improvement.
    • Kerala leads with an MMR of 20, indicating robust institutional care and maternal health awareness.
    • Southern States (like Tamil Nadu and Andhra Pradesh) show better performance (MMR under 50–60), while EAG States such as Madhya Pradesh (175) and Assam (167) remain critical zones.
    • “Other” States: Maharashtra (38) and Gujarat (53) have made notable progress, while Punjab (98) and Haryana (106) still struggle.

     

    Why is India’s Maternal Mortality Ratio still high despite better healthcare access?

    • Regional Disparities in Healthcare Infrastructure: MMR is significantly higher in Empowered Action Group (EAG) states like Assam (167) and Madhya Pradesh (175), compared to Kerala (20). Eg: States like Bihar and UP face shortages in skilled staff and poor facility access, despite national programmes.
    • Inadequate Functioning of FRUs (First Referral Units): Many FRUs lack specialists, blood banks, and operating theatres. Over 66% of specialist posts remain vacant. Eg: In 2,856 designated FRUs, many lack anaesthetists or functional surgical units, risking lives in emergencies.
    • Three Delays in Maternal Care: Delays in seeking care, reaching hospitals, and receiving treatment result in avoidable deaths.  

    How are the three key delays contributing to maternal deaths?

    • Delay in Decision-Making at Home: Families often fail to recognise danger signs during pregnancy or childbirth and delay seeking medical help. Eg: A pregnant woman showing signs of excessive bleeding may not be taken to a hospital promptly due to family neglect, financial constraints, or the belief that delivery is natural.
    • Delay in Reaching a Healthcare Facility: Lack of timely transportation from remote or rural areas hinders access to skilled birth attendants or emergency care. Eg: A woman in a tribal village may take hours to reach a hospital due to poor roads or lack of ambulances, resulting in delivery en route.
    • Delay in Receiving Adequate Care at the Facility: Even after reaching a hospital, care may be delayed due to absence of doctors, operation theatres, or blood supply. Eg: A woman experiencing uterine rupture may not get immediate surgery because the anaesthetist is unavailable or the OT isn’t ready.
    What are First Referral Units (FRUs)?

    First Referral Units (FRUs) are designated health facilities equipped to provide comprehensive emergency obstetric and newborn care (CEmONC). These units serve as the first-level referral centres for maternal and child health emergencies, especially in rural and underserved areas.

     

    How can FRUs be made more effective in reducing maternal deaths?

    • Ensure Availability of Specialist Medical Staff: FRUs must be equipped with qualified obstetricians, anaesthetists, and paediatricians to handle maternal emergencies. Eg: In many districts, over 60% vacancies in specialist posts mean pregnant women cannot access timely surgeries like C-sections, leading to avoidable deaths.
    • Establish Fully Functional Emergency Infrastructure: FRUs must have operational operation theatres, blood banks, and 24×7 emergency care to address complications like postpartum haemorrhage. Eg: A woman suffering massive bleeding after childbirth can be saved if a blood transfusion and surgery are available within two hours.
    • Strengthen Referral and Transport Systems: Ensure robust ambulance networks and clear referral protocols to reduce delays in reaching FRUs from rural or remote areas. Eg: The 108 ambulance service, when linked efficiently with FRUs, can reduce deaths caused by obstructed labour during long-distance travel.

    What lessons does the Kerala model offer for reducing MMR nationwide?

    • Confidential Review of Maternal Deaths: Kerala uses a systematic review process to study every maternal death to identify medical and systemic gaps. Eg: Led by Dr. V.P. Paily, Kerala’s Confidential Review Committee analyses causes like hemorrhage, embolism, or surgical delay, enabling precise interventions.
    • High-Quality Emergency Obstetric Care: Kerala emphasizes emergency preparedness, with trained obstetricians, well-equipped operation theatres, and availability of blood banks.  
    • Holistic Maternal Health Approach: Kerala addresses not only physical but also mental health aspects of pregnancy, like antenatal depression and postpartum psychosis.  

    Way forward: 

    • Strengthen FRUs and Emergency Care Infrastructure: Ensure that all First Referral Units (FRUs) are fully staffed with specialists, equipped with blood banks, operation theatres, and essential medicines to manage obstetric emergencies swiftly.
    • Scale Up Kerala’s Model Nationwide: Implement confidential maternal death reviews, train healthcare personnel in advanced obstetric practices, and integrate mental health support into maternal care programs across all States.

  • [1st July 2025] The Hindu Op-ed: How do unsafe cancer drugs reach patients?

    PYQ Relevance:

    [UPSC 2014] While doctor’s prescription is a must to get drugs, many people buy them over the counter without prescription. Discuss the contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved.

    Linkage: The wider discussion about checking drug quality and the difficulties in doing so is very important to stop unsafe drugs, like cancer medicines, from reaching patients. This question is relevant because it looks into how drugs are monitored and the problems faced in keeping them safe.

     

    Mentor’s Comment:  A major global investigation by the Bureau of Investigative Journalism, reported by The Hindu, has revealed that poor-quality and unsafe cancer drugs, many of them from India, have been sent to over 100 countries. These faulty medicines have caused serious health problems, including the deaths of children in Yemen, Colombia, and Saudi Arabia. The report highlights serious regulatory weaknesses in low- and middle-income countries, and shows that the WHO’s warning system only acts after harm is done. This is especially worrying because it affects cancer patients, one of the most vulnerable groups.

    Today’s editorial talks about the poor-quality and unsafe cancer drugs. This topic is important for GS Paper II (Health & Governance) in the UPSC mains exam.

    _

    Let’s learn!

    Why in the News?

    Recently, a major global investigation by the Bureau of Investigative Journalism, reported by The Hindu, found that low-quality and unsafe cancer drugs.

    The Bureau of Investigative Journalism (TBIJ) is an independent, non-profit news organization based in the United Kingdom. It was founded in 2010 with the aim of producing in-depth, public interest journalism that holds power to account.

    What are the major quality risks in cancer drug manufacturing and distribution?

    • Contamination during manufacturing: Risk of bacterial contamination from improper disinfection, untrained staff, or poor cleanroom discipline. Even small errors like air movement or touching non-sterile items can spread bacteria.
    • Poor quality control: Failure to test raw ingredients, clean equipment, or filter water properly can make life-saving drugs toxic or lethal.
    • Distribution chain vulnerabilities: Changes in temperature, humidity, or poor handling during transport can degrade drug quality. The complex journey from raw materials to patient requires strict monitoring at each stage.

    Why are poorer countries more exposed to unsafe cancer drugs?

    • Weak Regulatory Frameworks: Many low-income countries lack strong drug regulatory authorities and legal frameworks to ensure medicine quality. Eg: In Nepal, there is no effective testing or monitoring of imported drugs due to limited institutional capacity.
    • Lack of Testing Infrastructure and Experts: These countries often do not have certified laboratories or trained personnel to check for contamination, dosage accuracy, or manufacturing faults. Eg: Nepal and similar nations lack verified experts or facilities to evaluate drug safety before market entry.
    • Inability to Track Drugs Through Supply Chains: Poor digital and logistical infrastructure leads to ineffective drug tracking, making it easier for substandard or counterfeit drugs to infiltrate the system. Eg: In countries with porous borders and no tracking systems, drugs can be repackaged or sold without oversight.
    • Corruption and Weak Enforcement: Corruption in customs, licensing, and procurement processes allows unverified drugs to enter public hospitals and pharmacies unchecked. Eg: In some regions, low-cost cancer drugs without proper quality assurance enter due to bribery and lack of regulatory follow-up.
    • Dependence on Low-Cost Imports Without Verification: Due to budget constraints, poorer nations rely heavily on cheap generic imports without adequate checks for Good Manufacturing Practices (GMP) or source validation. Eg: In Yemen (2022), at least 10 children died after receiving contaminated methotrexate, highlighting the consequences of poor import verification.

    How does WHO ensure drug safety?

    • Rapid Alert System for Dangerous Drugs: WHO operates a global Rapid Alert System to identify and inform member countries about harmful or substandard medicines. Eg: If contaminated cancer drugs are reported in one country, WHO sends out a global alert so others can take preventive action.
    • Global Benchmarking and Certification Tools: WHO uses tools like the Global Benchmarking Tool to assess national regulatory systems and ranks them from Level 1 (weakest) to Level 4 (strongest). Eg: In 2023, 70% of member countries were rated at Level 1 or 2, showing limited capacity to regulate drug safety.
    • Prequalification, GMP, and CoPP Systems: WHO runs prequalification programs to approve safe drugs, ingredients, and labs; enforces Good Manufacturing Practices (GMP); and issues the Certificate of Pharmaceutical Product (CoPP) to confirm quality of exported drugs. Eg: A CoPP acts like a passport for medicines, verifying they are approved and safely made in the exporting country.

    What are the steps taken by the Indian Government?

    • Strengthening Drug Regulatory Framework: The government has empowered the Central Drugs Standard Control Organization (CDSCO) to regulate drug approval, quality checks, and enforcement across India. CDSCO conducts inspections and sampling under the Drugs and Cosmetics Act, 1940 to detect substandard medicines.
    • Track and Trace Mechanism: India has introduced a barcode-based Track and Trace system for export of pharmaceutical products to improve transparency and traceability. Eg: The system helps monitor supply chain integrity and detect counterfeit drugs, especially in exports.
    • The Production Linked Incentive (PLI) Scheme for pharmaceuticals promotes domestic manufacturing of quality drugs and APIs while reducing import dependence. Eg: Incentives are given to firms that meet Good Manufacturing Practices (GMP) and global export standards.

    Way forward: 

    • Establish a National Drug Quality Monitoring Authority: Create a centralised, independent regulatory body to oversee real-time quality audits, enforce uniform GMP standards, and ensure accountability across manufacturing units.
    • Invest in Testing Infrastructure and Skilled Workforce: Strengthen drug testing laboratories, equip them with modern technology, and train qualified professionals to carry out rigorous inspections and batch verifications at every stage.

  • National Polio Surveillance Network (NPSN)

    Why in the News?

    The Indian government has proposed a phased winding down of the National Polio Surveillance Network (NPSN), a WHO-established network critical to tracking and eliminating polio in India.

    About National Polio Surveillance Network (NPSN):

    • Launch : The NPSN was established in 1997 as a collaboration between the World Health Organization (WHO) and the Ministry of Health and Family Welfare (MoHFW), Government of India.
    • Objective: Its main goal is to detect and monitor the poliovirus in India to enable quick response and containment.
    • Operational Structure: The network functions under the National Polio Surveillance Project (NPSP) and includes over 200 field surveillance units across the country.
    • Methodology: The core method is Acute Flaccid Paralysis (AFP) surveillance, which tracks sudden paralysis in children under 15 — a key indicator of polio.
    • Environmental Surveillance: The NPSN also tests sewage and water samples to detect silent circulation of the virus.
    • Laboratory Support: A network of WHO-accredited laboratories confirms virus presence through testing of stool and water samples.
    • Rapid Response: Every suspected case is quickly investigated, and public health teams are deployed for control and containment.
    • Expanded Role: Over time, NPSN has also supported surveillance for measles, rubella, DPT, and helped train health workers on new vaccines.

    Polio and Its Eradication in India:

    • About: Polio is a highly infectious viral disease primarily affecting children under 5, potentially causing paralysis or death.
    • Transmission: The disease spreads via the faecal-oral route, mostly through contaminated water or food.
    • Types of Polioviruses:
      • WPV1 still exists in Pakistan and Afghanistan.
      • WPV2 and WPV3 have been eradicated globally.
    • Infection Mechanism: Once inside the body, the virus multiplies in the intestines and may attack the nervous system, causing permanent paralysis.
    • Prevention through Vaccination:
      • Oral Polio Vaccine (OPV) is given at birth, 6, 10, and 14 weeks, with a booster at 16–24 months.
      • Injectable Polio Vaccine (IPV) is administered with the third DPT dose under the Universal Immunization Programme (UIP).
    • Pulse Polio Campaign (1995): India launched the Pulse Polio Immunization Campaign, providing oral polio drops to all children under 5.
    • Eradication Milestones: The last wild polio case in India was reported in 2011, and in 2014, WHO officially declared India polio-free.
    • Role of NPSN: The success was enabled by strong surveillance, mass immunization, and dedicated work by NPSN and its partners.
    [UPSC 2016] ‘Mission Indradhanush’ launched by the Government of India pertains to:

    (a) Immunization of children and pregnant women*

    (b) Construction of smart cities across the country

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

    (d) New Educational Policy

     

  • India’s first ICMR-SCD Stigma Scale 

    Why in the News?

    The Indian Council of Medical Research (ICMR) has developed the ICMR-SCD Stigma Scale for India (ISSSI) to help understand and reduce stigma faced by patients and caregivers from sickle cell disease (SCD).

    What is Sickle Cell Disease (SCD)?

    • Nature of Disease: SCD is a genetic disorder where red blood cells become sickle-shaped, reducing oxygen delivery in the body.
    • Complications: These sickle cells can block blood vessels, break easily, and cause anemia, organ damage, and painful episodes.
    • Cause: The disease is inherited, requiring one defective gene from each parent; one gene leads to sickle cell trait.
    • Symptoms: Common symptoms include fatigue, body pain, swollen limbs, frequent infections, and organ damage.
    • Treatment Options: There is no universal cure, but bone marrow transplants and gene therapy offer potential solutions; supportive care helps manage symptoms.

    Note:

    • Anaemia is a condition where the blood lacks enough healthy red blood cells (RBCs) or haemoglobin.
    • All SCD patients have anaemia, but not all anaemia is due to Sickle Cell Disease.

    About the ICMR-SCD Stigma Scale for India (ISSSI):

    • Purpose: The ISSSI is India’s first tool designed to measure stigma faced by sickle cell disease (SCD) patients and their caregivers.
    • Developing Authority: It was developed by ICMR to understand and address the social impact of SCD in India’s diverse communities.
    • Global Context: This is the fourth stigma scale worldwide and the first validated for Indian conditions.
    • Scientific Validation: The tool was validated in a study published in The Lancet (Regional Health – South-East Asia).
    • Availability: The ISSSI is now approved for use in both clinical and research settings across India.
    • Components: It includes two formats — ISSSI-Pt for patients and ISSSI-Cg for caregivers.
    • Stigma Dimensions: It captures issues related to family expectations, reproductive concerns, social disclosure, illness burden, interpersonal challenges, and negative healthcare experiences.
    • Data Sources: The scale was developed using inputs from 6 culturally diverse districts: Alluri Seetharama Raju, Anuppur, Chhoteudepur, Kandhamal, Mysuru, and Udalguri.

    India’s Strategy: Anaemia Mukt Bharat (AMB)

    • Launch Year: The AMB Mission was launched in 2018 to reduce anemia using a 6x6x6 strategy.
    • Target Groups: It covers six groups — young children, school children, adolescents, women of reproductive age, pregnant women, and lactating mothers.
    • Key Interventions: Actions include iron and folic acid supplements, deworming, nutrition education, digital health tools, IFA-fortified foods, and disease screening (including SCD).
    • Supporting Systems: It is backed by inter-ministerial coordination, state-level units, research centers, the AMB Dashboard, digital tracking, and supply chain support.
    • Reach: The mission aims to impact around 450 million people, focusing on real-time monitoring and last-mile delivery.
    [UPSC 2023] Consider the following statements in the context of interventions being undertaken under Anaemia Mukt Bharat Strategy:

    1. It provides prophylactic calcium supplementation for pre-school children, adolescents and pregnant women. 2. It runs a campaign for delayed cord clamping at the time of child-birth. 3. It provides for periodic deworming to children and adolescents. 4. It addresses non-nutritinoal causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis.

    How many of the statements given above are correct?

    Options: (a) Only one (b) Only two (c) Only three* (d) All four

     

  • Trends in Maternal Mortality (2000-2023), Report

    Why in the News?

    In 2023, India had the second-highest maternal deaths globally, with 19,000 deaths, tied with the Democratic Republic of Congo, and second only to Nigeria. This equated to 52 fatalities daily according to the UN Report.

    Trends in Maternal Mortality (2000-2023), Report

    About the UN Report

    • The report, titled ‘Trends in Maternal Mortality 2000-2023’, was prepared by the World Health Organisation (WHO), UNICEF, UN Population Fund, World Bank, and the UN Department of Economic and Social Affairs (population division).
    • It provides global data on maternal mortality and highlights the countries with the highest rates of maternal deaths.

    Note:

    • Maternal Mortality refers to the death of a woman during pregnancy, childbirth, or within 42 days after delivery, due to complications related to pregnancy or childbirth, as per WHO.
    • Maternal Mortality Ratio (MMR) refers to the number of maternal deaths per 100,000 live births in a given time period, usually over a year.

    Key Highlights of the Report:

    • Nigeria had the highest number of maternal deaths with 75,000 deaths, accounting for 28.7% of global deaths in 2023.
    • The top four countries (India, Nigeria, DRC, Pakistan) accounted for 47% of global maternal deaths.
    • Despite a population similar to India, China had only 1,400 maternal deaths in 2023.
    • Maternal mortality globally declined by 40% between 2000 and 2023, due to improved healthcare access.
    • COVID-19 caused an additional 40,000 maternal deaths in 2021 due to service disruptions.
    • The global MMR remained high, with 260,000 maternal deaths in 2023, one death every two minutes.

    India’s Progress in Reducing Maternal Mortality:

    • India’s MMR declined by 78% from 362 in 2000 to 80 in 2023 (NFHS 2019-21).
    • Institutional deliveries increased from 79% in 2015-16 to 89% in 2019-21, with Kerala achieving 100%.
    • Eight states (including Kerala, Maharashtra, Telangana, Tamil Nadu) reduced MMR to below the SDG target of 70 per 100,000 live births.

    Various Schemes for Maternal Health in India:

    Scheme  Launched Objective Notable Features Target Beneficiaries
    Janani Suraksha Yojana (JSY) 2005 To reduce maternal and neonatal mortality by promoting institutional deliveries. Cash incentives, Focus on rural areas, Increased access to institutional deliveries. Pregnant women from poor socio-economic backgrounds.
    Pradhan Mantri Matru Vandana Yojana (PMMVY) 2017 To provide maternity benefits and promote institutional deliveries. Cash benefit of ₹5,000 for the first child, Additional incentives for girl child under PMMVY 2.0. Women pregnant with their first child after 01.01.2017.
    Janani Shishu Suraksha Karyakaram (JSSK) 2011 To eliminate out-of-pocket expenses for pregnant women and sick infants. Free delivery services, Free transport, Free post-delivery services. Pregnant women and sick infants in public health institutions.
    Surakshit Matritva Aashwasan (SUMAN) 2019 To provide assured, dignified, and quality healthcare at no cost. Zero denial policy, Quality of care, Focus on respectful care. All pregnant women and newborns visiting public health institutions.
    LaQshya 2017 To improve the quality of care in labor rooms and maternity operation theatres. Focus on improving infrastructure, Monitoring and evaluation, Quality assurance. Pregnant women receiving care in labor rooms and maternity OT.

     

    [UPSC 2023] Consider the following statements in relation to Janani Suraksha Yojna:

    1. It is safe motherhood intervention of the State Health Departments.

    2. Its objective is to reduce maternal and neonatal mortality among poor pregnant women.

    3. It aims to promote institutional delivery among poor pregnant women.

    Select the correct answer using the code given below:

    (a) 1 and 2 only (b) 2, 3 and 4 only (c) 1, 3 and 4 only (d) 1, 2, 3 and 4

     

  • Central Sector Scheme for Promotion of International Cooperation for AYUSH 

    Why in the News?

    The Ministry of Ayush is implementing the Central Sector Scheme for Promotion of International Cooperation for AYUSH to enhance global recognition and development of AYUSH systems, including Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy.

    About the Scheme

    • The scheme focuses on promoting AYUSH systems internationally, contributing to their global growth.
    • The scheme is announced on the AYUSH website, and applications are invited through open advertisements.
    • Proposals are screened by a committee and approved for financial assistance based on needs and activity limits.
    • Key Components of the Scheme:
      1. International Exchange of Experts & Officers: Facilitates deputation of AYUSH experts for international conferences and training.
      2. Incentives for Drug Manufacturers: Provides financial support for international propagation and product registration.
      3. Market Development Support: Supports exhibitions, conferences, and market surveys for international market development.
      4. Promotion through Young Postgraduates: Deploys young postgraduates to promote AYUSH abroad through NGOs.
      5. Translation and Publication: Funds the translation and publication of AYUSH literature in foreign languages.
      6. AYUSH Information Cells/Health Centres: Establishes AYUSH cells and health centers in foreign countries through Indian missions.
      7. International Fellowship Programme: Offers fellowships to foreign nationals to study AYUSH courses in India.

    Significance of Yoga and AYUSH in India’s International Outreach

    • The International Day of Yoga (IDY) was declared by the United Nations in 2014, with ₹161 crore spent on its promotion. IDY celebrations spread Yoga’s global message.
    • Yoga is now part of the National Curriculum Framework (NCF), making it compulsory for students from Class I to Class X.
    • The Yoga Certification Board (YCB) under the Ministry of Ayush certifies yoga professionals and accredits institutions, ensuring quality and standards in Yoga practice.
    • The Ministry of Ayush has signed 24 Country-to-Country MoUs and 51 Institute-to-Institute MoUs to promote Indian traditional medicine systems globally.

  • Health Expenditure at 1.84% of GDP

    Why in the News?

    The Union government has steadily increased its spending on healthcare, with the expenditure rising to 1.84% of GDP in 2021-22, up from 1.15% in 2013-14.

    Overview of India’s Health Expenditure

    • India has shown a consistent increase in government spending on healthcare, reflecting a growing commitment to improving the public healthcare system.
    • As of 2021-22, government health expenditure (GHE) rose to 1.84% of GDP, up from 1.15% in 2013-14, and is on track to meet the National Health Policy 2017 target of 2.5% of GDP by 2025.
    • The rise in health expenditure has been particularly significant post–COVID-19, with a 37% increase in government spending from 2020-21 to 2021-22.
    • This has led to better healthcare accessibility, reduced financial burden on individuals, and greater focus on strengthening healthcare infrastructure.

    What is Total Health Expenditure?

    • Total Health Expenditure (THE) refers to the sum of all current and capital expenditures incurred by the government, private sector, and external sources for healthcare purposes in a given period.
    • This includes:
      • Current Health Expenditure (CHE): Ongoing spending on healthcare services, such as hospitals, doctor visits, and medical supplies.
      • Capital Expenditure: Investments in healthcare infrastructure, such as building hospitals or purchasing medical equipment.
    • In 2020-21, India’s THE was estimated at ₹7,39,327 crores, constituting 3.73% of GDP, with a per capita expenditure of ₹5,436.
    • In 2021-22, this figure increased to ₹9,04,461 crores, representing 3.83% of GDP, reflecting a proactive government response to healthcare challenges and pandemic management.

    Reasons for Reduced Out-of-Pocket Expenditure (OOPE)

    The reduction in OOPE can be attributed to:

    • Increased government health spending, making healthcare more affordable.
    • Expansion of public health services, including vaccination and preventive care.
    • Growth in government-funded health insurance and social security programs, reducing reliance on personal funds.
    • Health initiatives like Ayushman Bharat have eased the financial burden.
    • Improved public healthcare access and financial protection have reduced hardship for low- and middle-income families.

    PYQ:

    [2021] “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

     

  • [12th March 2025] The Hindu Op-ed: Building compassion into the health-care structure 

    PYQ Relevance:

    Q)  Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC CSE 2021)

     

    Mentor’s Comment: UPSC mains have always focused on the moral imperative of a Welfare State, primary health structure (2021) and Appropriate local community-level healthcare intervention (2018).

    On February 7, 2025, the WHO released the “Compassion and Primary Health Care” report, emphasizing compassion as a transformative force in health care. Based on my interactions with medical pioneers and global advocacy efforts, including the 74th World Health Assembly, I am encouraged to see growing recognition of compassion’s vital role in improving health care worldwide.

    Today’s editorial highlights the importance of compassionate health care, offering valuable insights for GS Papers, particularly in policy-making and ethics discussions.

    _

    Let’s learn!

    Why in the News?

    Compassionate health care should guide the actions of industry leaders, hospitals, and health-care organizations.

    What is the key message of the WHO report “Compassion and Primary Health Care”?

    • Compassion as a Transformative Force: The report highlights compassion as a core value in improving primary health care outcomes. Example: A cancer patient’s recovery improves significantly when doctors spend an extra 40 seconds expressing support, as found in a Johns Hopkins study.
    • Improved Patient Outcomes through Compassion: Compassionate care leads to faster recovery, shorter hospital stays, and reduced patient anxiety.Example: Stanford University’s CCARE research found that patients treated with compassion experience quicker healing and fewer complications.
    • Benefits for Health-Care Providers: Compassion reduces stress, prevents burnout, and increases job satisfaction for medical professionals. Example: Nurses who engage in compassionate care report stronger patient relationships and improved emotional well-being.
    • Distinguishing Compassion from Empathy and Sympathy: Compassion involves mindful problem-solving while maintaining emotional stability, unlike empathy, which may cause emotional fatigue. Example: A compassionate doctor can acknowledge a patient’s suffering while staying emotionally balanced to provide sustained care.
    • Global Call for Compassionate Health Systems: The report urges policymakers to integrate compassion into health systems and decision-making processes. Example: The WHO calls for training programs to equip health workers with compassionate communication skills across nations.

    Why is compassion considered beneficial for both patients and health-care providers?

    • Faster Recovery and Better Patient Outcomes: Compassionate care leads to quicker recovery, reduced pain, and shorter hospital stays for patients. Example: A Johns Hopkins study found that when doctors express solidarity (e.g., saying, “We are in this together”), patient anxiety decreases, improving their healing process.
    • Enhanced Patient Trust and Satisfaction: Patients feel heard, valued, and safe when treated with compassion, which strengthens their trust in the healthcare system. Example: Cancer patients who receive compassionate communication are more compliant with treatment and express higher satisfaction with care.
    • Reduced Stress and Burnout for Health-Care Providers: Compassion reduces emotional exhaustion and prevents burnout by fostering emotional resilience. Example: Nurses trained in compassionate care report lower stress levels and improved emotional well-being.
    • Stronger Patient-Provider Relationships: Compassion fosters deeper connections, improving communication and shared decision-making between patients and healthcare providers. Example: Physicians who practice compassionate care build long-term patient trust, leading to better health outcomes and loyalty.
    • Increased Job Satisfaction and Professional Fulfillment: Compassion enhances job satisfaction by giving healthcare providers a sense of purpose and fulfillment. Example: Doctors who engage in compassionate interactions report feeling more connected to their profession and experience greater personal reward.

    How does compassion differ from sympathy, empathy, and kindness in the context of health care?

    • Compassion: Compassion is the ability to recognize a patient’s suffering and actively take steps to alleviate it. It involves an emotional connection combined with a willingness to help. Example: A nurse notices that a terminally ill patient is in pain despite receiving standard treatment. She advocates for a change in medication to improve the patient’s comfort while offering emotional support to the family.
    • Sympathy: Sympathy is feeling sorrow or concern for someone’s suffering but without deeply sharing their emotional experience. Example: A doctor expresses condolences to a patient’s family after delivering bad news but does not necessarily feel the pain personally.
    • Empathy: Empathy is the ability to understand and share the feelings of another person by mentally putting oneself in their position. Example: A physician listens to a patient with chronic pain, acknowledges the emotional toll, and adjusts treatment plans accordingly while providing reassurance.

    What are the steps taken by the government? 

    • Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides free health coverage to economically vulnerable families. Example: Over 50 crore beneficiaries are eligible for ₹5 lakh annual health coverage per family for secondary and tertiary care, reducing financial burdens and ensuring accessible healthcare.
    • National Health Mission (NHM): Strengthens rural and urban healthcare infrastructure and ensures equitable healthcare access. Example: Under NHM, initiatives like Janani Shishu Suraksha Karyakram (JSSK) provide free maternal care during pregnancy, delivery, and postnatal services, ensuring compassionate care for mothers and newborns.
    • Tele-MANAS (Tele Mental Health Assistance and Networking Across States): Provides free tele-mental health services to address rising mental health concerns. Example: Launched in 2022, this initiative provides 24/7 mental health support, helping patients access timely counseling and care, especially in rural areas.
    • Pradhan Mantri National Dialysis Program (PMNDP): Provides free dialysis services to patients with chronic kidney disease. Example: More than 12 lakh dialysis sessions are provided annually across 800+ districts, reducing the financial and emotional stress on patients and their families.
    • Health and Wellness Centers (HWCs): Deliver comprehensive primary healthcare closer to communities. Example: Over 1.6 lakh HWCs have been established nationwide, offering preventive care, maternal health services, and non-communicable disease screenings, fostering compassionate and inclusive healthcare.

    Way forward: 

    • Integrate Compassion Training in Medical Education: Include structured programs to develop compassionate communication and patient-centered care skills for all healthcare professionals, ensuring empathy and emotional resilience.
    • Strengthen Policy Frameworks for Compassionate Care: Implement guidelines that prioritize compassion in healthcare delivery, with regular assessments and incentives to encourage patient-centered, humane practices across public health systems.

  • [8th March 2025] The Hindu Op-ed: What ails Pre-Clinical PG Courses?

    PYQ Relevance:

    Q) Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC CSE 2018)

     

    Mentor’s Comment: UPSC mains have always focused on the ‘Health for All’ (2018) and primary health structure is a necessary precondition (2021).

    No students enrolled in postgraduate (PG) medical pre-clinical courses like anatomy, biochemistry, physiology, forensic medicine, microbiology, and pharmacology at Vydehi Institute of Medical Sciences and Research Centre (VIMS), Bengaluru, until the second round of PG-NEET counselling.

    Today’s editorial discusses the issues related to postgraduate medical seats. This content would help in GS Paper 2 and 3 in the mains paper.

    _

    Let’s learn!

    Why in the News?

    Many postgraduate medical seats are vacant this year because students are choosing pre-clinical courses.

    Why are postgraduate medical students reluctant to choose pre-clinical courses in Karnataka?

    • Lack of Job Opportunities: Pre-clinical graduates cannot practice as doctors and are limited to working in laboratories, diagnostic centers, or as faculty. Example: Despite reducing tuition fees and offering job guarantees, private institutions like the Vydehi Institute of Medical Sciences struggle to fill pre-clinical seats due to limited employment avenues.
    • Lower Salary Compared to Clinical Courses: Pre-clinical roles offer significantly lower remuneration than clinical practice, making them financially unattractive. Example: A clinical doctor can earn a higher salary working in hospitals or private practice, while pre-clinical graduates face salary stagnation in academic or lab-based roles.
    • Limited Career Progression and Mobility: Clinical course graduates have the flexibility to work globally and in various healthcare sectors, while pre-clinical graduates are restricted to teaching or research roles. Example: An MD in General Medicine can practice as a physician anywhere, whereas an MD in Anatomy primarily qualifies for academic positions.
    • High Capital Requirement for Self-Employment: Establishing independent diagnostic centers requires significant investment, which deters pre-clinical graduates from entrepreneurial ventures. Example: Diagnostic centers with advanced technology demand substantial startup costs, making it challenging for pre-clinical graduates to become self-employed.
    • Persistent Seat Vacancies Reflect Low Demand: Consistent under-enrollment over the years signals a long-term disinterest in these courses. Example: In 2024-25, only 6 out of 104 MD Anatomy seats were filled in Karnataka, despite five rounds of counselling and reduced cut-off percentages.

    What is the trend of student enrollment in PG medical courses at the all-India level?

    • Substantial Increase in PG Medical Seats: The number of PG medical seats has risen from 31,185 before 2014 to 70,645 by the 2023-24 academic year, marking a 127% increase.
    • Growth in Medical Colleges: The total number of medical colleges has expanded by 82%, from 387 before 2014 to 704 in 2023. This expansion has contributed to the increased availability of both undergraduate (UG) and PG medical seats.
    • Rising Demand for Medical Education: The number of candidates aspiring to study MBBS grew from 16 lakh in 2019 to 24 lakh in 2024, reflecting a heightened interest in medical education.
    • Improved UG to PG Seat Ratio: The ratio of UG to PG medical seats improved from 2.1:1 in 2018-19 to 1.9:1 in 2022-23, indicating better alignment between the number of medical graduates and available PG training opportunities.
    • Emerging Challenges: Despite the increase in seats, challenges such as geographic disparities in seat distribution and concerns about the quality of education persist.
      • For example,  Karnataka has the highest number of PG medical seats, totaling 5,984, with a significant contribution from private institutions, but States like Arunachal Pradesh, Dadra and Nagar Haveli, Mizoram, and Nagaland currently do not offer PG medical seats.

    What is the significance of pre-clinical courses? 

    • Foundation for Advanced Medical Practice: Pre-clinical courses (Anatomy, Physiology, Biochemistry) provide the scientific basis for understanding human biology and disease mechanisms. Example: The COVID-19 pandemic highlighted the importance of biochemistry in vaccine development and understanding viral behavior.
    • Essential for Medical Education and Training: These courses are crucial for training future doctors, ensuring they understand the human body before clinical practice. Example: Medical schools worldwide adopted virtual anatomy labs during the pandemic, enhancing remote learning and maintaining education continuity.
    • Innovation in Diagnostic and Therapeutic Techniques: Pre-clinical research drives advancements in diagnostic tools and medical treatments. Example: Advances in physiology have contributed to wearable health devices like continuous glucose monitors for diabetic patients.

    How has the National Medical Commission (NMC) addressed the issue of unfilled PG medical seats in Karnataka?

    • Reduction of NEET-PG Cut-off Scores: In an unprecedented move, the NEET-PG 2023 cut-off was reduced to zero, making all candidates who appeared for the exam eligible for PG medical programs. This decision aimed to expand the pool of eligible candidates and fill vacant seats across various specialties.
    • Guidelines for Interstate Posting Under District Residency Programme: The NMC issued directives emphasizing strict adherence to the Post-Graduate Medical Education Regulations, 2023.
      • These guidelines facilitate the interstate posting of PG medical students under the District Residency Programme, ensuring a more even distribution of medical professionals and addressing regional disparities in seat occupancy.
    • Monitoring and Rectifying Seat Allocation Discrepancies: The NMC has been proactive in addressing discrepancies between its records and those of state authorities. For instance, admissions to 23 PG medical seats in Bengaluru were put on hold due to mismatches between NMC and Directorate of Medical Education (DME) lists. Such actions ensure that seat allocations are transparent and accurate.
    • Annual Increase of PG Seats: The NMC has facilitated the process for medical institutions to apply for an increase in PG seats for the academic year 2025-26. By inviting applications and setting clear guidelines, the commission aims to enhance the availability of PG medical seats, thereby reducing the likelihood of vacancies.

    Way forward: 

    • Enhance Pre-Clinical Career Prospects: Introduce incentives like research grants, industry collaborations, and fellowship programs to improve career progression and salary prospects for pre-clinical graduates.
    • Targeted Seat Distribution and Quality Monitoring: Implement region-specific seat allocation policies and strengthen regulatory oversight to ensure quality education and equitable access across underserved states.