An Extended Pradhan Mantri Surakshit Matritva Abhiyan (E-PMSMA) strategy was launched to ensure quality Antenatal Care (ANC) for pregnant women.
The strategy focuses on individual tracking of high-risk pregnancies (HRP) and provision of additionalPMSMA sessions beyond the 9th of every month.
AboutHigh-Risk Pregnancy:
A high-risk pregnancy involves greater risk of health complications for the mother, the foetus, or both, due to pre-existing medical conditions, conditions that develop during pregnancy, or foetal issues.
Common Factors:
Maternal Health Conditions: Pre-existing diabetes, hypertension, HIV, kidney disease, or conditions arising during pregnancy like gestational diabetes and preeclampsia.
Obstetric Factors: Previous caesarean section, history of preterm labor, multiple pregnancies, and congenital malformations.
About Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
Details
About
An initiative to provide quality antenatal care (ANC) to all pregnant women.
Launch
October 2016
Target Group
All pregnant women, especially those in their second and third trimesters.
Frequency
Services provided on the 9th of every month at government health facilities.
Objective
Ensure safe motherhood by providing comprehensive and quality antenatal care universally.
Key Functions
General Check-Up: Physical and clinical examinations by medical professionals.
Laboratory Investigations: Routine blood tests, urine tests, and other necessary laboratory investigations.
Ultrasound: Ultrasound examination to monitor foetal growth and development.
Counseling: Nutritional and lifestyle counseling to ensure a healthy pregnancy.
High-Risk Identification: Screening and identification of high-risk pregnancies and appropriate referrals for specialized care.
Key Features
Free of Cost: All services under PMSMA are provided free of cost.
Fixed Day ANC Services: Antenatal care services are provided on a fixed day every month.
Lab Investigations: Basic investigations like Hb, urine albumin, RBS, malaria test, VDRL test, blood grouping, CBC, ESR, and USG.
Public-Private Partnership: Encourages participation of private sector healthcare providers in providing ANC services.
Incentives: Incentives for healthcare providers who participate in the program.
Categorization of Pregnant Women
Green Sticker – for women with no risk factor detected
Red Sticker – for women with high risk pregnancy
BlueSticker – for women with Pregnancy Induced Hypertension
YellowSticker – pregnancy with co-morbid conditions such as diabetes, hypothyroidism, STIs
Benefits
Improved Maternal Health: Regular and comprehensive ANC helps in early detection and management of complications, improving maternal health outcomes.
Reduced Mortality Rates: Timely and quality care reduces maternal and infant mortality rates.
Health Education: Provides health education and counseling to pregnant women, promoting better health practices.
High-Risk Management: Identifies and manages high-risk pregnancies effectively, ensuring specialized care for those who need it.
PYQ:
[2024] With reference to the ‘Pradhan Mantri Surakshit Matritva Abhiyan’, consider the following statements:
1. This scheme guarantees a minimum package of antenatal care services to women in their second and third trimesters of pregnancy and six months post-delivery health care service in any government health facility.
2. Under this scheme, private sector health care providers of certain specialities can volunteer to provide services at nearby government health facilities.
Which of the statements given above is/are correct?
Q1 COVID-19 pandemic has caused unprecedented devastation worldwide. However, technological advancements are being availed readily to win over the crisis. Give an account of how technology was sought to aid the management of the pandemic. (UPSC IAS/2020)
Q2 Critically examine the role of WHO in providing global health security during the Covid-19 pandemic. (UPSC IAS/2020)
Note4Students:
Mains: Reasons behind the disagreement on the Pandemic Treaty;
Mentor comments: Despite extensive negotiations, 194 WHO member states failed to finalize a historic Pandemic Agreement to bolster global pandemic preparedness and reduce inequities highlighted by COVID-19. At the 77th World Health Assembly (May 27-June 1, 2024), two significant developments occurred. First, amendments to the International Health Regulations (IHR) 2005 were agreed upon, drawn from 300 global reform proposals. These amendments aim to improve response to Public Health Emergencies of International Concern (PHEIC) and introduce a Pandemic Emergency (PE) category, ensuring equitable access to health products and financial support for developing countries, emphasizing solidarity and equity, and mandating a National IHR Authority.
Let’s learn!
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Why in the News?
The 77th World Health Assembly in May 2024 failed to finalize the treaty due to disagreements on key articles, particularly PABS, technology transfer, and the One Health approach.
Background:
The COVID-19 pandemic exposed severe limitations in the International Health Regulations (IHR) and the WHO’s institutional capacities to effectively prevent, prepare for and respond to global health emergencies.
In light of the pandemic’s devastating global impact, many countries called for a stronger international framework to deal with future pandemics.
Responding to these calls, a special session of the World Health Assembly (WHA) in November 2021 agreed to establish an intergovernmental negotiating body (INB) to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response
What is the Pandemic Treaty?
The Pandemic Treaty, also known as the International Treaty on Pandemic Prevention, Preparedness and Response, is a proposed international agreement currently being negotiated by the 194 member states of the World Health Organization (WHO).
Key Provisions
Pathogen Access and Benefit Sharing (PABS): The treaty aims to establish a PABS system to ensure that genetic resources and pathogen samples shared from developing countries are reciprocated with corresponding benefits, such as vaccines and diagnostics.
Technology Transfer and Intellectual Property: The treaty seeks to address issues related to technology transfer, local production, and intellectual property rights to enhance the manufacturing capacities of low- and middle-income countries.
One Health Approach: The treaty emphasizes a holistic approach that recognizes the interconnections between human, animal, and environmental health, promoting coordinated public health measures across these domains.
Reasons behind the disagreement
Pathogen Access and Benefit Sharing (PABS): The PABS mechanism under Article 12 is a central point of contention, with low- and middle-income countries (LMICs) advocating for guaranteed access to at least 20% of shared pandemic products.
In contrast, many high-income countries argue that this percentage should be the maximum limit, with some refusing to agree to any fixed percentage.
Technology Transfer and Intellectual Property: Disagreements over technology transfer provisions are significant, with LMICs pushing for mandatory technology transfer and intellectual property waivers to enable local production of vaccines and treatments.
High-income countries prefer voluntary agreements, fearing that mandatory requirements could undermine their intellectual property rights.
One Health Approach: The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, has faced resistance from LMICs. They view it as an additional burden without adequate funding, while high-income countries strongly support it.
Geopolitical Discord: Geopolitical tensions and competing interests between higher- and lower-income countries have hindered progress in negotiations.
Misinformation and Distrust: The negotiations have been affected by misinformation, skepticism, and distrust among member states. Some countries are concerned about the implications of the agreement on their national sovereignty and public health policies.
Urgency vs. Comprehensive Solutions: There is a tension between the urgency to finalize an agreement and the desire to address complex issues comprehensively. Some countries are pushing for quick resolutions, while others emphasize the need for thorough discussions to ensure long-term effectiveness.
Way forward:
Promote Inclusive Dialogue and Mutual Compromise: Need to facilitate continuous, transparent dialogue among all member states to address concerns and build trust. Encourage mutual compromise by balancing the interests of both high- and low-income countries, ensuring that all parties feel their needs and perspectives are being considered.
Strengthen Financial and Technical Support for LMICs: Need to enhance financial and technical assistance for low- and middle-income countries to implement the proposed treaty provisions effectively.
PYQ Relevance: Mains: Q1 Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest?(UPSC IAS/2015) Q2 What do you understand by nanotechnology and how is it helping in health sector? (UPSC IAS/2020)
Prelims: Q Doctors Without Borders (Medecins Sans Frontieres)’, often in the news, is: (a) a division of World Health Organization (b) a non-governmental international organization (c) an inter-governmental agency sponsored by European Union (d) a specialized agency of the United Nations
Note4Students:
Mains:Challenges related to Homeless individuals;
Mentor comments: Socio-normative representations of homeless persons living with mental illness (HPMI) often depict them as refuge seekers, leading to interventions focused on transferring them to mental hospitals or shelters. This perspective assumes that displacement from the streets is necessary due to associated risks, which, while valid, oversimplifies their complex realities. Such representations result in coercive measures that fail to recognise the agency of HPMI, perpetuating a cycle of institutionalization rather than fostering genuine community reintegration and support. Addressing these representations is crucial for developing more effective and respectful care strategies.
Let’s learn!
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Why in the News?
Homeless individuals with mental illness are often viewed as needing rescue, leading to their forced relocation to hospitals or shelters, despite the debatable risks of street living.
Efforts at Integration
Collaborative Initiatives in India: The collaboration among various organizations, including the National Health Mission and local civil society groups, has facilitated access to emergency care and recovery centers (ECRCs) in district hospitals, improving support for homeless persons with mental illness (HPMI).
Breaking Down Asylum Models: The integration of services aims to dismantle the traditional asylum model, which often perpetuates negative stereotypes about mental illness, by providing more immediate and localized care.
Last-Mile Proximal Care: The establishment of ECRCs ensures that care reaches individuals in scattered geographies, addressing the immediate needs of those experiencing crises.
Transformative Care Models: Thefocus on smaller care units that are adequately staffed emphasizes personal attention and the management of comorbidities, which is essential for those facing prolonged adversities.
Problems with institutional spaces:
Long-Term Custodial Care: Approximately 37% of individuals in state psychiatric facilities have long-term needs, with many having histories of homelessness. The median duration of stay is six years, indicating a reliance on institutional care rather than effective community reintegration.
According to the World Health Organization, mental disorders account for 10.6% of total disability among older adults.
Rigid Discharge Criteria: Discharge criteria for individuals in psychiatric facilities are often overly simplistic, leading to inadequate support for those transitioning back to community life.
Isolation from Social Resources: Institutional settings create barriers to accessing social resources and community participation, leading to social isolation and a lower quality of life.
Mental Health America reports that over half (54.7%) of adults with mental illness do not receive treatment, often due to such barriers.
Ineffective Rehabilitation Models: Current rehabilitation models often default to custodial care, failing to promote innovative, community-based solutions.
Initiatives like Housing First and the ‘Home Again’ collaborative in India demonstrate the feasibility of comprehensive social and clinical care, yet traditional models continue to limit the potential for improved outcomes for individuals with mental health challenges.
Way forward:
Shift from Paternalistic to Liberatory Strategies: The need to take social protection measures for homeless people with mental illness (HPMI) must transition from paternalistic interventions to liberatory-focused strategies that honour individual agency.
This includes implementing a modest monthly disability allowance of ₹1,500 to provide financial support while addressing bureaucratic barriers to accessing essential documentation like Aadhar and banking services.
Holistic and Imaginative Approaches: Supportive measures must be complemented by imaginative and holistic strategies that address structural issues such as discrimination, violence, and social segregation.
With the worst of the COVID-19 pandemic behind us (though the World Health Organization warns the virus still lingers), the Union Budget shifted focus to economic growth levers like infrastructure and employment.
It was also hoped that recognizing population health as crucial for economic growth would lead to continued investment in strengthening health systems.
A budget estimate refers to the initial allocation of funds designated for various programs, departments, or projects within a fiscal year. It represents the government’s expectations regarding how much money will be required to meet planned expenditures.
In contrast, revised estimates come into play later in the fiscal year. After assessing the actual expenditures and needs after the first six months, the government may adjust the initial budget estimates based on how much of the allocated funds have been utilised and what additional resources may be necessary.
Comparisons with Previous Years
Budgetary Estimates: The comparison of the Budget Estimates (BE) for health between 2023-24 and 2025-25, reveals minimal increases:
Overall Health Ministry Budget: 1.98% increase
National Health Mission (NHM): 1.16% increase
PMJAY: 1.4% increase
Overall Health Ministry budget: The present allocation made in the current Budget is deemed to be inadequate for expanding health coverage services and enhancing the impact of flagship health programs, particularly in light of rising non-communicable diseases and the goal of universal health coverage by 2030.
Misleading Comparisons: When we compare the Budget estimates with the previous Revised estimates (RE) the budgetary increase of nearly 12% is misleading, as the RE reflects actual spending rather than the program’s needs.
Missed Opportunities
Health Workforce Development: While the budget mentioned an increase in new medical colleges, it failed to address the critical need for a multi-layered, multi-skilled health workforce.
Drug Pricing Mechanisms: Although customs duties were waived on three anti-cancer drugs. However, the budget missed the chance to implement price controls and pooled procurement strategies that could have lowered drug costs across both public and private healthcare sectors. Establishing such mechanisms could enhance the affordability and accessibility of essential medications.
Climate-Resilient Agriculture: While the budget committed to climate-resilient agriculture, which is crucial for food security, it did not sufficiently link these efforts to health outcomes, such as nutrition and public health, which are critical in the context of rising health challenges.
Limited Coverage of Middle Class: PMJAY primarily targets the bottom 40% of the population based on economic status, leaving the middle class without coverage.
Focus on Secondary and Tertiary Care: The program emphasizes secondary and tertiary healthcare, often neglecting primary care services. This approach limits comprehensive health coverage and fails to address preventive healthcare needs, which are crucial for achieving UHC.
Awareness and Accessibility Issues: There is a significant disparity in awareness and accessibility of PMJAY across states.
For example, awareness is notably higher in Tamil Nadu (80%) compared to Bihar (20%).
Way forward:
Targeted Funding for Flagship Programs: Need to allocate a more substantial increase in the budget for the National Health Mission (NHM) and Pradhan Mantri Jan Arogya Yojana (PMJAY) to the eradication of non-communicable diseases, tuberculosis elimination by 2025.
Strengthen Primary Healthcare: Govt. should ensure adequate funding for primary healthcare services, which form the foundation for preventive and community health initiatives.
Mains PYQ:
Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (2015)
In May, a speeding car, allegedly driven by a teenager, resulted in the deaths of two young techies in Pune.
The Juvenile Justice Board (JJB) initially granted the minor bail on conditions like writing a 300-word essay on road safety. This decision sparked public outrage and criticism from the Maharashtra Deputy CM.
Later, the JJB canceled the minor’s bail and sent him to an observation home, which was again challenged in the Bombay High Court.
The Bombay High Court eventually ordered the release of the minor, stating that the JJB’s remand order was illegal and that the minor should be in the care of his paternal aunt as per the Juvenile Justice Act.
What were the provisions led under the previous Juvenile Justice (Care and Protection of Children) Act of 2015?
Definitions:
Section 2 defines a “child” as a person below the age of 18 years.
Section 2(13) defines “children in conflict with law” as those who are alleged or found to have committed an offence.
Section 2(14) defines “children in need of care and protection” as those meeting certain criteria, such as being homeless, engaged in illegal labour, victims of abuse, etc.
Juvenile Justice Boards (JJBs):
Section 4 mandates the establishment of Juvenile Justice Boards in each district.
Section 4(2) states that the JJBs shall comprise a Metropolitan Magistrate or a Judicial Magistrate of the First Class and two social workers.
Section 8 outlines the powers and functions of the JJBs in handling cases related to children in conflict with the law.
Child Welfare Committees (CWCs):
Section 27 requires the establishment of Child Welfare Committees in each district.
Section 28 defines the composition and functions of the CWCs in the care, protection, treatment, development, and rehabilitation of children in need of care and protection.
Adoption Procedures:
Chapter VIII (Sections 56-65) provides a comprehensive adoption regime, including the establishment of the Central Adoption Resource Authority (CARA).
Sections 56-65 outline the adoption procedures and ensure transparency and accountability.
Rehabilitation and Social Reintegration:
Section 39 emphasizes the rehabilitation and social reintegration of children in conflict with the law through various measures, including counseling, education, skill development, and community-based programs.
Preliminary Assessment for Heinous Offences:
Section 15 mandates a preliminary assessment by the JJB to determine if a child in the age group of 16-18 years accused of committing a heinous offence should be tried as an adult.
Children’s Court:
Section 19 provides for the establishment of a Children’s Court to try children in the age group of 16-18 years accused of committing heinous offences.
Mandatory Reporting:
Section 19(1) makes it mandatory to report the presence of a child in need of care and protection to the authorities, and failure to do so is a punishable offence.
Registration of Child Care Institutions:
Section 41 requires all childcare institutions, whether run by the government or NGOs, to be registered within six months of the commencement of the Act.
Penalties:
Chapter XI (Sections 75-85) prescribes penalties for various offences, including the non-registration of childcare institutions and the sale and procurement of children.
Amendment in 2021
Empowering District Magistrates: The amendment authorized District Magistrates, including Additional District Magistrates, to issue adoption orders under Section 61 to ensure speedy disposal of cases and enhance accountability.
Strengthening Child Welfare Committees (CWCs): The eligibility parameters for the appointment of CWC members were redefined, and criteria for disqualification were introduced under Section 28 to ensure that only competent and capable individuals were appointed.
Categorization of Offences: The amendment categorized offences where the maximum sentence is more than 7 years imprisonment but no minimum sentence is prescribed or the minimum sentence is less than 7 years as “serious offences” under Section 2(54).
Addressing Implementation Challenges: The amendment introduced changes to remove difficulties arising in the interpretation of various provisions of the Act and to clarify the scope of certain provisions.
Need for Accountability:
Promoting Justice and Fairness: Accountability ensures that juvenile offenders are held responsible for their actions in a manner that aligns with principles of justice and fairness.
Preventing Recidivism and Ensuring Rehabilitation: Holding juvenile offenders accountable helps in addressing underlying issues that contribute to their offending behaviour.
Maintaining Public Confidence and Trust: Accountability in the juvenile justice system enhances public confidence in the legal process and ensures transparency in decision-making.
Conclusion: Implement comprehensive rehabilitation programs that are tailored to the individual needs of juvenile offenders, focusing on mental health support, educational opportunities, vocational training, and family reintegration.
Mains PYQ:
Q Examine the main provisions of the National Child Policy and throw light on the status of its implementation. (2016)
Recent discourse suggests HPV vaccination prevents cervical cancer, but evidence linking HPV to cancer is inconclusive and most infected individuals don’t develop cancer, raising doubts about vaccine necessity.
What is Cervical Cancer?
Cervical cancer is a type of cancer that starts in the cells lining the cervix, which is the lower part of the uterus that connects to the vagina. It is usually a slow-growing cancer that may not have symptoms in its early stages.
Present trends of cervical cancer prevalence in India and the Globe
Global Trends: Cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths reported in 2020.
Mortality rates vary widely by region, with the highest rates observed in low- and middle-income countries due to limited access to screening and treatment.
Trends in India: In India, cervical cancer is the second most common cancer among women aged 15-44 years. It accounts for approximately 17% of all female cancer deaths in the country, with over 97,000 new cases reported annually.
Recent debate – How does vaccination against HPV prevent cervical cancer and consequent death?
Efficacy Against HPV Infection and Cervical Cancer: HPV vaccines target high-risk HPV types, notably types 16 and 18, which are responsible for a significant proportion of cervical cancer cases worldwide.
Clinical trials and real-world data consistently demonstrate the effectiveness of HPV vaccines in reducing HPV infection rates and preventing cervical cancer.
Public Health Impact and Benefits: Countries with high HPV vaccination coverage have observed significant declines in HPV infection rates and cervical cancer incidence among vaccinated populations.
Vaccination programs aim to achieve herd immunity, thereby reducing overall transmission of HPV and protecting unvaccinated individuals.
Debate and Challenges: Debate surrounds the universal versus selective vaccination strategies, with considerations on cost-effectiveness, accessibility, and cultural acceptance.
Challenges include vaccine hesitancy, particularly in some regions, as well as affordability and logistical barriers to widespread vaccination coverage.
Challenges Prevalent in Vaccine Manufacturing
Complex Manufacturing Processes: Vaccine manufacturing involves complex biological processes and stringent quality control measures.
Developing and scaling up production requires specialized facilities and skilled personnel, which can be costly and time-consuming to establish.
High Regulatory Standards: Vaccines are subject to rigorous regulatory scrutiny to ensure safety, efficacy, and consistency.
Meeting regulatory requirements in multiple jurisdictions adds complexity and may delay the approval and market entry of new vaccines.
Supply Chain and Distribution: Maintaining a reliable supply chain for vaccine components and ensuring cold chain storage and distribution are critical challenges.
This becomes even more pronounced in resource-constrained settings or during global health emergencies where demand surges.
Its Impact on India
Delayed Access to Affordable Vaccines: India’s capability to produce vaccines at scale is hindered by stringent patent laws and complex regulatory requirements.
This delays the availability of affordable vaccines domestically, impacting public health initiatives and access for vulnerable populations.
Economic and Health Implications: High costs associated with vaccine development and production limit affordability and accessibility, exacerbating healthcare inequalities.
This affects India’s ability to address preventable diseases effectively, impacting public health outcomes and economic productivity.
Unavailability of Competing Vaccines and Future Scope
Lack of Market Competition: Despite the expiration of earlier patents, there is a notable absence of competing HPV vaccines from domestic manufacturers in India.
This limits options for consumers and healthcare providers, potentially leading to higher prices and reduced accessibility, particularly in the private market.
Potential for Future Development: Several Indian biotech companies had announced plans to develop HPV vaccines, indicating a future scope for competition and potentially lower prices.
However, these initiatives have not materialized into market-ready products, highlighting challenges in vaccine development and commercialization in India’s regulatory and economic environment.
Way forward:
Promote Research and Development Incentives: Encourage and support Indian biotech companies through research grants, tax incentives, and streamlined regulatory pathways for HPV vaccine development.
Enhance Public-Private Partnerships: Foster collaborations between government entities, academic institutions, and private-sector vaccine manufacturers to improve vaccine accessibility and affordability.
Mains PYQ:
Q What are the research and developmental achievements in applied biotechnology? How will these achievements help to uplift the poorer sections of the society? (UPSC IAS/2021)
The Centre has notified amended rules allowing women government employees to take 180 days of maternity leave for children born through surrogacy.
Changes are introduced in the Central Civil Services (Leave) Rules, 1972.
There were previously no rules granting maternity leave to women government employees for children born through surrogacy.
Back2Basics: Surrogacy (Regulation) Act, 2021
Purpose: The Act aims to regulate surrogacy in India by prohibiting commercial surrogacy and allowing only altruistic surrogacy.
Eligibility Criteria:
Only Indian couples who have been legally married for at least five years can opt for surrogacy.
The woman must be between 25 to 50 years old, and the man must be between 26 to 55 years old.
Both partners must not have any living biological, adopted, or surrogate children.
Surrogate Mother Criteria:
The surrogate mother must be a close relative of the intending couple.
She should be a married woman having her own child and must be 25 to 35 years old.
Prohibitions:
Commercial surrogacy is banned under this Act.
Any form of payment to the surrogate mother beyond medical expenses and insurance coverage is prohibited.
Penalties:
Engaging in commercial surrogacy can lead to imprisonment up to 10 years and a fine up to Rs 10 lakhs.
Regulatory Bodies:
The Act establishes a National Surrogacy Board at the national level and State Surrogacy Boards at the state level to oversee the implementation of the law.
About the Central Civil Services (Leave) (Amendment) Rules, 2024
The amendment is issued under this notification, exercising the powers conferred by the proviso to Article 309 of theConstitution.
Article 309 provides that acts of the appropriate Legislature may regulate the recruitment and conditions of service of personsappointed to public services and posts in connection with the affairs of the Union or any State.
Authority: The President of India has made these amendments to the Central Civil Services (Leave) Rules, 1972.
Features and Benefits:
Surrogacy Inclusion: These amendments specifically address the needs of surrogacy, providing equitable maternity, paternity, and childcare leave benefits to government employees involved in surrogacy.
Enhanced Leave Entitlements:
Maternity Leave: 180 days for both the surrogate and the commissioning mother.
Paternity Leave: 15 days for the commissioning father within six months of the child’s birth.
Child Care Leave: Available to the commissioning mother. Female government servants and single male government servants are already allowed childcare leave for a maximum of 730 days (2 years!) during their entire service for the care of their two eldest surviving children.
Flexibility and Inclusivity:
The amendments aim to provide more flexible and inclusive leave options for government employees, recognizing diverse family structures and reproductive choices.
Support for Families:
These changes enhance support for government employees, ensuring they can adequately care for their children and family needs, especially in cases of surrogacy.
Administrative Implementation:
The rules simplify the process for applying for and approving leave, ensuring that employees can easily access their entitlements.
Impact:
Employee Well-being: Improved leave policies contribute to better work-life balance and overall well-being for government employees.
Gender Equality: By providing paternity leave and child care leave in surrogacy cases, the rules promote gender equality and shared parenting responsibilities.
Organizational Efficiency: Streamlined leave procedures and clear guidelines help maintain productivity and efficiency within government departments.
PYQ:
[2020] In the context of recent advances in human reproductive technology, “Pronuclear Transfer” is used for:
(a) fertilization of egg in vitro by the donor sperm
(b) genetic modification of sperm-producing cells
(c) development of stem cells into functional embryos
(d) prevention of mitochondrial diseases in offspring
This year’s theme for International Fatty Liver Day, an awareness initiative observed annually in June, is ‘Act Now, Screen Today’. This theme holds more urgency now than ever before.
Liver Diseases in recent times
Liver diseases have long been primarily linked to excessive alcohol consumption, which continues to be a major cause of advanced chronic liver disease.
However, in recent years, a new and quietly escalating threat to liver health has emerged: non-alcoholic fatty liver disease.
India’s Growing Burden of Fatty Liver Disease
Note: MASLD, or Metabolic dysfunction-associated steatotic liver disease, is a reclassification of what was previously known as non-alcoholic fatty liver disease (NAFLD).
High Prevalence Rates: The global prevalence of Metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated at 25-30%. In India, a 2022 meta-analysis revealed that the pooled prevalence of fatty liver among adults was 38.6%. Among obese children in India, the prevalence was around 36%.
Progression of Disease: The continuous damage caused by fatty liver leads to more severe conditions such as steatohepatitis and cirrhosis, often requiring liver transplants.
Causes of Growing Burden of Fatty Liver Disease
Lack of Early Detection: Fatty liver disease often goes undetected in early stages due to lack of symptoms. Diagnosis usually occurs at an advanced stage, when significant liver damage has already taken place.
Diet and Insulin Resistance: Excessive consumption of carbohydrates, especially refined carbs and sugars, leads to metabolic problems. High carbohydrate intake results in persistently high insulin levels and insulin resistance, promoting the conversion of excess glucose into fatty acids, which are then stored in the liver.
Initiatives Taken by the Government
Integration with NPCDCS: The Ministry of Health & Family Welfare launched operational guidelines for integrating NAFLD with the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in February 2021.
Health Promotion and Prevention: The Ayushman Bharat- Health and Wellness Centres (AB-HWCs) are being used to promote healthy living and screen for hypertension, diabetes, and other common NCDs.
Personalization is the Key
Tailored Screening Tests: The selection of screening tests and their frequency should be based on individual risk factors, including family history, lifestyle, and pre-existing health conditions.
Avoiding Generic Assumptions: Clinicians should not rely solely on age or physical markers; instead, they should consider a comprehensive risk profile. Non-communicable diseases are increasingly affecting diverse populations, including children.
Integrated Health Strategies: Combining dietary modifications, regular physical activity, and effective weight management to mitigate liver disease risks.
Frequent Screenings: Regular monitoring of liver health through non-invasive tools like vibration-controlled transient elastography. Continuous assessment of liver stiffness to detect early stages of liver fibrosis and monitor treatment responses.
Active Health Management: Emphasis on the importance of individuals taking control of their health by being aware of their diet and lifestyle choices.Encouragement of frequent health screenings to detect and manage liver disease early.
Way Forward:
Awareness Campaigns: Government initiatives focus on raising awareness about the importance of liver health and the risks associated with MASLD.
Health Screenings: Programs promoting comprehensive health screenings that include physical examinations, blood tests, and abdomen ultrasounds to detect liver diseases early.
Mains PYQ
Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
Q 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. (UPSC IAS/2020)
Mentors comment: In the last week of May, a tragic fire at a private neonatal care nursing home in New Delhi shocked everyone. Political parties started blaming each other, and the media exaggerated by incorrectly claiming that many nursing homes in Delhi operate without a license. Despite the intense media coverage, the incident has been largely forgotten, leaving the grieving parents behind. Instead of focusing on who to blame, it’s important to recognize that such tragedies are usually the result of systemic failures—in this case, the failure of health-care regulations.
Let’s learn–
Why in the news?
Health regulations are crucial, but their implementation in India needs to be thoughtful and carefully balanced.
Regulation and standards in the Indian health care system
Excessive and Complex Regulations: Some states have over 50 approvals required under multiple regulations for each healthcare facility, creating a bureaucratic burden. Despite the complexity, there is a perception among officials that the private health sector is under-regulated.
Unrealistic Standards: Many healthcare quality standards set by the government, such as those in the Clinical Establishments (Registration and Regulation) Act, 2010, and the Indian Public Health Standards (IPHS), are considered unrealistic and difficult to implement. Only a small percentage of government primary healthcare facilities meet these standards despite their aspirational goals.
Mixed health-care system in India
Diverse Healthcare Providers: India’s healthcare system includes both government and private sector providers, ranging from single-doctor clinics and small nursing homes to large corporate hospitals, each serving different population segments.
Dominance of Private Sector: The private sector delivers approximately 70% of outpatient services and 50% of inpatient services, indicating a significant reliance on private facilities for health care by the Indian population.
Regulatory and Quality Challenges: There are disparities in regulation enforcement and quality standards between the private and government sectors, with issues such as approval delays, cost of compliance, and ensuring consistent quality care across diverse facilities.
Challenges related to mixed health-care system
Regulatory Disparities: Uneven enforcement of regulations between private and government health facilities. Overzealous regulation of private facilities while government facilities face fewer consequences for similar infractions.
Approval Delays: Sluggish approval processes for private facilities, causing operational delays and financial strain. Long waiting periods for renewal applications, even when submitted well in advance.
Cost and Accessibility: High cost of services in large corporate hospitals compared to smaller clinics and nursing homes. Limited accessibility of government facilities for certain populations, despite being free or low-cost.
Differential Standards: Impractical to hold small clinics and nursing homes to the same standards as large hospitals. Need for a tiered approach to regulation, with essential and desirable standards based on facility type.
Financial Burden: High cost of compliance with regulations for smaller facilities, potentially making health services unaffordable for patients. The a need for government subsidies or funding to help smaller providers meet regulatory standards without increasing costs for patients.
Stakeholder Involvement: Insufficient involvement of health-care providers, facility owners, and community members in the formulation of regulations. Lack of representation from various types of facilities in regulatory processes.
Public Perception and Trust: Political rhetoric and sensational media coverage undermining trust in health-care providers. Potential for increased violence against health-care providers due to public mistrust.
Infrastructure and Safety: Inconsistent emphasis on essential safety measures like fire safety across facilities. Need for equitable implementation of safety standards in all healthcare buildings.
Affordable care is one need
Role of Small Providers: Single doctor clinics and small nursing homes are crucial for providing initial access and health services, particularly for middle-income and low-income populations. These smaller providers deliver a significant portion of health services at a lower cost compared to large corporate hospitals.
Supportive Regulations: There is a need for regulations that support small providers to keep healthcare costs low and affordable. Guidelines should be practical and implementable, harmonizing multiple regulations and simplifying the application process with timely approval.
Differential Approach: Regulations should recognize the different capabilities of various health facilities. Smaller clinics and nursing homes should not be held to the same standards as large hospitals to avoid escalating costs that could be transferred to patients. Essential and desirable regulatory points should be established, with regular self-assessments and inspections to ensure compliance.
Government subsidies and funding should be considered to help smaller facilities adhere to necessary regulations without increasing costs for patients.
Why do we need to Focus on the primary caregivers?
Accessibility and Affordability: Single-doctor clinics and small nursing homes provide essential health services at a lower cost, making health care more accessible and affordable for middle-income and low-income populations.
Primary Care Foundation: Promoting primary care helps manage health issues early, reducing the burden on secondary and tertiary care facilities and supporting the goals of the National Health Policy, 2017, for people-centric, accessible, and affordable health services.
Sustainable Support: Simplified, fair, and collaborative regulatory processes, along with government subsidies, can help primary-care providers operate effectively, ensuring quality and safety without escalating costs for patients.
Conclusion: Primary health care is crucial for achieving the SDG goal of universal health coverage by providing accessible, affordable, and quality health services, thus reducing the burden on higher-level care facilities and promoting overall health equity.
Q Public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)
Mentor Comment: Health insurance, now central to India’s UHC policy, is being enhanced by digital advancements, enabling reforms akin to the U.S. but with cost-effective local adaptations. A South Indian healthcare chain recently integrated insurance and care provision, forming an Indian-style MCO. This prompts reflection on MCOs’ potential to extend universal health care in India significantly.
Let’s learn_ _
Why in the news?
Universal healthcare poses a multifaceted challenge, yet managed care organizations may offer a piece of the solution that Indian healthcare requires.
What is a Managed Care Organization?
A Managed Care Organization (MCO) is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.
The background of Managed Care Organizations (MCOs) in the United States and India:
Evolution of MCOs in the United States:
MCOs have their origins in rudimentary prepaid healthcare practices in the 20th century.
The mainstreaming of MCOs gained momentum in the 1970s due to concerns over healthcare costs.The economic slowdown post-1970s made high insurance premiums less attractive to purchasers.
A shift occurred towards integrating insurance and healthcare provisioning functions. Focus areas included prevention, early management, and cost control, all under a fixed premium paid by enrollees.
MCOs have evolved through multiple generations and forms, deeply penetrating the health insurance market. While evidence of their effectiveness in improving health outcomes and prioritizing preventive care is mixed, they have been effective in reducing costly hospitalizations and associated costs.
Evolution of MCOs in India:
The first public commercial health insurance emerged in the 1980s.The focus has primarily been on indemnity insurance and covering hospitalization costs.
There is a significant market for outpatient consultations, valued at nearly $26 billion.
Health insurance in India has traditionally lagged behind life and general insurance. The sector faces issues such as lack of innovation and high, often unsustainable, operational costs.
As per Thomas (2011), Health insurance has played a secondary role to other forms of insurance. The industry’s operational inefficiencies and high costs have been persistent issues.
Challenges in India:
Lack of Natural Incentives for Cost Control: The evolutionary trajectory of Indian health insurance has not incentivized consumer-driven cost control.
Target Demographic: Health insurance has mainly targeted a thin, urban, well-off segment, neglecting broader demographics.
Informality in Outpatient Practices: There is widespread informality among outpatient practices, complicating efforts to standardize and regulate care.
Lack of Clinical Protocols: The absence of widely accepted clinical protocols hampers the quality and consistency of care.
Economic Viability: Unprofitable operations and unaffordable premiums pose significant economic challenges, preventing sustainable growth and systemic improvement.
Limited Impact on UHC: Private initiatives, despite their potential, are unlikely to significantly contribute to Universal Health Coverage (UHC) without public support.
Insufficient Control Over Patient Journeys: Health insurers have little control over the patient’s journey before hospitalization, limiting their ability to manage early interventions and reduce costs through comprehensive outpatient care.
Prospective Solutions and Remaining Issues:
Potential for Big Healthcare Brands: Large healthcare brands with loyal urban patient bases and substantial resources may initiate successful managed care projects.
Need for Public Patronage: Exploring managed care with cautious and incremental public patronage could be promising, indicating a need for government involvement to achieve broader impacts.
Underutilization of Outpatient Insurance: Given the low share of insurance in outpatient care spending and the average of three consultations per year per person, there is significant potential to reduce healthcare costs through early interventions and comprehensive outpatient care coverage.
NITI Aayog Report:
Outpatient care insurance scheme: In 2021, NITI Aayog released a report advocating for an outpatient care insurance scheme based on a subscription model to enhance savings through improved care integration.
Yield significant benefits: A well-functioning managed care system can yield significant benefits, including consolidating practices, streamlining management protocols, and emphasizing preventive care in the private sector.
Catering for the beneficiaries of PMJAY: The report highlights the potential of incentives under the Ayushman Bharat Mission to encourage the establishment of hospitals in underserved areas catering to beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY).
Conclusion: While Managed Care Organizations are not a perfect solution, they can play a role in addressing the complexities of achieving Universal Health Coverage (UHC) in India by being part of a broader strategy.
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