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.
Over 30 years, a study examining 20 diseases revealed minimal advancements in narrowing the disparity between genders as per “the Lancet Public Health Journal”.
What does the New Lancet report say?
On Health Disparities: The study highlights that women tend to suffer more from lower back pain, depression, and headaches, while men have shorter life expectancies due to higher rates of road accidents, cardiovascular diseases, and, recently, COVID-19.
On Health Burden: Women spend more time in poor health, while men are more likely to die prematurely from severe conditions.
Overall Global Analysis: The analysis examines differences in the 20 leading causes of illness and death globally, considering all ages and regions.
What Causes the Differences in Diseases Between Women and Men? (Observations)
Biological Factors:
Hormonal Differences: Hormonal fluctuations in women, such as during menstrual cycles, pregnancy, and menopause, can influence susceptibility to certain conditions like migraines, depression, and autoimmune diseases.
Genetic Variations: Variations in genes and genetic predispositions may contribute to differences in disease susceptibility and severity between sexes.
Anatomical Variances: Physiological differences, such as in skeletal structure and hormonal regulation, can affect the manifestation of certain diseases like lower back pain and reproductive disorders.
Societal and Gender Norms:
Healthcare-Seeking: Societal norms and gender roles may influence healthcare-seeking behaviors, with men often less likely to seek medical attention for mental health issues due to perceived notions of masculinity.
Occupational Hazards: Occupational differences between genders can lead to varying exposures to health risks, with certain professions associated with higher rates of injury or exposure to harmful substances.
Socioeconomic Factors: Disparities in socioeconomic status can impact disease prevalence and outcomes differently for women and men.
Healthcare System Bias:
Diagnostic Bias: Gender biases in healthcare may result in underdiagnosis or misdiagnosis of certain conditions in women, leading to delays in treatment and poorer health outcomes.
Treatment Disparities: Differences in treatment approaches and responses may exist between sexes, with women sometimes receiving less aggressive treatment for cardiovascular diseases or being undertreated for pain conditions.
Research Bias: Historically, medical research has often focused on male subjects, leading to a lack of understanding of how diseases manifest and progress differently in women.
No Improvement in Care for Women Over Time
Stable Gender Gap: Despite overall health improvements, the disparity between male and female health conditions remains stable.
Conditions Affecting Women: Conditions like lower back pain and depressive disorders have shown little to no decrease over time compared to male-dominated conditions.
Reproductive Focus: Global health systems have historically focused on women’s reproductive health, neglecting other significant health issues affecting women.
What Needs to Be Done (Way Forward)
Better Data Collection: Governments should consistently collect and categorize health data by sex and gender to better understand and address health disparities.
Targeted Health Interventions: Specific health interventions should be developed and implemented based on detailed sex and gender data.
Increased Funding: More financial resources should be allocated to underfunded conditions that disproportionately affect women, such as mental health.
Addressing Healthcare Bias: Efforts should be made to eliminate biases in healthcare to ensure women receive appropriate and timely treatment for their conditions.
Mains PYQ:
Q Can the vicious cycle of gender inequality, poverty and malnutrition be broken through microfinancing of women SHGs? Explain with examples. (UPSC IAS/2021)
A global report highlights a significant rise in unhealthy food consumption in India, surpassing intake of vegetables, fruits, and other nutritious foods.
Global Food Policy Report 2024: Food Systems for Healthy Diets and Nutrition was released by “theInternational Food Policy Research Institute (IFPRI)”.
About CGIAR:
CGIAR (formerly the Consultative Group on International Agricultural Research) is a global partnership uniting organizations engaged in research for a food-secure future.
Focus: Its mission focuses on reducing poverty, enhancing food and nutrition security, and improving natural resources and ecosystem services.CGIAR conducts research and partners with other organizations to transform global food systems and ensure equitable access to sustainable, healthy diets.
Emerging Trends in India:
Increase in consumption of unhealthy food: There is a significant increase in the consumption of unhealthy foods such as salty or fried snacks compared to nutritious options like vegetables and fruits. About 38% of the population consumes unhealthy foods, while only 28% consume all five recommended food groups.
The consumption of processed foods and ready-made convenience foods is rising. From 2011 to 2021, malnutrition in India increased from 15.4% to 16.6%.The prevalence of overweight adults rose from 12.9% in 2006 to 16.4% in 2016.
Processed food consumption is on the rise in India
South Asian Highlights
Processed Food Consumption: Increasing intake of processed foods like chocolates, salty snacks, beverages, and ready-made meals in India and other South Asian countries.
Malnutrition Rates: High levels of undernutrition and micronutrient deficiencies coexist with rising rates of overweight, obesity, and diet-related noncommunicable diseases (NCDs).
Food Budget Trends: Packaged food spending in India’s household food budgets nearly doubled from 6.5% to 12% between 2015 and 2019.
Issue of Double Malnutrition:
Double malnutrition refers to the coexistence of undernutrition and micronutrient deficiencies with overweight and obesity, or diet-related noncommunicable diseases (NCDs).
High levels of undernutrition (stunting and wasting) and micronutrient deficiencies persist even as overweight and obesity rates increase.
More than two billion people, especially in Africa and South Asia, cannot afford a healthy diet.
Dietary Guidelines by ICMR:
The Indian Council of Medical Research (ICMR) released 17 dietary guidelines to promote healthy eating.
Guidelines emphasize reading food labels to make informed choices and minimizing the consumption of high-fat, sugar, salt, and ultra-processed foods.
The guidelines highlight the importance of diverse diets over cereal-centric agriculture and food policies.
ICMR advises against the misleading information often presented on packaged foods.
Way forward:
Strengthen Nutritional Policies: Develop and enforce policies that promote the consumption of nutritious foods. Implement taxes on unhealthy foods and subsidies for fruits, vegetables, and other micronutrient-rich foods.
Regulate Processed Foods: Implement strict regulations on the marketing of unhealthy foods, especially targeting children.
Mains PYQ:
Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15) (UPSC IAS/2018)
[2022] 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?
[2020] Critically examine the role of WHO in providing global health security during the Covid-19 pandemic.
Note4Students:
Prelims: NA
Mains: Hypertension, WHO’s HEARTS Strategy, India’s Hypertension Control Initiative (IHCI)
Mentor’s Comment: Hypertension, a major but overlooked risk factor for heart attacks and strokes, causes 10.8 million preventable deaths annually, surpassing risks like tobacco use and high blood sugar. The WHO’s 2023 report reveals that 1.3 billion adults globally have hypertension, with 46% unaware of their condition. In India, 311 million adults suffer from hypertension, triple the number with diabetes.
Let’s learn___
Why in the News?
Over the past three years, the COVID-19 vaccine has attracted significant public attention as a potential risk factor for blood clot formation, leading to sudden cardiac arrest.
What is Hypertension?
Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated. Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.
WHO Report on Hypertension
2023 WHO Report: In 2023, the World Health Organization (WHO) released its first-ever report on hypertension titled “Global Report on Hypertension: The Race against a Silent Killer.”
Silent Killer: Hypertension is often called a silent killer because people are usually unaware of their high blood pressure until they develop complications.
Leading Cause of Death: High blood pressure causes more deaths than other leading risk factors, such as tobacco use and high blood sugar.
Rising Numbers: The number of adults with hypertension nearly doubled since 1990 to reach 1.3 billion.
Awareness and Control: Globally, an estimated 46% of adults with hypertension are unaware of their condition, and less than half (42%) are diagnosed and treated. Only one in five adults (21%) with hypertension has it under control.
Hypertension in India
Prevalence in India: The Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study estimates that in India, 311 million people (or one in every three adults) have hypertension.
Comparison with Diabetes: In India, adults with hypertension are threefold of the estimated 101 million people living with diabetes.
Dietary Salt and Hypertension
Impact of Excess Salt: Excess dietary salt intake (five grams or more per day) is a key risk factor for hypertension and contributed to two million cardiovascular disease deaths in 2019.
Benefits of Reducing Salt Intake: Research shows that reducing salt intake can reduce cardiovascular disease risks by 30% and mortality by 20%.
Salt Consumption in India: Indian adults consume on average eight to 11 grams of salt per day, which is approximately twice the WHO-recommended daily intake.
Deaths Due to High Salt Intake: High salt intake is responsible for an estimated 175,000 deaths in India.
Hypertension across Socio-Economic Groups
Universal Impact: Hypertension affects all socio-economic groups.
Health Camps Findings: A Delhi-based NGO, Foundation for People-centric Health Systems, conducted 50 health camps in five localities of Delhi and Gurugram from October 2023 to March 2024, screening and treating around 12,000 people.
Detection in Low-Income Groups: Many were women, migrant workers, and rickshaws and taxi drivers from low-income groups. A large number were found to have diabetes and hypertension, with most cases detected for the first time in these camps, indicating gaps in awareness, detection, and treatment.
Back2Basics: India’s Hypertension Control Initiative (2021):
Objective: India aims to put 75 million people with hypertension and/or diabetes on standard care by 2025.
Initiation and Expansion: The IHCI, a collaborative project of ICMR, Ministry of Health and Family Welfare/Directorate General of Health Services, WHO India, and other partners, was initiated in November 2017 in 25 districts across five states and expanded to 140-plus districts of India in 2023.
Strategies: IHCI follows five simple and scalable strategies implemented through primary health care:
-Simplified drug and dose-specific treatment protocols for primary-care settings. -Strengthening the drug supply chain by including protocol-based drugs in the State essential drug list, forecasting drugs based on morbidity, and ensuring adequate budget allocation in annual plans. -Team-based and decentralized care. -Patient-centric measures such as dispensing 30 days of medicine during each patient visit. -Use of information systems for program monitoring.
Programmatic Learnings from IHCI
Access and Utilization: Nearly six years of IHCI implementation has resulted in two major learnings:
Simple treatment protocols with fewer drugs, reliable drug supply, linking patients to facilities closer to home for follow-up, and engaging teams increase access and utilization of health services from government facilities.
Simplified program monitoring makes performance assessment quantifiable and actionable.
Recognition: The IHCI won the 2022 UN Interagency Task Force and WHO Special Programme on Primary Health Care Award.
Future Goals and Prevention
Global Goals: Seventy-six million cardiovascular deaths and 450 million disability-adjusted life years (DALYs) could be avoided if countries achieve 50% population hypertension control by 2050.
India’s Targets: An estimated 4.6 million deaths can be prevented in India by 2040 if half the hypertensive population has its blood pressure under control, helping to achieve targets under the National Health Policy and global commitments like universal health coverage.
Way Forward
Raise Awareness: Educate the public about the risks and long-term adverse impacts of untreated hypertension. High blood pressure can affect multiple organs, including the heart, kidneys, brain, and eyes.
Scale Up Evidence-Based Interventions: Expand successful programs like IHCI. Use strategies and lessons from such experiences to design interventions for other lifestyle diseases like diabetes and chronic kidney diseases.
Focus on Non-Modifiable Risk Factors: Address non-modifiable risk factors such as family history, age over 65 years, and pre-existing comorbidities like diabetes and/or kidney disease. Focus on healthy adults with known non-modifiable risk factors.
Reduce Dietary Salt Consumption: Implement strategies like “SHAKE the salt habit” under WHO’s HEARTS strategy:
Surveillance to measure and monitor salt use.
Harness industry to promote and reformulate foods with less salt.
Adopt standard labelling and marketing.
Educate and communicate to empower individuals to eat less salt.
Support environments that promote healthy eating.
Conclusion: As hypertension continues to exact a heavy toll on global health, concerted efforts are needed to raise awareness, implement evidence-based interventions, and promote healthier lifestyles. By prioritizing hypertension control initiatives and fostering a culture of preventive healthcare, we can mitigate the devastating impact of this silent killer on communities worldwide.
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