Subject: Social Justice

Central Idea: The article discusses the decision by the Indian Ministry of Health and Family Welfare to rename and expand its program for the control and prevention of non-communicable diseases (NCDs).

What are Non-Communicable Diseases (NCDs)?

• NCDs are also known as chronic diseases, which are not caused by infectious agents and are not transmissible from person to person.
• NCDs are long-lasting and progress slowly, typically taking years to manifest symptoms.
• Examples of NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.
• These diseases are often caused by modifiable risk factors such as unhealthy diet, lack of physical activity, tobacco and alcohol use, and environmental factors.
• NCDs are a major cause of morbidity and mortality worldwide, accounting for around 70% of all deaths globally.

Why in news?

• The addition of many new diseases and health initiatives have prompted the Indian government to expand and rename its NCD program.

Renaming of the NCD Program and Portal

• The Ministry has renamed the NPCDCS as the “National Programme for Prevention & Control of Non-Communicable Diseases [NP-NCD].”
• The application or software named Comprehensive Primary Healthcare Non-Communicable Disease (CPHC NCD IT) will now be renamed “National NCD Portal.”
• The Ministry communicated this decision to the States on May 3, 2023, through a one-page letter and asked them to adhere to the changes.

Implementation and future action

• The NPCDCS is implemented under the National Health Mission across India.
• The letter addressed to Principal Secretaries and Health Secretaries of all States and Union Territories advised the government to use the new names for the scheme and portal in all their future references and correspondences with the Indian government.
• Under NPCDCS, 677 NCD district-level clinics, 187 District Cardiac Care Units, 266 District Day Care Centres and 5,392 NCD Community Health Centre-level clinics have been set up.

Burden of NCDs in India

• The study ‘India: Health of the Nation’s States – The India State-Level Disease Burden Initiative in 2017’ by the ICMR estimated that the proportion of deaths due to NCDs in India has increased from 37.9% in 1990 to 61.8% in 2016.
• The four major NCDs are:

1. Cardiovascular diseases (CVDs)
2. Cancers
3. Chronic respiratory diseases (CRDs) and
4. Diabetes

• The study shared four behavioural risk factors – unhealthy diet, lack of physical activity, and the use of tobacco and alcohol.

Solutions to mitigate NCD burden

• Promote healthy lifestyle: Encourage people to adopt healthy lifestyle habits such as regular physical activity, balanced and nutritious diet, avoiding tobacco and alcohol, and getting enough sleep.
• Increase awareness and education: Increase awareness among the public about the risk factors of NCDs and educate them about ways to prevent these diseases.
• Improve healthcare infrastructure: Increase access to healthcare facilities, especially in rural and remote areas, to ensure early detection, treatment, and management of NCDs.
• Implement policies and regulations: Implement policies and regulations that promote healthy living, such as increasing taxes on tobacco and alcohol products, and regulating the marketing of unhealthy food products.
• Foster public-private partnerships: Foster partnerships between the government, private sector, and civil society organizations to work collaboratively towards preventing and managing NCDs.
• Increase research and innovation: Increase research and innovation in the prevention, early detection, and treatment of NCDs to develop new and effective interventions.

 

 

Get an IAS/IPS ranker as your personal mentor for UPSC 2024 | Schedule your FREE session and get the Prelims prep Toolkit!

Central Idea: The National Organ and Tissue Transplant Organisation (NOTTO) is working on a transplant manual as a step-by-step guide for the implementation of organ donation and transplantation programmes in hospitals and a standard course for training transplant coordinators.

Organ transplant in India: Key statistics

• According to data accessed from the Health Ministry, the number of organ transplants has increased by over three times from 4,990 in 2013 to 15,561 in 2022.
• Of the 15,561 transplants, a majority — 12,791 (82%) — are from live donors and 2,765 (18%) are from cadavers (the dead).
• Up to 11,423 of the 15,561 organ transplants are for the kidney, followed by liver (766), heart (250), lung (138), pancreas (24) and small bowel transplants (3).
• Most of these transplants occur in private hospitals, the numbers in government hospitals are relatively lower.

About National Organ Transplant Programme (NOTP)

• In 2019, the GoI implemented the NOTP for promoting deceased organ donation.
• Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994.

Types of Organ Donations

• The law allows both deceased and living donors to donate their organs.
• It also identifies brain death as a form of death.
• Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives or, in some special cases, out of affection and attachment towards the recipient.

(1) Deceased donors:

• They may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine.
• Uterus transplant is also performed, but it is not regarded as a life-saving organ.
• Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained.
• Brainstem death is also recognized as a form of death in India, as in many other countries.
• After a natural cardiac death, organs that can be donated are cornea, bone, skin, and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs

(2) Living donors:

They are permitted to donate the following:

• one of their kidneys
• portion of pancreas
• part of the liver

Features of the NOTP

• Under the NOTP a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organization (NOTTO), New Delhi.
• Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio-material centre.
• As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organization (ROTTO), Chennai, Tamil Nadu.

More moves for facilitation:  Green Corridors

• Studies have suggested that the chances of transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.
• Therefore, the transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of India.
• A “green corridor” refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.

Recent amendments

(1) No Age Bar

• Now an individual of any age can register for organ transplant.
• People beyond 65 years in need of an organ donation will also be eligible to get one.
• The government has decided to do away with a clause in the National Organ and Tissue Transplant Organisation (NOTTO) guidelines as the clause violates the Right to Life.

(2) Doing away with domicile compulsion

• Earlier an organ recipient could register for a prospective transplant in domicile State.
• States like Gujarat had made it mandatory for registered patients to furnish a domicile certificate to be eligible for a transplant.
• In November last year, the Gujarat High Court quashed the discriminatory policy of the State government.

---

About NOTTO

National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.

1. National Human Organ and Tissue Removal and Storage Network
2. National Biomaterial Centre (National Tissue Bank)

[I] National Human Organ and Tissue Removal and Storage Network

• This has been mandated as per the Transplantation of Human Organs (Amendment) Act 2011.
• The network will be established initially for Delhi and gradually expanded to include other States and Regions of the country.
• Thus, this division of the NOTTO is the nodal networking agency for Delhi and shall network for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
• It functions as apex centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country.

[II] National Biomaterial Centre (National Tissue Bank)

• The Transplantation of Human Organs (Amendment) Act 2011 has included the component of tissue donation and registration of tissue Banks.
• It becomes imperative under the changed circumstances to establish National level Tissue Bank to fulfill the demands of tissue transplantation including activities for procurement, storage and fulfil distribution of biomaterials.
• The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues.

The centre will take care of the following Tissue allografts:

1. Bone and bone products
2. Skin graft
3. Cornea
4. Heart valves and vessels

---

Various issues involved

• Lack of awareness: Lack of awareness leads to myths and misconceptions about organ donation, which further discourages people from donating organs.
• Religious and cultural beliefs: Some religious and cultural beliefs view organ donation as a desecration of the body, which hinders organ donation.
• Lack of infrastructure: India faces a shortage of medical infrastructure and facilities for organ donation.
• Legal and regulatory challenges: India’s organ donation system is heavily regulated by the Transplantation of Human Organs and Tissues Act, 1994.
• Socioeconomic factors: Poverty and lack of education can lead to reduced access to information and medical services, making it difficult for people to donate organs.
• Organized crime: Organized criminal networks involved in organ trafficking and commercialization also create challenges for organ donation in India.
• Stigma and Discrimination: Stigma against organ recipients, particularly those who receive transplants from other communities or castes, is also a challenge in promoting organ donation in India.

Way forward

• Developing a National Organ and Tissue Donation Registry: The registry could maintain a database of donors and recipients, along with their medical history and compatibility information.
• Setting up Mobile Organ Donation Units: These units could be equipped with medical personnel and equipment to conduct donation procedures in remote areas.
• Crowdfunding for Organ Transplant Surgeries: This could be used as a means to raise funds for organ transplant surgeries, especially for underprivileged individuals who cannot afford the cost of treatment.
• Promoting Living Donor Transplants: Living donor transplants can help increase the number of organs available for transplantation.
• Incentivizing for Organ Donation: Incentives could be introduced to encourage more people to donate organs. This could include tax breaks, priority access to medical treatment, and other benefits.
• Leveraging Technology: Technology could be used to develop better donor and recipient matching algorithms, create virtual waiting lists, and streamline the donation and transplantation process.
• International Collaboration: India could collaborate with other countries to share best practices, leverage technology, and develop new approaches to organ donation and transplantation.

 

Get an IAS/IPS ranker as your personal mentor for UPSC 2024 | Schedule your FREE session and get the Prelims prep Toolkit!

Central idea: The National Health Account Estimates 2019-20 report shows an increase in government spending and a decline in out-of-pocket expenditure on healthcare.

About National Health Account (NHA) estimates

• The NHA estimates for India 2019-20 is the seventh consecutive report prepared by the National Health Systems Resource Centre (NHSRC).
• NHSRC was designated as National Health Accounts Technical Secretariat (NHATS) in 2014 by the Union Health Ministry.
• The NHA estimates use an accounting framework based on the internationally accepted standard of System of Health Accounts, 2011 developed by the WHO.
• India now has a continuous series of NHA estimates from 2013-14 to 2019-20, making the estimates comparable internationally.
• The estimates enable policymakers to monitor progress in different health financing indicators of the country.

Key highlights

	Description
Government spending as % of GDP	Increased from 1.13% (FY 2015) to 1.35% (FY 2020) Per capita health spending of the government has also increased from Rs 1,108 in FY 2015 to Rs 2,014 in FY 2020. Govt share in total healthcare spending has increased from 29% in 2015 to 41.4% in 2020
Declining out-of-pocket expenditure	Proportion of total healthcare spending that comes from people’s pockets has decreased from 62.6% in 2015 to 47.1% in 2020 Govt aims to further reduce out-of-pocket expenditure by investing in public health and insurance To reduce the financial burden of healthcare on individuals and increase the utilization of healthcare services
Government spending on primary healthcare	Increased from 51.3% in 2015 to 55.9% in 2020. Govt. invested in creating 1.5 lakh health and wellness centres that can screen people for cancers, diabetes, and eye disease.
Increase in social security expenditure	Increased from 5.7% of total healthcare spending in 2015 to 9.3% in 2020. Suggests that the government is investing more in social welfare programs.
Increase in spending on insurance	Privately purchased health insurance increased from 3.9% of total health expenditure in 2015 to 7.72% in 2020 Govt. financed health insurance spending also went up from 3.8% in 2015 to 6.37% in 2020
Health spending by states	Only two big states and three smaller ones have crossed the target of 8% of their budget going towards healthcare as set by the National Health Policy 2017.

 

Key issues

• Marginal increase: Activists are concerned about the marginal increase in government spending.
• Global laggard: This increase in government health expenditure as a percentage of GDP also takes into account capital spending, which puts India in 164th place out of 184 countries in terms of government health spending.
• No proportional increase: Total spending on health as a proportion of GDP has been going down, from 3.9% in 2015 to 3.3% in 2020, indicating a decline in consumption of healthcare services.

Conclusion

• Overall, the report shows that government spending on healthcare has been increasing, while out-of-pocket expenditure has been declining.
• There is a need to invest in public health and insurance and increase the contribution of states towards healthcare.

 

Get an IAS/IPS ranker as your personal mentor for UPSC 2024 | Schedule your FREE session and get the Prelims prep Toolkit!

Malaria is all set to become a notifiable disease across India, which will require cases to be reported to government authorities by law.

About Malaria

	Description
Definition	A potentially life-threatening disease caused by parasites that are transmitted through the bite of infected female Anopheles mosquitoes
Causes	Four species of plasmodium parasites, namely plasmodium vivax, plasmodium falciparum, plasmodium malariae, and plasmodium ovale
Spread	Bite of infected female Anopheles mosquitoes
Symptoms	Fever, chills, headache, muscle pain, fatigue, nausea, vomiting
Diagnosis	Blood test
Treatment	Antimalarial drugs
Prevention	Insecticide-treated bed nets, indoor residual spraying, wearing protective clothing, using mosquito repellent, avoiding mosquito bites
Vaccine	RTS,S/AS01 (Mosquirix)

 

Why in news?

• The move is part of India’s vision to become malaria-free by 2027 and to eliminate the disease by 2030.

Menace of malaria in India

• In India, 80% of malaria cases occur among 20% of its population living in the 200 high-risk districts of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, West Bengal and the seven north-eastern states.
• With only fewer than half of those infected reaching a clinic or hospital, the cases and deaths are much higher than recorded.

What is Notifiable Disease?

• A notifiable disease is a disease that is required by law to be reported to government authorities.
• In India, the Ministry of Health and Family Welfare maintains a list of notifiable diseases under the National Health Mission.
• This is done to track the spread of the disease and to take necessary measures to control and prevent its spread.
• Reporting notifiable diseases is important for public health surveillance and response to outbreaks.

Malaria as a Notifiable Disease

• Malaria is currently a notifiable disease in 33 states and Union Territories in India.
• Bihar, Andaman and Nicobar Islands, and Meghalaya are in the process of putting malaria in the notifiable disease category.

Other measures to curb malaria

• Malaria Elimination Programme: The government has launched the National Framework for Malaria Elimination in India 2016-2030 to eliminate malaria from the country by 2030.
• Joint Action Plan: The Health Ministry has initiated a joint action plan with the Ministry of Tribal Affairs for malaria elimination in tribal areas. This plan aims to bring down malaria cases to zero in tribal areas, which are among the most vulnerable to the disease.
• HIP-Malaria Portal: The Ministry has ensured the availability of near-real-time data monitoring through an integrated health information platform and periodic regional review meetings to keep a check on malaria growth across India.

Vaccines developed so far

• The WHO has approved the rollout of two first-generation malaria vaccines, RTS,S and R21, in high-transmission African countries.
• Bharat Biotech, an Indian company, has been licensed to manufacture the RTS,S vaccine, with adjuvant provided by GSK.
• The R21 vaccine, developed by scientists at Oxford University, has shown promising results in phase 2 clinical studies and has been approved by regulatory authorities in Ghana and Nigeria.
• Scientists at the International Centre for Genetic Engineering and Biotechnology (ICGEB) in New Delhi have developed and produced two experimental blood-stage malaria vaccines, with Phase I clinical trials completed for one of them.

 

 

Get an IAS/IPS ranker as your personal mentor for UPSC 2024 | Schedule your FREE session and get Prelims prep Toolkit!

Central idea: The Centre has exempted all drugs and food for special medical purposes, imported for personal use, for the treatment of rare diseases listed under the National Policy for Rare Diseases 2021 from basic customs duty.

What are Rare Diseases?

• Rare diseases are those medical conditions that affect a small percentage of the population.
• In India, a disease is considered rare if it affects less than 1 in 2,000 people.
• These diseases are often genetic and are chronic, degenerative, and life-threatening.
• There are over 7,000 known rare diseases, and it is estimated that about 70 million people in India are affected by them.
• Many of these diseases do not have a cure, and the treatment can be expensive and difficult to access.

Need for duty exemption

• This decision has been taken to help reduce the burden of the cost of treatment for patients and families.
• The drugs and food required for the treatment of these rare diseases are often expensive and need to be imported.
• This exemption will result in substantial cost savings and provide much-needed relief to patients with rare diseases.

Key medicines under this exemption

• The central government has fully exempted Pembrolizumab (Keytruda), a drug used in the treatment of various types of cancer, from basic customs duty.
• Previously, the GST rate for Keytruda was cut to 5 per cent from 12 per cent in a meeting held in September 2021 by the GST Council.
• Life-saving drugs Zolgensma and Viltepso used in the treatment of spinal muscular atrophy were exempted from GST when imported for personal use.

How the new duty exemption works?

• The exemption has been granted by the Central Board of Indirect Taxes and Customs (CBIC) by substituting “Drugs, Medicines or Food for Special Medical Purposes (FSMP)” instead of “drugs or medicines”.
• To avail of this exemption, the individual importer has to produce a certificate from the central or state director health services or district medical officer/civil surgeon of the district.

How are life-saving medicines taxed?

• Drugs/medicines generally attract basic customs duty of 10 per cent, while some categories of lifesaving drugs/vaccines attract a concessional rate of 5 per cent or nil.
• In its meeting in September 2021, the GST Council had reduced tax rates for several life-saving drugs.

 

---