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Subject: Social Justice

  • How lack of public data on pandemic could harm us

    Context

    Questions are being asked about India’s preparedness as the cases with the Omicron variant of the Coronavirus has been on the rise in the country.

    Where does India stand?

    [1] The Positives

    • Addressing oxygen shortage: The extreme shortages of oxygen that we saw barely six months ago will hopefully not be a feature of a third wave.
    • Vaccinated population: We have now vaccinated more than 50% of the adult population with both doses of vaccine, and approximately 85% have received one or two doses.
    • Ramping up testing to deal with a spike should not require an increase in capacity.
    • More vaccine doses: We have more vaccine doses than in May 2021 and the potential for oral antiviral therapy in the near future.

    [2] The negatives

    • Lack of data: An urgent and important one is the lack of publicly available data on the pandemic from Government sources, particularly in regard to testing, but also in terms of being able to correlate disease severity with age, prior medical conditions, locations and other variables.
    • Data from the Indian Council of Medical Research (ICMR), India’s premier medical research agency, remains inaccessible.
    • The National Centre for Disease Control (NCDC) has not responded.
    • The CoWIN data contains valuable information but it is of little value for future planning and prediction unless it can be tied to testing data and clinical information at the level of individuals.
    • ICMR data not correlated to CoWIN platform data: The Indian Council of Medical Research holds data on every COVID-19 test conducted in India.
    • However, these data are not correlated to the vaccine data in the CoWIN platform.
    • Data with States is inaccessible: Data on hospitalisations, etc. are apparently available at the State level, but seem inaccessible.

    What we can know from the data about pandemic

    • Infer the probability of reinfection: If we knew that a person had tested positive on successive tests separated by, say four months or more, with a negative test in-between, that would suggest a reinfection.
    • We could then infer the probability of such a reinfection.
    • Probability of vaccine breakthrough infection: With information about testing and vaccination status, we could compute the probability of a vaccine breakthrough event.
    • To know the efficacy of single vaccine dose: By checking to see whether the positive test happened after the first but before the second dose of vaccine, or after the second dose, the relative efficacy of such single vaccine doses at preventing disease could be derived.
    • Effect of the vaccine on disease severity: By examining symptoms reported after a vaccine breakthrough event, we could understand the extent to which vaccines reduce disease severity.
    • Impact of new variant: Add to this a layer of sequence information, and we could study the impact of new variants.

    Role of the volunteer organisation

    • The most trustworthy and granular data on cases in India have resulted from the remarkable and public-spirited work of a volunteer organisation, Covid19India.org.
    • Their work has now been taken over by several other voluntary groups, all operating on the same broad principles of data accessibility: covid19bharat.org, incovid19.org and covid19tracker.in.

    Way forward

    • Commitment towards data accessibility: We need to stress on data availability because this is the one area where a swift realignment is possible.
    • The more widely data are shared, the greater the likelihood of integration of the rapidly shifting scientific frontier with clinical practice.
    • Learning from the experience of South Africa: With the advantages of a relatively high-quality surveillance system among low- and middle-income countries (LMIC) countries, bolstered by a commitment towards transparency and data accessibility, South Africa’s rapid sharing allowed the world to prepare swiftly for the appearance of the highly mutated Omicron variant.
    • It is clear that pre-emptive decisions on vaccination and other measures could be made faster and better if more integrated data were available.

    Consider the question “Why availability and accessibility of data is important in dealing with the Covid-19 pandemic? What are the challenges facing health data accessibility in India?”

    Conclusion

    Now, more than ever before is the time for us to urgently reassess our attitude towards data for public health purposes and the role of national health agencies in sharing data, generated with public funds, with scientists in India and across the world.

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  • Amendment to the NDPS Act

    The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2021 was passed by Lok Sabha.

    Must read:

    [Burning Issue] Substance Abuse in India

    About NDPS Act

    • The Narcotic Drugs and Psychotropic Substances Act, commonly referred to as the NDPS Act was promulgated in 1985.
    • It prohibits a person from the production/manufacturing/cultivation, possession, sale, purchasing, transport, storage, and/or consumption of any narcotic drug or psychotropic substance

    What is the 2021 amendment?

    • The 2021 Bill amends the Narcotic Drugs and Psychotropic Substances Act, 1985 and seeks to rectify a drafting “anomaly” created by a 2014 amendment to the parent legislation.
    • It contains a legislative declaration about what one section refers to.
    • It says Section 2 clause viii(a) corresponds to clause viii(b) in Section 27, since 2014 when the provision was first brought in.
    • Section 27A of the NDPS Act, 1985, prescribes the punishment for financing illicit traffic and harbouring offenders.

    Earlier amendment in 2014

    • In 2014, a substantial amendment was made to the NDPS Act to allow for better medical access to narcotic drugs.
    • It defined “essential drugs”; under Section 9 and allowed the manufacture, possession, transport, import inter-State, export inter-State, sale, purchase, consumption and use of essential narcotic drugs.
    • But before the 2014 amendment, a Section 2(viii)a already existed and contained a catalogue of offences for which the punishment is prescribed in Section 27A.

    What is Section 21A?

    • Section 27A reads: Whoever indulges in financing, directly or indirectly or harbours any person engaged in any of the aforementioned activities, shall be punishable with rigorous imprisonment.
    • The term shall not be less than ten years and may extend to twenty years.
    • The accused shall also be liable to fine which shall not be less than one lakh rupees but which may extend to two lakh rupees.

    What was the drafting “anomaly”?

    • While defining “essential drugs” in 2014, the legislation re-numbered Section 2.
    • The catalogue of offences, originally listed under Section 2(viii)a, was now under Section 2(viii)b.
    • In the amendment, Section 2(viii)a defined essential narcotic drugs.
    • However, the drafters missed amending the enabling provision in Section 27A to change Section 2(viii)a to Section 2(viii)b.

    What was the result of the drafting error?

    • Section 27A punished offences mentioned under Section 2(viiia) sub-clauses i-v.
    • However, Section 2 (viiia) sub-clauses i-v, which were supposed to be the catalogue of offences, does not exist after the 2014 amendment. It is now Section 2(viiib).
    • This error in the text meant since 2014, Section 27A was inoperable.

    When was the error noticed?

    • In June this year, the Tripura High Court, while hearing a reference made by the district court, flagged the drafting error, urging the Centre to bring in an amendment and rectify it.
    • In 2016, an accused had sought bail before a special judge in West Tripura in Agartala, citing this omission in drafting.

    Why can’t it be applied retrospectively?

    • Article 20(1) of the Constitution says that no person shall be convicted of any offence except for violation of the law in force at the time of the commission.
    • The person shall not be subjected to a penalty greater than that which might have been inflicted under the law in force at the time of the commission of the offence.
    • This protection means that a person cannot be prosecuted for an offence that was not a “crime” under the law when it was committed.

    Does the latest amendment make it retrospective?

    • In September, the government brought in an ordinance to rectify the drafting error, which Lok Sabha. “It shall be deemed to have come into force on the 1st day of May 2014,” the Bill reads.
    • Retrospective application is permitted in clarificatory amendments.
    • This 2021 amendment is not a substantive one, that is why the retrospective is allowed.

     

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  • Tobacco Consumption in India

    Tobacco use is known to be a major risk factor for several non-communicable diseases in India.

    Tobacco abuse in India

    • In India, 28.6% of adults above 15 years and 8.5% of students aged 13-15 years use tobacco in some form or the other.
    • This makes the country the second-largest consumer of tobacco in the world.

    Concern: No action against Tobacco

    • India bears an annual economic burden of over â‚č1, 77,340 crores on account of tobacco use.
    • There has been no major increase in taxation of tobacco products to discourage the consumption of tobacco in the past four years since the introduction of GST.
    • Only in 2020-21, the Union Budget had the effect of increasing the average price of cigarettes by about 5%.
    • Yet, the excise duty on tobacco in India continues to remain extremely low.

    A worrying trend

    • No increase in tax: The absence of an increase in tax means more profits for the tobacco industry and more tax revenue foregone for the government.
    • Revenue losses: This revenue could have easily been utilized during the COVID-19 pandemic.
    • Losses due to GST: There has been a 3% real decline in GST revenues from tobacco products in each of the past two financial years.

    Present governance of Tobacco

    • GST slab: Tobacco at present is a highly taxed commodity. It is kept in the 28% GST slab (other than for tobacco leaves which is taxed at 5%).
    • Heavy cess: Tobacco and its various forms are also subject to a heavy burden of cess, given that the commodity is seen as a sin good.
    • Statutory warning: The government also uses pictures of cancer patients on the packages of cigarettes to discourage its use.

    Federal issues

    • Excise taxes on many tobacco products used to be regularly raised in the annual Union Budgets before the GST.
    • Similarly, several State governments used to regularly raise value-added tax (VAT) on tobacco products.
    • During the five years before the introduction of the GST, most State governments had moved from having a low VAT regime on tobacco products to having a high VAT regime.

    Implication of such policies

    • Increased consumption: The lack of tax increases in post-GST years might mean that some current smokers smoke more now and some non-smokers have started smoking.
    • Reverse trend in decline: This could potentially lead to a reversal of the declining trend in prevalence.
    • Affordability: Tobacco products are more affordable post-GST as shown in recent literature from India.
    • Missing up national target: This might jeopardise India’s commitment to achieving 30% tobacco use prevalence reduction by 2025 as envisaged in the National Health Policy of 2017.

    Way forward

    • Several countries in the world have high excise taxes along with GST or sales tax and they are continuously being revised.
    • We must adhere to the WHO recommendation for a uniform tax burden of at least 75% for each tobacco product.
    • The Union government should take a considerate view of public health and significantly increase excise taxes — either basic excise duty or NCCD — on all tobacco products.
    • Taxation should achieve a significant reduction in the affordability of tobacco products to reduce tobacco use prevalence and facilitate India’s march towards sustainable development goals.

     

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  • Global Health Security Index, 2021

    Countries across all income levels remain dangerously unprepared to meet future epidemic and pandemic threats, according to the new 2021 Global Health Security (GHS) Index.

    About GHS Index

    • The GHS Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations.
    • It is a project of the Johns Hopkins Centre for Health Security, the Nuclear Threat Initiative (NTI) and the Economist Intelligence Unit (EIU) and was first launched in October 2019.
    • It assesses countries across 6 categories, 37 indicators, and 171 questions using publicly available information.
    • It benchmarks health security in the context of other factors critical to fighting outbreaks, such as political and security risks, the broader strength of the health system, and country adherence to global norms.

    Parameters assessed

    The report is based on a questionnaire of 140 questions, organized across 6 categories, 34 indicators, and 85 sub-indicators. The six categories are:

    1. Prevention: Prevention of the emergence or release of pathogens
    2. Detection and Reporting: Early detection and reporting for epidemics of potential international concern
    3. Rapid Response: Rapid response to and mitigation of the spread of an epidemic
    4. Health System: Sufficient and robust health system to treat the sick and protect health workers
    5. Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms
    6. Risk Environment: Overall risk environment and country vulnerability to biological threats

    Global performance

    • In 2021, no country scored in the top tier of rankings and no country scored above 75.9, the report showed.
    • The world’s overall performance on the GHS Index score slipped to 38.9 (out of 100) in 2021, from a score of 40.2 in the GHS Index, 2019.
    • This, even as infectious diseases are expected to have the greatest impact on the global economy in the next decade.
    • Some 101 countries high-, middle- and low-income countries, including India, have slipped in performance since 2019.

    Indian scenario

    • India, with a score of 42.8 (out of 100) too, has slipped by 0.8 points since 2019.
    • Three neighboring countries — Bangladesh, Sri Lanka and Maldives — have improved their score by 1-1.2 points.

    Conclusion

    • Health emergencies demand a robust public health infrastructure with effective governance.
    • The trust in government, which has been a key factor associated with success in countries’ responses to COVID-19, is low and decreasing, the index noted.

     

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  • Need for closer scrutiny of reduced out-of-pocket expenditure on health

    Context

    The National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP.

    India’s total public spending on health

    • One of the lowest in the world: India’s total public spending on health as a percentage of GDP or in per capita terms has been one of the lowest in the world.
    • Majority spent by the States: The Union government traditionally spends around a third of the total government spending whereas the majority is borne by the States.
    • There has been a policy consensus for more than a decade now that public spending has to increase to at least 2.5% of GDP.
    • However, there has not been any significant increase so far.
    • Despite several pronouncements, it has continued to hover around 1%-1.2% of GDP.

    Why NHA report is being celebrated?

    • The National Health Accounts (NHA) report capture spending on health by various sources, and track the schemes through which these funds are channelised to various providers in a given time period for a given geography.
    • The National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP.
    • The increase shown in NHA 2017-18 is largely due to increase in Union government expenditure.
    • Increase in Centre’s share: For 2017-18, the Centre’s share in total public spending on health has jumped to 40.8%.
    • However, if we study the spending pattern of the Ministry of Health and Family Welfare and the Ministry of AYUSH, we see that expenditure increased to 0.32% of GDP from 0.27% in 2016-17 — insufficient to explain the overall jump.

    Issues with NHA report

    • Expenditure of DMS included: Much of this increase has actually happened on account of a tripling of expenditure of the Defence Medical Services (DMS).
    • Compared to an expenditure of â‚č10,485 in 2016-17, it increased to â‚č32,118 crore.
    • Though the increasing spending for the health of defence personnel is a good thing, such spending does not benefit the general population. 
    •  Within government expenditure, the share of current health expenditure has come down to 71.9% compared to 77.9% a year ago.
    • Capital expenditure included: This essentially means, capital expenditure has increased, and specifically in defence.
    • There is a problem in accounting capital expenditure within the NHA framework.
    • Why capital expenditure needs to be left out: Equipment brought or a hospital that is built serves people for many years, so the expenditure incurred is used for the lifetime of the capital created and use does not get limited to that particular year in which expenditure is incurred.
    • The World Health Organization proposes to leave out capital expenditure from health accounts estimates, instead focus on current health expenditure.
    • Incomparable to other countries: In NHA estimates in India, in order to show higher public investment, capital expenditure is included; thus, Indian estimates become incomparable to other countries.
    • The NHA estimate also shows that out-of-pocket expenditure as a share of GDP has reduced to less than half of the total health expenditure.
    • NSSO 2017-18 data suggest that during this time period, utilisation of hospitalisation care has declined compared to 2014 NSSO estimates for almost all States and for various sections of society.
    • Sign of distress: The decline in out-of-pocket expenditure is essentially due to a decline in utilisation of care rather than greater financial protection.
    • Actually, the NSSO survey happened just after six months of demonetisation and almost at the same time when the Goods and Services Tax was introduced.
    • The disastrous consequences of the dual blow of demonetisation and GST on the purchasing power of people are quite well documented.
    • Another plausible explanation is linked to limitations in NSSO estimates. The NSSO fails to capture the spending pattern of the richest 5% of the population (who incur a large part of the health expenditure).
    • Thus, out-of-pocket expenditure measured from the NSSO could be an under-estimate as it fails to take into account the expenditure of the richest sections.

    Conclusion

    The reduction of out-of-pocket expenditure is a sign of distress and a result of methodological limitations of the NSSO, rather than a sign of increased financial protection.

     

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  • What the NFHS data reveals about inequality in India

    Context

    The release of the NFHS data (and the Niti Aayog’s study on developing a multi-dimensional index of poverty — MPI) has led to a considerable amount of discussion, and justifiably so.

    Understanding the progress and development: MPI

    • The MPI is an Oxford-based initiative that develops an exclusive broadly non-monetary living standard index of poverty.
    • MPI indices are the third in the series of global studies on poverty.
    • Global studies on poverty: Global studies started with the World Bank’s income/consumption-based measure of absolute poverty.
    • The UN expanded the monetary index adding health and education indicators via the Human Development Index (HDI).

    Evolution of poverty over time

    • Like with the other poverty indices (World Bank and HDI), most information and useful policy analysis comes via a study of the inter-temporal evolution of poverty. 
    • Regional inequality: Ajit Ranade acknowledges that regional inequality has existed for some time, but he argues that poverty incidence across Indian states even as per the MPI is astoundingly unequal.
    • T N Ninan talks about the simultaneous existence of Africa’s Sahel region and the Philippines in India.
    • He finds that the two Indias are not getting any closer.
    • Indeed, India’s development trajectory has not been uniform, but the regional imbalance of development cannot be viewed at a fixed point in time.

    Analysing the NHFS data

    • A detailed examination of the summary statistics reported in the NFHS data (large and small states of India for the two years 2015-16 and 2019-21), reveals the opposite result.
    • Convergence: The analysis reveals remarkable convergence in living standards, a convergence possibly unparalleled in Indian history and in the space of just five years.
    • NFHS reports the averages for all states, and for 131 variables, for two years 2015-16 and 2020-21.
    • Seventeen of these 131 welfare indicators are used to construct indices under four classifications.
    • Improvement in lives of girls/women: The first classification concerns itself with the improvement in the lives of girls/women (five indicators, for example, sex ratio, fertility, female education).
    • Housing conditions: The second bucket consists of housing conditions (three indicators, for example, improved sanitation, clean fuel).
    • Children’s welfare: The third list consists of children’s welfare (four indicators such as adequate diet, stunting)
    • Women’s welfare: The fourth classification includes women’s empowerment (five indicators, for example, owning a house, less spousal violence).
    • Given that Niti Aayog’s report primarily relies on the NFHS-4, these findings can be used as the baseline scenario to evaluate the delta — that is, the per cent change in indicators between NFHS-4 and NFHS-5.
    • The table reports the results for several states.

    • Seventeen indicators imply a maximum possible score of 1,700.
    • Kerala performs the best with an aggregate index of 1,300 in NFHS-5 — a very small 1.5 per cent increase from its 2015-16 value.
    • In contrast, Bihar increases its index by 56 per cent.
    • Punjab does better than Tamil Nadu and today has a higher index – 1,240 versus 1,178 in 2020-21.
    • UP (along with Rajasthan and MP) performs the best — a 60 plus per cent increase in the welfare index, more than five times the increase in the rich states.

    Major findings from the NHFS data

    • Convergence: Higher improvement by less developed states is evidence in support of catch-up, which suggests that regional imbalances are reducing, and in some indicators, rapidly so.
    • States such as UP, Bihar and Jharkhand are fast approaching similar standards for select indicators as some of the “developed” states.
    • Result of targeted intervention: This acceleration in catch up is no coincidence, but rather an outcome of an approach that involves targeted interventions to improve developmental outcomes.
    • The approach was not just limited to sanitation, proper fuel or electricity — interventions that are targeted to an individual household — but also to the holistic development of an entire region.

    Consider the question “What does NHFS-5 data reveal about the inequality in India?”

    Conclusion

    India has been, and was, not one but several Indias. What is remarkable about its recent history is the rapid process of uneven change — where progress is considerably higher for the poorer states — the convergent, and inclusive pattern of development. That is the real story behind the NFHS-4 and NFHS-5 numbers.

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  • What the latest NFHS data says about the New Welfarism

    Context

    The second and final phase of NFHS-5 was released which covered 11 states (including Uttar Pradesh (UP), Tamil Nadu, Punjab, Rajasthan, Madhya Pradesh (MP), Jharkhand, Haryana, and Chhattisgarh) and about 49 per cent of the population.

    Major findings

    [1] Success of New Welfarism

    • Figure one plots household access to improved sanitation, cooking gas and bank accounts used by women.
    • The improvements are as striking as they were based on the performance of the phase 1 states.
    • In all cases, access has increased significantly, although claims of India being 100 per cent open defecation-free still remain excessive.

    [2] Child-related outcomes

    • India-wide, stunting has declined although the pace of improvement has slowed down post-2015 compared with the previous decade.
    • For example, stunting improved by 0.7 percentage points per year between 2005 and 2015 compared to 0.3 percentage points between 2015 and 2021.
    • On diarrhoea too, adding the new data reverses the earlier finding.
    • However, on anaemia and acute respiratory illness, there seems to have been deterioration.
    • The new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 and phase 2 states.
    •  The interesting pattern is that nearly all the phase 2 states show large improvements, whereas most of the phase 1 states exhibited a deterioration in performance.

    [3] Catch up by the laggard states

    • If the new child stunting numbers are right, a different picture of India emerges.
    • Apparently, Madhya Pradesh now has fewer stunted children than Gujarat; Uttar Pradesh and Jharkhand are almost at par with Gujarat; Chhattisgarh fares better than Gujarat, Karnataka, and Maharashtra; and Rajasthan and Odisha fare better than Gujarat, Karnataka, Maharashtra, West Bengal, Telangana and Himachal Pradesh!
    • On child stunting, the old BIMARU states (excepting Bihar) are no longer the laggards; the laggards are Gujarat, Maharashtra, and Karnataka, and to a lesser extent, West Bengal, Andhra Pradesh and Telangana.
    • Indeed, the decline in stunting achieved by the poorer states such as UP, MP, Chhattisgarh and Rajasthan would be all the more remarkable given the overall weakness in the economy between 2015 and 2021.

    Conclusion

    When commentators speak of two Indias, it is now important to ask: Which ones and on what metrics.

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  • Assisted Reproductive Technology (Regulation) Act, 2021

    The Lok Sabha has passed the Assisted Reproductive Technology- ART (Regulation) Bill,, 2020 that proposes the establishment of a national registry and registration authority for all clinics and medical professionals serving in the field.

    Key highlights of the Bill:

    Definition of ART

    • The Bill defines ART to include all techniques that seek to obtain a pregnancy by handling the sperm or the oocyte (immature egg cell) outside the human body and transferring the gamete or the embryo into the reproductive system of a woman.
    • Examples of ART services include gamete (sperm or oocyte) donation, in-vitro-fertilisation (fertilising an egg in the lab), and gestational surrogacy (the child is not biologically related to surrogate mother).
    • ART services will be provided through: (i) ART clinics, which offer ART related treatments and procedures, and (ii) ART banks, which store and supply gametes.

    Regulation of ART clinics and banks

    • The bill provides that every ART clinic and bank must be registered under the National Registry of Banks and Clinics of India.
    • It will act as a central database with details of all ART clinics and banks in the country.
    • State governments will appoint registration authorities for facilitating the registration process.
    • Clinics and banks will be registered only if they adhere to certain standards (specialised manpower, physical infrastructure, and diagnostic facilities).
    • The registration will be valid for five years and can be renewed for a further five years.

    Conditions for gamete donation and supply

    • Screening of gamete donors, collection and storage of semen, and provision of oocyte donor can only be done by a registered ART bank.
    • A bank can obtain semen from males between 21 and 55 years of age, and oocytes from females between 23 and 35 years of age.
    • An oocyte donor should be an ever-married woman having at least one alive child of her own (minimum three years of age).
    • The woman can donate oocyte only once in her life and not more than seven oocytes can be retrieved from her.
    • A bank cannot supply gamete of a single donor to more than one commissioning couple (couple seeking services).

    Conditions for offering ART services:

    • ART procedures can only be carried out with the written informed consent of both the party seeking ART services as well as the donor.
    • The party seeking ART services will be required to provide insurance coverage in the favour of the oocyte donor (for any loss, damage, or death of the donor).
    • The Bill also requires checking for genetic diseases before the embryo implantation.

    Rights of a child born through ART

    • A child born through ART will be deemed to be a biological child of the commissioning couple and will be entitled to the rights and privileges available to a natural child of the commissioning couple.
    • A donor will not have any parental rights over the child.

    National and State Boards:

    • The Bill provides that the National and State Boards for Surrogacy constituted and will for the regulation of ART services.
    • Key powers and functions of the National Board include:
    1. Advising the central government on ART related policy matters
    2. Reviewing and monitoring the implementation of the Bill
    3. Formulating code of conduct and standards for ART clinics and banks
    4. Overseeing various bodies to be constituted under the Bill
    5. State Boards will coordinate enforcement of the policies and guidelines for ART as per the recommendations, policies, and regulations of the National Board

    Offences and penalties

    Offences under the Bill include:

    1. Abandoning, or exploiting children born through ART,
    2. Selling, purchasing, trading, or importing human embryos or gametes,
    3. Using intermediates to obtain donors,
    4. Exploiting commissioning couple, woman, or the gamete donor in any form, and
    5. Transferring the human embryo into a male or an animal
    • These offences will be punishable with a fine between 5 and 10 lakh rupees for the first contravention.
    • For subsequent contraventions, these offences will be punishable with imprisonment for a term between eight and 12 years, and a fine between 10 and 20 lakh rupees.
    • Any clinic or bank advertising or offering sex-selective ART will be punishable with imprisonment between five and ten years, or fine between Rs 10 lakh and Rs 25 lakh, or both.
    • No court will take cognisance of offences under the Bill, except on a complaint made by the National or State Board or any officer authorised by the Boards.

     

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  • National Health Accounts Estimates: 2017-18

    Out-of-pocket expenditure (OOPE) as a share of total health expenditure and foreign aid for health has both come down as per the findings of the National Health Accounts (NHA) estimates for India for 2017-18.

    What is National Health Accounts (NHA)?

    • The NHA estimates are prepared by using an accounting framework based on internationally accepted System of Health Accounts 2011, provided by the World Health Organization (WHO).
    • It is released by Ministry of Health & Family Welfare.
    • It describes health expenditures and flow of funds in the country’s health system over a financial year of India.
    • It answers important policy questions such as what are the sources of healthcare expenditures, who manages these, who provides health care services, and which services are utilized.
    • It is a practice to describe the health expenditure estimates according to a global standard framework, System of Health Accounts 2011 (SHA 2011), to facilitate comparison of estimates across countries.

    Objective of the NHA

    • To describe the Current Health Expenditures (CHE).

    The details of CHE are presented according to

    • Revenues of healthcare financing schemes: – entities that provide resources to spend for health goods and services in the health system;
    • Healthcare financing schemes: entities receiving and managing funds from financing sources to pay for or to purchase health goods and services;
    • Healthcare providers: entities receiving finances to produce/ provide health goods and services;
    • Healthcare functions: It describes the use of funds across various health care services.

    About NHA (2017-2018)

    • The 2017-18 NHA estimates shows government expenditure on health exhibiting an increasing trend and growing trust in public health care system.
    • With the present estimate of NHA 2017-18, India has a continuous Time Series on NHA estimates for both government and private sources for five years since 2013-14.
    • These estimates are not only comparable internationally, but also enable the policy makers to monitor progress towards universal health coverage as envisaged in the National Health Policy, 2017.

    Key Highlights

    Increase in GDP share: The NHA estimates for 2017-18 clearly show that there has been an increase in the share of government health expenditure in the total GDP from 1.15% in 2013-14 to 1.35% in 2017-18.

    Increase in govt share in expenditures: In 2017-18, the share of government expenditure was 40.8%, which is much higher than 28.6% in 2013-14.

    Per-Capita increase in expenditure: In per capita terms, the government health expenditure has increased from Rs 1042 to Rs.1753 between 2013-14 to 2017-18.

    Focus on total healthcare: The primary and secondary care accounts for more than 80% of the current Government health expenditure.

    Social security expenditure: The share of social security expenditure on health, which includes the social health insurance program, Government financed health insurance schemes, and medical reimbursements made to Government employees, has increased.

    Decline in foreign aid: The findings also depict that the foreign aid for health has come down to 0.5%, showcasing India’s economic self-reliance.

    Decline in OOPE: The government’s efforts to improve public health care are evident with out-of-pocket expenditure (OOPE) as a share of total health expenditure coming down to 48.8% in 2017-18 from 64.2% in 2013-14.

    Way forward

    • After 18 months of Covid-19, financial year 2017-18 appears to be from another era.
    • However, learnings from that year’s NHA help us to plan for health system strengthening in the post-Covid years.
    • The special financing packages for Covid emergency response, announced by the central government in 2020 and 2021, represent an extraordinary situation.
    • The resolve to increase public financing for health must remain strong even after Covid.

     

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  • Key Demographic Transitions captured by 5th round of NFHS

    The Union health ministry released the summary findings of the fifth round of the National Family and Health Survey (NFHS-5), conducted in two phases between 2019 and 2021.

    About NFHS

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • The previous four rounds of the NFHS were conducted in 1992-93, 1998-99, 2005-06 and 2015-16.
    • The survey provides state and national information for India on:

    Fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services etc.

    Objectives of the survey

    Each successive round of the NFHS has had two specific goals:

    • To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes
    • To provide information on important emerging health and family welfare issues.

    Key highlights of the NFHS-5

    [1] Women outnumbering men

    • NFHS-5 data shows that there were 1,020 women for 1000 men in the country in 2019-2021.
    • This is the highest sex ratio for any NFHS survey as well as since the first modern synchronous census conducted in 1881.
    • To be sure, in the 2005-06 NFHS, the sex ratio was 1,000 or women and men were equal in number.

    [2] Fertility has decreased

    • The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to replace itself from one generation to next.
    • TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1. To be sure, in rural areas, the TFR is still 2.1.
    • In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.

    [3] Population is ageing

    • A decline in TFR, which implies that lower number of children are being born, also entails that India’s population would become older.
    • Sure enough, the survey shows that the share of under-15 population in the country has therefore further declined from 28.6% in 2015-16 to 26.5% in 2019-21.

    [4] Children’s nutrition has improved

    • The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.
    • However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.
    • The share of overweight children has increased from 2.1% to 3.4%.

    [5] Nutrition problem for adults

    • For children and their mothers, there are at least government schemes such as Integrated Child Development Services (ICDS) that seek to address the nutritional needs at the time of childbirth and infancy.
    • However, there is a need to address the nutritional needs of adults too.
    • The survey has shown that though India might have achieved food security, 60% of Indians cannot afford nutritious diets.
    • While the share of women and men with below-normal Body Mass Index (BMI) has decreased, the share of overweight and obese (those with above-normal BMI) and the share of anaemic has increased.

    [6] Basic sanitation challenges

    • Availability of basic amenities such as improved sanitation facilities clean fuel for cooking, or menstrual hygiene products can improve health outcomes.
    • There has been an improvement on indicators for all three since the last NFHS. However, the degree of improvement might be less than claimed by the government.
    • For example, only 70% population had access to an improved sanitation facility.
    • While not exactly an indicator of open defecation, it means that the remaining 30% of the population has a flush or pour-flush toilet not connected to a sewer, septic tank or pit latrine.

    [7] Use of clean fuel

    • The share of households that use clean cooking fuel is also just 59%.

    [8] Financial inclusion

    • The share of women having a bank account that they themselves use has increased from 53% to 79%.
    • Households’ coverage by health insurance or financing scheme also has increased 1.4 times to 41%, a clear indication of the impact of the government’s health insurance scheme.

     

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