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Subject: Social Justice

  • Project Sampoorna: A successful measure against malnutrition

    Project Sampoorna’s success in reducing child malnutrition is a model that can be easily implemented anywhere.

    What is Project Sampoorna?

    • Project Sampoorna has been implemented in the Bongaigaon district of Assam.
    • It aims to target Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM).
    • It was launched to target the mothers of SAM/ MAM children with the tagline being ‘Empowered Mothers, Healthy Children’.
    • It was based on the success of the community-based COVID-19 management model (Project Mili Juli).

    Key features of the project

    • Under this project, the mother of a healthy child of an Anganwadi Centre was paired with the target mother and they would be Buddy Mothers.
    • They were usually neighbours and shared similar socioeconomic backgrounds.
    • They were given diet charts to indicate the daily food intake of their children and would have discussions on all Tuesdays at the Anganwadi centres.
    • 100 millilitres of milk and an egg on alternate days for the children for the first 3 months were provided so that their mothers could stabilise themselves in the newly found jobs.
    • Children who had not improved were checked and treated by doctors under the Rashtriya Bal Swasthya Karyakram (RBSK).

    Success of the project

    • This project has prevented at least 1,200 children from becoming malnourished over the last year.
    • National Nutrition Mission and the State government recognised this project in the ‘Innovation Category’.
    • The mothers were enrolled in Self Help Groups (SHGs) under the National Rural Livelihoods Mission (NRLM) and were thus working.

     

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  • Global Drug Policy Index inaugurated

    The first-ever Global Drug Policy Index was recently inaugurated.

    Global Drug Policy Index

    • It is released by the Harm Reduction Consortium, ranks Norway, New Zealand, Portugal, the UK and Australia as the five leading countries on humane and health-driven drug policies.
    • It is a data-driven global analysis of drug policies and their implementation.
    • It is composed of 75 indicators running across five broad dimensions of drug policy:
    1. Criminal justice
    2. Extreme responses
    3. Health and harm reduction
    4. Access to internationally controlled medicines and
    5. Development

    Highlights of the 2021 ranking

    • The five lowest-ranking countries are Brazil, Uganda, Indonesia, Kenya, and Mexico.
    • Norway, despite topping the Index, only managed a score of 74/100.
    • And the median score across all 30 countries and dimensions is just 48/100.

    India’s performance

    • India’s rank is 18 out of 30 countries
    • It has an overall score of 46/100.

     

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  • Should the NDPS Act be amended?

    • The Union Ministry of Social Justice and Empowerment has proposed certain changes to some provisions of the Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985.
    • The recommendations have assumed importance in the backdrop of some high-profile drug cases including the recent arrest of Bollywood actor’s son.

    What is NDPS Act?

    • The NDPS Act, 1985 is the principal legislation through which the state regulates the operations of narcotic drugs and psychotropic substances.
    • It provides a stringent framework for punishing offenses related to illicit traffic in narcotic drugs and psychotropic substances through imprisonments and forfeiture of property.
    • This is a stringent law where the death penalty can be prescribed for repeat offenders.

    Key amendments suggested

    • To decriminalise the possession of narcotic drugs in smaller quantities for personal purposes.
    • Persons using drugs in smaller quantities be treated as victims.

    Issues with the NDPS Act

    Ans. First arrest and then investigate

    • First arrest and then investigate seems to be the principle for investigations under the NDPS Act.
    • Section 50 of the Act (conditions under which search of persons shall be conducted) needs to be followed scrupulously.
    • When officials stumble upon a person carrying drugs during raids or a routine check, the drugs must be seized in front of a Gazetted Officer or a Magistrate.

    Why such provision?

    • In cases of sudden development, the suspect is taken to the nearby Magistrate or the latter is brought to the spot and then only drugs are seized.
    • If this is not adhered to, the court acquits the accused persons. Only then the next stage of investigation commences.
    • While tracking drugs cases, investigators go from consumers to drug suppliers.

    Is there any scope of mi-use?

    • It is not possible at all. Once cannot manage all the people all the time.
    • Since the seizure procedure is to be followed, there could be one Magistrate at the time of seizing drugs, another during further investigation and a different Magistrate at the time of trial.
    • Moreover, governments can change.

    Challenges in enforcing the NDPS Act

    (a) Peddling

    • Since drug peddling is an organised crime, it is challenging for the police to catch the persons involved from the point of source to the point of destination.
    • Identifying drugs that are being transported is a challenge since we cannot stop each and every vehicle that plies on Indian roads.

    (b) Transportation

    • Most drug bust cases are made possible with specific information leads.
    • Unless we check every vehicle with specially trained sniffer dogs, it is difficult to check narcotic drugs transportation.

    (c) Production

    • The main challenge is to catch those producing these substances. Secret cultivation are mostly carried on in LWE affected areas.
    • Going beyond State jurisdiction, finding the source of narcotic substances and destroying them is another big challenge.

    (d) Delay in trials

    • Securing conviction for the accused in drugs cases is yet another arduous task. There are frequent delays in court procedures.
    • Sometimes, cases do not come up for trial even after two years of having registered them.
    • By then, the accused are out on bail and do not turn up for trial.
    • Bringing them back from their States to trial is quite difficult let alone getting them convicted.

    Other Challenges

    (a) Growing hopelessness in society

    • The COVID-19 pandemic, for instance, has aggravated anxieties among the youth.
    • Joblessness and livelihood losses are the major push factors.

    (b) Issues in rehabilitation

    • The proposal to send persons to rehabilitation centres is good on paper but we do not have the infrastructure to ensure that it is properly implemented.
    • We don’t have adequate de-addiction centre counsellors. We face an acute shortage of psychiatrists and counsellors.

    Issues in legalization of drugs

    • Legalisation of drugs usage will only compound the problem.
    • It could lead to the proliferation of drugs.
    • It is dangerous. More and more people may start using them.

    Way forward

    • We need to thoroughly examine why and how people are getting addicted to narcotic drugs.
    • No doubt the NDPS Act is stringent, but we need to make a distinction between the drug peddler and the end user.
    • The person using it in smaller quantities for personal use cannot be bracketed with the person producing narcotic drugs.
    • We need to make a clear distinction between a drug supplier and an end user.
    • A drug user needs to be seen as a patient. The Act as of now prescribes jail for everyone — the end user and the drug supplier.
    • Instead of suggesting proposals to change sections of the law for the entire country, it would be advisable to introduce this on a pilot basis in one State that faces an acute drugs-related problem.

    Conclusion

    • We should examine the root cause of the problem.
    • Relying only on law-enforcing agencies, however hard they are at work to address the problem, is not going to solve it.
    • Civil society and governments will have to work together to create an enabling environment to address the issue.

     

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  • Strengthening healthcare through ABHIM

    Context

    The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM), announced recently, seeks to realise greater investment in the health system as proposed in the Budget, implement the Fifteenth Finance Commission recommendations such as strengthening of urban and rural primary care, stronger surveillance systems and laboratory capacity.

    Measures of ABHIM

    • It will support infrastructure development of 17,788 rural health and wellness centres (HWCs) in seven high-focus States and three north-eastern States.
    • In addition, 11,044 urban HWCs will be established in close collaboration with Urban Local Bodies.
    • The various measures of this scheme will extend primary healthcare services across India.
    • Areas like hypertension, diabetes and mental health will be covered, in addition to existing services.
    • Support for 3,382 block public health units (BPHUs) in 11 high-focus States and establishment of integrated district public health laboratories in all 730 districts will strengthen capacity for information technology-enabled disease surveillance.
    • To enhance the capabilities for microbial surveillance, a National Platform for One Health will be established.
    • Four Regional National Institutes of Virology will be established.
    • Laboratory capacity under the National Centre for Disease Control, the Indian Council of Medical Research and national research institutions will be strengthened.
    • Fifteen bio-safety level III labs will augment the capacity for infectious disease control and bio-security.

    Way forward

    • There is a need to train and deploy a larger and better skilled health workforce.
    • We must scale up institutional capacity for training public health professionals.
    • Private sector participation in service delivery may be invited by States, as per need and availability.
    • ABHIM, if financed and implemented efficiently, can strengthen India’s health system by augmenting capacity in several areas and creating a framework for coordinated functioning at district, state and national levels.
    • Many independently functioning programmes will have to work with a common purpose by leaping across boundaries of separate budget lines and reporting structures.
    • That calls for a change of bureaucratic mindsets and a cultural shift in Centre-State relations.

    Conclusion

    The ABHIM can fix the weaknesses in India’s healthcare system.

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  • Preparing for outbreaks

    Context

    Prime Minister Narendra Modi launched the Ayushman Bharat Health Infrastructure Mission, one of the largest pan-India schemes for strengthening healthcare infrastructure, in his parliamentary constituency Varanasi in Uttar Pradesh.

    Aims of Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) and how it seeks to achieve it

    • This was launched with an outlay of ₹64,180 crore over a period of five years.
    •  In addition to the National Health Mission, this scheme will work towards strengthening public health institutions and governance capacities for wide-ranging diagnostics and treatment, including critical care services.
    • The latter goal would be met with the establishment of critical care hospital blocks in 12 central institutions such as the All India Institute of Medical Sciences, and in government medical colleges and district hospitals in 602 districts.
    • Laboratories and their preparedness: The government will be establishing integrated district public health labs in 730 districts to provide comprehensive laboratory services.
    • Research: ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
    • One health approach: The government also aims to develop a core capacity to deliver the ‘one health’ approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals.
    • Surveillance labs: A network of surveillance labs will be developed at the block, district, regional and national levels for detecting, investigating, preventing, and combating health emergencies and outbreaks.
    • Local capacities in urban areas: A major highlight of the current pandemic has been the requirement of local capacities in urban areas.
    • The services from the existing urban primary health centres will be expanded to smaller units – Ayushman Bharat Urban Health and Wellness Centres and polyclinics or specialist clinics.

    Conclusion

    The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) is another addition to the arsenal we have to prepare for such oubreaks in the future.

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  • Ayushman Bharat Health Infrastructure Mission

    PM has launched the Ayushman Bharat Health Infrastructure Mission (AB-HIM), one of the largest pan-India schemes for strengthening healthcare infrastructure.

    AB- Health Infrastructure Mission

    • AB-HIM is being rolled out as India’s largest scheme to scale up health infrastructure.
    • It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.

    Key features

    • Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
    • Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
    • Integrated public health labs: will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
    • Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
    • Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.

    Why is the scheme significant?

    • India has long been in need of a ubiquitous healthcare system.
    • A 2019 study has highlighted how access to public health care remained elusive to those living on the margins.
    • The study found that 70 per cent of the locations have public healthcare services.
    • However, availability was less in rural areas (65 per cent) compared to urban areas (87 per cent).
    • In 45 per cent of the surveyed locations, people could access healthcare services by walking, whereas in 43 per cent of the locations they needed to use transport.

     

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  • What the low rank on the Global Hunger Index means for India

    Context

    This year’s Global Hunger Index (GHI) ranks India 101 out of 116 countries for which reliable and comparable data exist.

    Government’s stand

    • Is India’s performance on hunger as dismal as denoted by the index or is it partly a statistical artefact?
    • This question assumes immediacy, especially since the government has questioned the methodology and claimed that the ranking does not represent the ground reality.
    • This calls for careful scrutiny of the methodology, especially of the GHI’s components.

    Understanding the GHI methodology

    • The GHI has four components.
    • The first — insufficient calorie intake — is applicable for all age groups.
    • The data on deficiency in calorie intake, accorded 33% weight, is sourced from the Food and Agriculture Organization’s Suite of Food Security Indicators (2021).
    • The remaining three — wasting (low weight for height), stunting (low height for age) and mortality — are confined to children under five years.
    • The data on child wasting and stunting (2016-2020), each accounting for 16.6% of weight, are from the World Health Organization, UNICEF and World Bank, complemented with the latest data from the Demographic and Health Surveys.
    • Under-five mortality data are for 2019 from the UN Inter-Agency Group for Child Mortality Estimation.

    Issues with GHI

    • The GHI is largely children-oriented with a higher emphasis on undernutrition than on hunger and its hidden forms, including micronutrient deficiencies.
    • The first component — calorie insufficiency — is problematic for many reasons.
    • The lower calorie intake, which does not necessarily mean deficiency, may also stem from reduced physical activity, better social infrastructure (road, transport and healthcare) and access to energy-saving appliances at home, among others.
    • For a vast and diverse country like India, using a uniform calorie norm to arrive at deficiency prevalence means failing to recognise the huge regional imbalances in factors that may lead to differentiated calorie requirements at the State level.

    Understanding the connection between stunting and wasting and ways to tackling them

    • India’s wasting prevalence (17.3%) is one among the highest in the world.
    •  Its performance in stunting, when compared to wasting, is not that dismal, though.
    • Child stunting in India declined from 54.2% in 1998–2002 to 34.7% in 2016-2020, whereas child wasting remains around 17% throughout the two decades of the 21st century.
    • Stunting is a chronic, long-term measure of undernutrition, while wasting is an acute, short-term measure.
    • Quite possibly, several episodes of wasting without much time to recoup can translate into stunting.
    • Effectively countering episodes of wasting resulting from such sporadic adversities is key to making sustained and quick progress in child nutrition.
    • Way forward: If India can tackle wasting by effectively monitoring regions that are more vulnerable to socioeconomic and environmental crises, it can possibly improve wasting and stunting simultaneously.

    Low child mortality

    • India’s relatively better performance in the other component of GHI — child mortality — merits a mention.
    • Studies suggest that child undernutrition and mortality are usually closely related, as child undernutrition plays an important facilitating role in child mortality.
    • However, India appears to be an exception in this regard.
    • This implies that though India was not able to ensure better nutritional security for all children under five years, it was able to save many lives due to the availability of and access to better health facilities.

    Conclusion

    The low ranking does not mean that India fares uniformly poor in every aspect. This ranking should prompt us to look at our policy focus and interventions and ensure that they can effectively address the concerns raised by the GHI, especially against pandemic-induced nutrition insecurity.

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  • India ranked 101 in Global Hunger Index (GHI)

    The Global Hunger Index 2021 has ranked India at 101 positions out of a total 116 countries.

    Note the parameters over which the GHI is based and their weightage composition.

    Global Hunger Index (GHI)

    • The Global Hunger Index is a peer-reviewed annual report, jointly published by Concern Worldwide and Welthungerhilfe.
    • It determines hunger on a 100-point scale, where 0 is the best possible score (no hunger) and 100 is the worst.
    • It is designed to comprehensively measure and track hunger at the global, regional, and country levels.
    • The aim of the GHI is to trigger action to reduce hunger around the world.

    For each country in the list, the GHI looks at four indicators:

    1. Undernourishment (which reflects inadequate food availability): calculated by the share of the population that is undernourished (that is, whose caloric intake is insufficient)
    2. Child Wasting (which reflects acute undernutrition): calculated by the share of children under the age of five who are wasted (that is, those who have low weight for their height)
    3. Child Stunting (which reflects chronic undernutrition): calculated by the share of children under the age of five who are stunted (that is, those who have low height for their age)
    4. Child Mortality (which reflects both inadequate nutrition and unhealthy environment): calculated by the mortality rate of children under the age of five

    India’s (poor) performance

    • India is among the 31 countries where hunger has been identified as serious.
    • Only 15 countries fare worse than India.
    • Some of these include Afghanistan (103), Nigeria (103), Congo (105), Mozambique (106), Sierra Leone (106), Timor-Leste (108), Haiti (109), Liberia (110), Madagascar (111) and Somalia (116).
    • India was also behind most of the neighbouring countries.
    • Pakistan was placed at 92 rank, Nepal at 76 and Bangladesh also at 76.

    Reasons for such poor performance

    • Poor maternal health: Mothers are too young, too short, too thin and too undernourished themselves, before they get pregnant, during pregnancy, and then after giving birth, during breast-feeding.
    • Poor sanitation: Poor sanitation, leading to diarrhoea, is another major cause of child wasting and stunting.
    • Food insecurity: Low dietary diversity in India is also a key factor in child malnutrition.
    • Poverty: Almost 50 million households in India are dependent on these small and marginal holdings.
    • Livelihood loss: The rural livelihoods loss after COVID and lack of income opportunities other than the farm sector have contributed heavily to the growing joblessness in rural areas.

    Issues over credibility of GHI

    • India has ranked among many African countries while it is among the top 10 food-producing countries in the world.

     

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  • On Digital Health ID, proceed with caution

    Much recently, the Prime Minister had launched the Digital Health ID project (DHID), generating debate on issues related to the use of technology in a broken health system.

    Explained: Digital Health ID

    Good intents of the DHID

    • The key objective of DHID is to improve the quality, access and affordability of health services by making the service delivery “quicker, less expensive and more robust”.
    • The ambition is undoubtedly high. Given that health systems are highly complex, the DHID would hardly be able to address some of the issues plaguing it.

    Why need DHID?

    (a) Record maintenance

    • The use of technology for record maintenance is not just inevitable but necessary. Its time has certainly come.
    • A decade ago, the process to shift towards electronic medical records was initiated in the private sector.
    • It met with limited success, despite the strong positives.
    • With DHID, the burden of storing and carrying health records for every visit to the doctor is minimised.

    (b) Better tracking of medical history

    • The doctor has instant access to the patient’s case history –the treatment undertaken, where and with what outcomes — enabling more accurate diagnosis and treatment.
    • As the DHID enables portability across geography and healthcare providers, it also helps reduce re-testing or repeating problems every time a patient consults a new doctor.
    • That’s a huge gain, impacting the quality of care and enhancing patient satisfaction and confidence.

    (c) Better Diagnosis

    • DHID can have a transformative impact in promoting ecosystems that function as paperless facilities.
    • Paperless hospitals can promote early diagnosis before the patient reaches the doctor after spending long hours in queue.
    • The doctor can already go through the patient’s record and the pharmacist can make the drugs available by the time the patient reached its counter.

    (d) Promoting medical research

    • Digitisation of medical records is another important positive, given the problems related to space and retrieving huge databases.
    • Well organised repositories that enable easy access to records can stimulate much-needed research on medical devices and drugs.
    • This storehouse of patient data can be valuable for clinical and operational research.

    Given our population, would this be an idealistic expectation?

    • We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.
    • While technology helps smoothen processes and enhance patient experience, there is a cost attached.
    • Investments have to be made upfront and results should not be expected overnight.

    Issues with DHID

    (a) A costly affair

    • In the immediate short run, DHID will increase administrative costs by about 20 per cent, due to the capital investment in data infrastructure.
    • Over the long run, the additional cost to healthcare is expected to be about 2 per cent.
    • Any scaling up of this reform would require extensive fiscal subsidies and more importantly providing techno-logistical support to both government and private hospitals.

    (b) Privacy concerns

    • Most important is the issue of privacy, the high possibility of hacking and breach of confidentiality.
    • The possibility of privacy being violated increases with the centralisation of all information.
    • Though it is said that the patient is the owner of the information, how many of us deny access, as a matter of routine, when we download apps or programmes that seek access to all our records?
    • How far is this “consent” practical for an illiterate, vulnerable patient desperate to get well?
    • So, taking refuge behind a technical statement that access is contingent on patient consent is unconvincing.

    Ground situation in India

    • Inherently unaffordable healthcare: The costs in the Indian context can be high and that should lead to a careful assessment of the project.
    • Digital divide: Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population.
    • Infrastructure gap: A large majority of facilities do not have the required physical infrastructure — electricity, accommodation, trained personnel.
    • Usual nature of technical glitches: Cards getting corrupted, servers being down, computers crashing or hanging, and power outages are common in India.
    • Conformity over data synchronization: The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects.
    • Accuracy of records: Besides, the efficacy of the DHID hinges on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded.
    • Increased workload on Medical Professionals: Moreover, while electronic mapping of providers may enable patients to spot a less busy doctor near their location, it is simplistic to assume that the patient will go there.

    Plugging the existing gaps

    • Patient preference for a doctor is dependent upon perception and trust. Likewise, teleconsultations need a huge backend infrastructure and organisation.
    • Teleconsulting has certainly helped patients access medical advice for managing minor ailments, getting prescriptions on the phone and even getting drugs delivered home.
    • But in handling chronic diseases that necessitate continuity of care, teleconsultations have been problematic and cannot be substituted for actual physical examination.
    • Continuity of care is central to good outcomes in inpatient management of chronic diseases.
    • The one serious shortcoming of using teleconsultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
    • Technology can be of little use in the absence of doctors and basic infrastructure.

    Way forward

    • What is needed is building very robust firewalls and trust.
    • Seeing the frequency with which Aadhaar cards have been breached, it is not unreasonable to be concerned with this issue and the implications it has at the family and societal levels.
    • For this reason, instead of a big bang approach, it is better to go slow and steady.
    • That’s the only way to ensure that a good policy does not die along the way due to poor implementation.

     

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  • What are the concerns of digital health mission?

    The Ayushman Bharat Digital Mission (ABDM), was recently launched by the PM.

    About Ayushman Bharat Digital Mission

    • The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
    • The mission will enable access and exchange of longitudinal health records of citizens with their consent.
    • This will ensure ease of doing business for doctors and hospitals and healthcare service providers.

    The key components of the project include

    • Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
    • Healthcare Professionals Registry (HPR)
    • Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine

    How will it work?

    • In order to be a part of the ABDM, citizens will have to create a unique health ID – a randomly generated 14-digit identification number.
    • The ID will give the user unique identification, authentication and will be a repository of all health records of a person.
    • The ID can also be made by self-registration on the portal, downloading the ABMD Health Records app on one’s mobile or at a participating health facility.
    • The beneficiary will also set up a Personal Health Records (PHR) address for the issue of consent, and for future sharing of health records.

    Major privacy issues involved

    • Informed Consent: The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
    • Data leakages issue: Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
    • Digital divide: Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
    • Data Migration: The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.

    Other challenges

    • Existing digitalization is yet incomplete: India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
    • Lack of healthcare facilities: The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
    • Lack of finance: With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.