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Subject: Social Justice

  • National Family Health Survey- 5 Part: I

    • Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable to all.
    • The data in NFHS-5 gives requisite input for strengthening existing programmes and evolving new strategies for policy intervention, therefore government and authorities should take steps to further improve the condition of women in India.

    The first phase of the fifth National Family Health Survey (NFHS-5) has been released.

    Do you think that India is still the sick man of Asia?

    What is the National Family Health Survey?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • 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, etc.
    • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

    Part I of the Survey

    • The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five UTs (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic.
    • Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.

    Highlights of the NHFS-5

    • The NFHS-5 contains detailed information on population, health, and nutrition for India and its States and Union Territories.
    • This is a globally important data source as it is comparable to Demographic Health Surveys (DHS) Programme of 90 other countries on several key indicators.
    • It can be used for cross country comparisons and development indices.

    Good news

    • Several of the 22 states and UTs, for which findings have been released, showed an increase in childhood immunisation.
    • There has been a drop in neonatal mortality in 15 states, a decline in infant mortality rates in 18 states and an increase in the female population (per 1,000 males) in 17 states.
    • Fertility rate decline and increase in contraceptive use were registered in almost all the states surveyed showing trends of population stabilization.

    Some bad news

    • There has been an increase in stunting and wasting among children in several states, a rise in obesity in women and children, and an increase in spousal violence.
    • In several other development indicators, the needle has hardly moved since the last NFHS-4.

    (1) Hunger Alarm

    • The proportion of stunted children has risen in several of the 17 states and five UTs surveyed, putting India at risk of reversing previous gains in child nutrition made over previous decades.
    • Worryingly, that includes richer states like Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh.
    • The share of underweight and wasted children has also gone up in the majority of the states.

    (2) Fertility Rate

    The total fertility rate (TFR) is defined as the average number of children that would be born to a woman by the time she ends childbearing.

    • The TFR across most Indian states declined in the past half-a-decade, more so among urban women, according to the latest NFHS-5.
    • Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.
    • In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.
    • India’s population is stabilizing, as the total fertility rate (TFR) has decreased across majority of the states.

    (3) Under-5 and infant mortality rate (IMR)

    • The Under 5 and infant mortality rate (IMR) has come down but in parallel recorded an increase in underweight and severely wasted under 5 children among 22 states that were surveyed.
    • These states are Goa, Gujarat, Himachal Pradesh, Kerala, Maharashtra, Meghalaya, Mizoram, Nagaland, Telangana, Tripura, West Bengal, Lakshadweep and Dadra & Nagar Haveli and Daman and Diu.

    For the first time: Gaps in internet use

    • In 2019, for the first time, the NFHS-5, which collects data on key indicators on population health, family planning and nutrition, sought details on two specific indicators: Percentage of women and men who have ever used the Internet.
    • On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet, according to the survey.
    1. First, only an average of 42.6 per cent of women ever used the Internet as against an average of 62.16 per cent among the men.
    2. Second, in urban India, average 56.81 per cent women ever used the Internet compared to an average of 73.76 per cent among the men.
    3. Third, dismal 33.94 per cent women in rural India ever used the Internet as against 55.6 per cent among men.
    • In urban India, 10 states and three union territories reported more than 50 per cent women who had ever used the Internet: Goa (78.1%), Himachal Pradesh (78.9%), Kerala (64.9%), and Maharashtra (54.3%).
    • The five states reporting the lowest percentage of women, whoever used the Internet in urban India were Andhra Pradesh (33.9%), Bihar (38.4%), Tripura (36.6%), Telangana (43.9%) and Gujarat (48.9%).

  • Matru Sahyogini Samitis Scheme

    The MP government has issued an order for the appointment of committees led by mothers to ensure better monitoring of services delivered at Anganwadi or day-care centres across the State.

    Try this PYQ:

    Q.Which of the following are the objectives of ‘National Nutrition Mission’?

    1. To create awareness relating to malnutrition among pregnant women and lactating mothers.
    2. To reduce the incidence of anaemia among young children, adolescent girls and women.
    3. To promote the consumption of millets, coarse cereals and unpolished rice.
    4. To promote the consumption of poultry eggs.

    Select the correct answer using the code given below:

    (a) 1 and 2 only

    (b) 1, 2 and 3 only

    (c) 1, 2 and 4 only

    (d) 3 and 4 only

    Matru Sahyogini Samitis

    • Called ‘Matru Sahyogini Samiti’ or Mothers’ Cooperation Committees, these will comprise 10 mothers at each Anganwadi centres.
    • They would be representing the concerns of different sets of beneficiaries under the Integrated Child Development Services, or National Nutrition Mission.
    • Beneficiaries’ would include children between six months to three years, children between three years and six years, adolescent girls and pregnant women and lactating mothers.
    • These mothers will keep a watch on weekly ration distribution to them as well as suggest nutritious and tasteful recipes for meals served to children at the centres.
    • The move is being taken as per the mandate of the National Food Security Act, 2013 (NFSA).

    Its’ functioning

    • The committees will include mothers of beneficiary children as well as be represented by pregnant women and lactating mothers who are enrolled under the scheme.
    • The Anganwadi scheme includes a package of six services delivered at the centres, including supplementary nutrition, health services including vaccination, early education, among others.
    • The Committees will also include a woman panch, women active in the community and eager to volunteer their support to the scheme, teachers from the local school, and women heads of self-help groups (SHG).

    Why such a move?

    • This is in a move that is aimed at strengthening community response to the problem of hunger and malnutrition in the State.
    • With the help of mothers, we will be able to turn anganwadis into a community health system, a nutrition management centre, and spread awareness against social evils.
    • These will turn into a model for local governance as well as allow for greater engagement between communities and the State government.

    Back2Basics: Integrated Child Development Services (ICDS)

    • The ICDS aims to provide food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
    • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.
    • The tenth FYP also linked ICDS to Anganwadi centres established mainly in rural areas and staffed with frontline workers.
    • The ICDS provide for anganwadis or day-care centres which deliver a package of six services including:
    1. Immunization
    2. Supplementary nutrition
    3. Health checkup
    4. Referral services
    5. Pre-school education (Non-Formal)
    6. Nutrition and Health information

    Implementation

    • For nutritional purposes, ICDS provides 500 kilocalories (with 12-15 grams of protein) every day to every child below 6 years of age.
    • For adolescent girls, it is up to 500-kilo calories with up to 25 grams of protein every day.
    • The services of Immunisation, Health Check-up and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare.

  • Threat of malnutrition to promise of India

    POSHAN Abhiyan has completed 1000 days. The article analyses the challenges country face on the nutrition front which has been exacerbated by the Covid-19 induced disruptions.

    Severity and impact of malnutrition

    • Malnourished children tend to fall short of their real potential — physically as well as mentally.
    • That is because malnutrition leaves their bodies weaker and more susceptible to illnesses.
    • In 2017, a staggering 68% of 1.04 million deaths of children under five years in India was attributable to malnutrition, reckoned a Lancet study in 2019.
    • Without necessary nutrients, their brains do not develop to the fullest.
    • Malnutrition places a burden heavy enough for India, to make it a top national priority.
    • About half of all children under five years in the country were found to be stunted (too short) or wasted (too thin) for their height, estimated the Comprehensive National Nutrition Survey, carried out by the Ministry of Health and Family Welfare with support of UNICEF three years ago.

    POSHAN Abhiyan against the background Covid-19 disruption

    • The Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan in 2018, led to a holistic approach to tackle malnutrition.
    • Under it, the government strengthened the delivery of essential nutrition interventions.
    • COVID-19 is pushing millions into poverty making them vulnerable to malnutrition and food insecurities.
    • Pandemic-prompted lockdowns disrupted essential services — such as supplementary feeding under anganwadi centres, mid-day meals, immunisation, and micro-nutrient supplementation which can exacerbate malnutrition.
    •  Leaders from academia, civil society, development partners, community advocates and the private sector have come together as part of ‘commitment to action’.
    • The ‘commitment to action’ includes commitments around sustained leadership, dedicated finances, multi-sectoral approach and increased uninterrupted coverage of a vulnerable population under programmes enhancing nutrition.

    Financial commitments

    • India already has some of the world’s biggest early childhood public intervention schemes such as the Integrated Child Development Scheme, the mid-day meal programme, and Public Distribution System.
    • India needs to ensure coverage of every single child and mother.
    • To ensure this, the country needs to retain its financial commitments for nutrition schemes.
    • Economic insecurities often force girls into early marriage, early motherhood, discontinue their schooling, and reduce institutional deliveries, cut access to micronutrient supplements, and nutritious food.
    •  Accelerating efforts to address these will be needed to stop the regression into the deeper recesses of malnutrition.

    Conclusion

    It takes time for nutrition interventions to yield dividends, but once those accrue, they can bring transformative generational shifts. Filling in the nutrition gaps will guarantee a level-playing field for all children and strengthen the foundations for the making of a future super-power.

  • Anganwadi centres

    The article highlights the role of Anganwadi’s in the effective implementation and service delivery under the ICDS.

    Gaps in the utilisation of services by ICDS

    • The economic fallout of COVID-19 makes the necessity of quality public welfare services more pressing than ever.
    • The Integrated Child Development Services (ICDS) programme is one such scheme.
    • ICDS caters to the nutrition, health and pre-education needs of children till six years of age as well as the health and nutrition of women and adolescent girls.  
    • However, recent reports have shown gaps in the utilisation of services.

    Recasting the Anganwadi centres

    • Anganwadi centres (AWCs) could become agents of improved delivery of ICDS’s services.
    • According to government data, the country has 13.77 lakh Anganwadi centres (AWCs).
    • These centres have expanded their reach, but they need to play a much larger role in anchoring community development.
    • Nearly a fourth of the operational AWCs lack drinking water facilities and 36 per cent do not have toilets.
    • In 2015, the NITI Aayog recommended better sanitation and drinking water facilities, improved power supply and basic medicines for the AWCs.
    • NITI Aayog also suggested that these centres be provided with the required number of workers, whose skills should be upgraded through regular training.
    •  It has acknowledged the need to improve anganwadi centres.
    • The Central government’s Saksham Anganwadi Scheme aims to upgrade 2.5 lakh such centres across the country. It is up to the state governments to take up the baton
    • Only a limited number of AWCs have facilities like creche, and good quality recreational and learning facilities for pre-school education.
    • An approach that combines an effective supplementary nutrition programme with pedagogic processes that make learning interesting is the need of the hour.

    Steps taken for effective implementation of ICDS

    • Effective implementation of the ICDS programme rests heavily on the combined efforts of the anganwadi workers (AWWs), ASHAs and ANMs.
    • The Centre’s POSHAN Abhiyaan has taken important steps towards building capacities of AWWs.
    • Technology can also be used for augmenting the programme’s quality.
    • AWWs have been provided with smartphones and their supervisors with tablets, under the government schemes.
    • Apps on these devices track the distribution of take-home rations and supplementary nutrition services.
    • The data generated should inform decisions to improve the programme.
    • In Andhra Pradesh and Telangana, anganwadi centres have been geotagged to improve service delivery.
    • Gujarat has digitised the supply chain of take-home rations and real-time data is being used to minimise stockouts at the anganwadi centres.

    Conclusion

    Government must act on the three imperatives. First, while infrastructure development and capacity building of the anganwadi remains the key to improving the programme, the standards of all its services need to be upscaled. Second, states have much to learn from each other’s experiences. Third, anganwadi centres must cater to the needs of the community and the programme’s workers.

  • Healthcare in India & Pandemic

    Pandemic has been ravaging the world in a way few could have imagined. It highlighted the flaws in our healthcare system. However, it also offers several important lessons for tackling future pandemics and healthcare emergencies.

    Where we stand after 1 year of pandemic

    • About a year after the first cases were reported, we are in a different position than at the start.
    • Doctors, public health specialists and policymakers have a better sense of the interventions that are required.
    • Many treatments initially proposed, based on expert experience, have been tested and removed from management strategies even as modified protocols have improved survival rates.
    • Vaccines have moved even faster than drugs with  nearly 40 of them undergoing clinical trials, a dozen of which are at the phase three stage, and at least one has been licensed post-phase three trials under conditional emergency use authorisation (EUA).
    • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.
    • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.

    Takeaways from our response to pandemic

    1) Increase investment on health services

    • The countries which handled the pandemic best (Thailand and Vietnam) have well-functioning health systems designed to deliver primary healthcare services.
    • These countries also have strong preventive and promotive health services as well as a dedicated public health workforce.
    • Their governments had made sustained investments in health over decades.
    • In contrast, countries which focused mainly on hospital centric medical systems struggled.

    2) Important role played by health workers

    • The role of community health workers in recognising, referring and motivating individuals for therapy was remarkable.
    • Healthcare workers, particularly those at the frontline, such as the accredited social health activists (ASHA) who visited hundreds of households repeatedly during the pandemic.
    •  If we are to build back better, we need to give them better recognition, salaries and career progression.

    3) Increase community participation

    • Third, community trust and participation is essential for implementation of non-pharmacological interventions.
    • Dharavi in Mumbai is an example of the difference community participation can make.

    4) Importance of data

    • Outside of the immediate response, the need for timely and quality data in a health information system was recognised again during the pandemic.
    • Without real time data on testing, disease surveillance and other outcomes, tailored responses are near impossible.
    • The solutions that have brought us hope have come from long-term private or public investments in scientific research and developments.

    Conclusion

    Future readiness needs to start now, and we have the resources and knowledge to do this — all we need is commitment and that is outlined in the recent National Health Policy 2017 and reiterated in the report of the Fifteenth Finance Commission, which for the first time has a dedicated chapter on health.

  • [pib] Digital platform ‘CO-WIN’

    A New Digital platform ‘CO-WIN’ is being used for COVID-19 Vaccine Delivery.

    Q.India’s first mass adult vaccination drive against COVID-19 is a difficult task. Explain.

    CO-WIN

    • This user friendly mobile app for recording vaccine data is working as a beneficiary management platform having various modules.
    • The platform will be used for recording vaccine data and will form a database of healthcare workers too.
    • The app will have separate modules for administrator, registration, vaccination, beneficiary acknowledgement and reports.
    • Once people start to register for the app, the platform will upload bulk data on co-morbidity provided by local authorities.
    • In the process of forming database of Healthcare Workers, which is in an advanced stage across all States/UTs, data is presently being uploaded on the Co-WIN platform.

    Prioritized group

    Prioritized Population Groups include:

    1. Healthcare Workers in both Government and Private Healthcare facilities
    2. Frontline Workers including personnel from state and central police department, armed forces, home guard, civil defence organizations, disaster management volunteers and municipal workers and
    3. Prioritized Age Group, which includes those aged above 50 years & those with co-morbidities

    (Note: This is not the sequence, but categorization.)

  • India’s Population with Disabilities

    December 3 is marked by the UN as International Day of Persons with Disabilities in a bid to promote a more inclusive and accessible world for the differently-abled and to raise awareness for their rights.

    Try this question from our AWE initiative:

    What are the legal provisions and policy initiatives in India for the welfare of persons with disabilities? What are the challenges faced by persons with disabilities in India? 10 marks

    Disability in India

    • About 2.2% of India’s population lives with some kind of physical or mental disability, as per the National Statistics Office report on disability released last year.

    How are the disabled identified?

    • Until the 2011 census, there were questions on seven kinds of disabilities in the questionnaire.
    • This list of disabilities was expanded to 21 when the Rights of People with Disabilities was introduced in 2016.
    • Accordingly, the 2019 report included questions to identify people with temporary loss of ability as well as neurological and blood disorders in addition.
    • The earlier definition included mental retardation and permanent inability to move, speak, hear and see.
    • Significantly, the revised definition recognizes deformities and injuries of acid attack victims as disabilities, entitling them to various relief measures.

    Who are disabled and in what way?

    • Rural men had the highest prevalence of disability in India, according to the NSO report.
    • A higher proportion of men were disabled in India compared with women, and disability was more prevalent in rural areas than in urban areas.
    • Inability to move without assistance was the most common disability. More men experienced locomotor disability than women.
    • These numbers were self-reported. In other words, the respondents were asked if they experienced any difficulty in performing tasks like moving, talking, etc.

    Are these measures in line with those from other surveys?

    • The 2011 census estimated that the number of people with disabilities in India is close to 2.68 crore (or 2.2% of the population) — that is more than the entire population of Australia.
    • This number was based on the older definition of disability, yet the proportion of disabled people in the population is not different from the 2019 NSO report, which used the expanded definition of disability.
    • Other metrics for evaluating disability have provided different estimates.
    • A group of doctors from AIIMS found that alternate questionnaires like the Rapid Assessment of Disability have resulted in a prevalence ranging from 1.6%-43.3%.

    How can the range be so wide?

    • The proportion of population facing disability becomes bigger as one move from a narrow definition to a broader one.
    • For instance, if one defines disability as the difficulty in accessing public services for all kinds of reasons, even social or economic, then the proportion goes up.

    Why is it important to map disabled people?

    • Like other disadvantaged groups, the disabled in India are entitled to some benefits, ranging from reservation in educational institutes to concessions on railway tickets.
    • To claim these benefits, they have to furnish certificates as proof of disability.
    • At the macro level, data on the prevalence and type of disability is useful while making allocations for welfare schemes.

  • [pib] E-Sanjeevani Telemedicine Service

    In a landmark achievement, eSanjeevani, Health Ministry’s national telemedicine initiative today completed 9 lakh consultations.

    Although telemedicine brings with it many benefits, there are some downsides to it as well. Discuss.

    What is E-Sanjeevani?

    • Ministry of Health & Family Welfare has launched two variants of eSanjeevani namely – doctor to doctor (eSanjeevani AB-HWC) in the hub and spoke model and patient to doctor (eSanjeevaniOPD).
    • E-Sanjeevani OPD (out-patient department) is a telemedicine variant for the public to seek health services remotely; it was rolled out on 13th of April 2020 during the first lockdown in the country.
    • It enables virtual meetings between the patients and doctors & specialists from geographically dispersed locations, through video conferencing that occurs in real-time.
    • At the end of these remote consultations, eSanjeevani generates electronic prescriptions which can be used for sourcing medicines.
    • Andhra Pradesh was the first state to roll out eSanjeevani AB-HWC services in November 2019.

    Benefits of telemedicine

    Telemedicine benefits patients in the following ways:

    • Transportation: Patients can avoid spending gas money or wasting time in traffic with video consultations.
    • No missing work: Today, individuals can schedule a consultation during a work break or even after work hours.
    • Childcare/Eldercare Challenges: Those who struggle to find care options can use telemedicine solutions.

  • What is the Emergency Use Authorization (EUA) for Drugmakers?

    The US drugmaker Moderna said it was applying for emergency use authorisation for its vaccine in India.

    Practice question for Mains:

    Q. What is Vaccine Nationalism? Discuss various ethical issues involved and its impact on vulnerable populations across the globe.

    Emergency Use Authorisation (EUA)

    • Vaccines and medicines, and even diagnostic tests and medical devices, require the approval of a regulatory authority before they can be administered.
    • In India, the regulatory authority is the Central Drugs Standard Control Organisation (CDSCO).
    • The approval is granted after an assessment of their safety and effectiveness, based on data from trials. In fact, approval from the regulator is required at every stage of these trials.
    • This is a long process, designed to ensure that medicine or vaccine is absolutely safe and effective.
    • The fastest approval for any vaccine until now — the mumps vaccine in the 1960s — took about four-and-a-half years after it was developed.

    Exceptions for emergency

    • In emergency situations, like the current one, regulatory authorities around the world have developed mechanisms to grant interim approvals.
    • However, there should sufficient evidence to suggest a medical product is safe and effective.
    • Final approval is granted only after completion of the trials and analysis of full data; until then, EUA allows the medicine or the vaccine to be used on the public.

    What is the process of getting a EUA in India?

    • India’s drug regulations do not have provisions for a EUA, and the process for receiving one is not clearly defined or consistent.
    • Despite this, CDSCO has been granting emergency or restricted emergency approvals to Covid-19 drugs during this pandemic — for remdesivir and favipiravir in June, and itolizumab in July.

    Associated risks

    • The public has to be informed that a product has only been granted a EUA and not full approval.
    • In the case of a Covid-19 vaccine, for example, people have to be informed about the known and potential benefits and risks.

    Not a compulsion

    • There has been an ongoing debate over whether people have the option of refusing to take the vaccine.
    • Incidentally, no country has made vaccination compulsory for its people.
    • Initially, all vaccines are likely to be deployed on emergency use authorizations only. Final approval from may take several months, or years.

  • Swasthya Sathi Health Insurance Scheme

    West Bengal CM has recently extended the Swasthya Sathi health insurance scheme to cover the entire population of the state.

    Do you know?

    Delhi, Telangana, Odisha and West Bengal have not implemented the Ayushman Bharat Scheme.

    Swasthya Sathi

    • The scheme was launched in West Bengal in 2016.
    • It is a basic health cover for secondary and tertiary care up to Rs five lakh per annum per family.
    • It is quite popular among rural and economically deprived sections of the state’s population.

    Highlights of the expanded scheme

    • Every family, every citizen irrespective of the age group will be included in this scheme
    • This is a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family
    • The scheme is completely funded by the state government
    • To cover the entire population of the state, each and every family will be given one smart card to avail the benefits under this scheme, where they will get cashless treatment
    • All state-run and private hospitals are going to come under the Swasthya Sathi
    • The card will be issued to the female guardians of families