Subject: Social Justice

The Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry has allowed postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.

Debate over Ayurvedic surgeries

• The Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy.
• The debate revolves Ayurveda doctors allowing  ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures.
• The AYUSH Ministry has clarified that the ‘Shalya’ and ‘Shalakya’ postgraduates were already learning these procedures in their (surgical) departments in Ayurvedic medical colleges as per their training curriculum.

Broader issue

• The broader issue is the feasiblity of short-term training equip them to conduct surgeries and if this dilutes the medicine standards in India.
•  As such, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course.
• Whether the surgeries conducted in Ayurvedic medical colleges and hospitals have the same standards and outcomes as allopathic institutions requires explication and detailed formal enquiry, in the interest of patient safety.

Why such a move?

• The shortage and unwillingness of allopathic doctors, including surgeons, to serve in rural areas is now a chronic issue.
• The government has tried to address this by mechanisms such as rural bonds, a quota for those who have served in rural service in postgraduate seats.
• However, it would probably still continue to fall short of enough trained specialists in rural areas.

Are there any restrictions on Ayurveda practitioners?

•  As of now, no such restriction exists that limits non-allopathic doctors, including those doing Ayurvedic surgical postgraduation, to rural areas.
• They have the same rights as allopathic graduates and postgraduates to practise in any setting of their choice.

Is it sensible to allow Ayurvedic surgeons to only assist allopathic surgeons, rather than perform surgeries themselves?

• The AYUSH streams are recognised systems of medicine, and as such are allowed to independently practise medicine.
• They have medical colleges with both undergraduate and postgraduate training, which include surgical disciplines for some systems, such as Ayurveda.
• There is, however, a difference in approach in the systems of medicine, and hence models, which allow for cross-pathy.

Various risks associated

• An apprenticeship model for Ayurvedic surgeons working with allopathic surgeons might fall into a regulatory grey zone.
• It might require re-training Ayurvedic practitioners in the science of surgical approaches in modern medicine.
• Even then, there might be a limit to what they are allowed to do. Any such experiment can put patient safety in peril, and hence, will need careful oversight and evaluation.

Can this lead to substandard care?

• Many patients prefer to receive treatment exclusively from AYUSH providers, while some approach this form of treatment as a complement to the existing allopathic treatment they are receiving.
• For invasive procedures, like surgery, the risk element can be high.

A matter of rights

• Patients have a right to know and understand who their surgeon would be, what system of medicine they belong to, and their expertise and level of training.
• There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals.

The government is using eVIN – Electronic Vaccine Intelligence Network in association with the United Nations Development Program (UNDP) to identify primary beneficiaries and vaccine distribution networks.

Try this question from CSP 2016:

Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

(a) Immunization of children and pregnant women

(b) Construction of smart cities across the country

(c) India’s own search for the Earth-like planets in outer space

(d) New Educational Policy

What is eVIN?

• E-VIN is an indigenously developed technology that digitizes vaccine stocks and monitors the temperature of the cold chain through a smartphone application.
• It was first launched across 12 states in 2015 to support better vaccine logistics management at cold chain points.
• It supports the central government’s Universal Immunization Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points across states and UTs.

Components of eVIN

• eVIN combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real-time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country.
• At present, 23,507 cold chain points across 585 districts of 22 States and 2 UTs routinely use the eVIN technology for efficient vaccine logistics management.

Benefits of eVIN

• It has helped create a big data architecture that generates actionable analytics encouraging data-driven decision-making and consumption-based planning.
• It helps in maintaining optimum stocks of vaccines leading to cost savings. Vaccine availability at all times has increased to 99% in most health centres in India.
• While instances of stock-outs have reduced by 80%, the time taken to replenish stocks has also decreased by more than half, on an average.
• This has ensured that every child who reaches the immunization session site is immunized, and not turned back due to unavailability of vaccines.

Managing the “infodemic” has been a serious challenge during the COVID-19 pandemic, says a Chief Scientist at World Health Organization (WHO).

Try this question for mains:

Q.‘Infodemic’ management these days has become a greater challenge than the actual course of pandemic management. Discuss.

Defining Infodemic

• Infodemic implies too much information, including false or misleading information, particularly on social media.
• It has led to confusion, risk-taking and ultimately mistrust towards governments and the public health response.

WHO framework for infodemics

• The WHO has a framework for managing the coronavirus infodemic.
• Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic.
• From the perspective of being the first “infodemiolgist” who originally coined the term almost two decades ago, the author posts four pillars of infodemic management:

1. Information monitoring (infoveillance)
2. Building eHealth Literacy and science literacy capacity
3. Encouraging knowledge refinement and quality improvement processes such as fact-checking and peer-review
4. Accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences

The article highlights the achievement in the fight against AIDS. Most significant are the achievements in the prevention of transmission from mother-to-child.

Significant gains

• As per recently released 2019 HIV estimates by the National AIDS Control Organization (NACO)/Ministry of Health and Family Welfare with the technical support of UNAIDS there has been a 66.1% reduction in new HIV infections among children and a 65.3% reduction in AIDS-related deaths in India over a nine-year period.
• The number of pregnant women living with HIV has reduced from 31,000 in 2010 to 20,000 in 2019.
• Overall, antenatal coverage has expanded, and HIV testing has increased over time and within target range.
• Treatment coverage has also expanded.

Progress in preventing mother to child transmission

• Under the leadership of NACO, a ‘Fast-Tracking of EMTCT (elimination of mother-to-child transmission) strategy-cum-action plan’ was outlined by June 2019.
• The plan entailed mobilisation and reinforcement of all national, State and partners’ collective efforts to achieve the EMTCT goal.
• Additionally, in March 2020, we began efforts to minimise challenges posed by the COVID-19 pandemic.
• From 2010 to 2019, India made important progress in reducing the HIV impact on children through prevention of mother-to-child transmission of HIV.
• This was done through education and communication programmes; increased access to HIV services with innovative delivery mechanisms for HIV testing; counselling and care; and treatment and follow-ups.
• India made HIV testing for all pregnant women free and HIV treatment is offered the same way nationwide without cost to pregnant mothers living with HIV through the national ‘treat all’ policy.
• For two years UNICEF has worked with the World Health Organization and NACO to identify high burden districts (in terms of density of pregnant women living with HIV) as the last mile towards disease elimination.
• Since 2002, when the EMTCT of HIV programmes were launched in India, a series of policy, programmatic and implementation strategies were rolled out so that all pregnant women can access free HIV testing and free treatment regimens for life to prevent HIV transmission from mothers to babies.
• This has been made possible in government health centres and grass-root level workers through village health and nutrition days and other grass-roots events under the National Health Mission.
• Indeed, the approach being promoted by UNICEF in focusing attention and resources in high burden districts is supported by the HIV strategic information division of NACO and UNAIDS to better understand the locations and populations most HIV affected, so that technical support and HIV services can be directed towards these areas.

Conclusion

Using data-driven and decision-making approaches it is certain that AIDS will no longer be a public health threat for children in India by the end of 2030, if not before.