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Subject: Social Justice

  • Partnership with the private sector in a fight against Covid-19

    The article delineates five areas in which partnership with the private sector is essential to deal effectively with the epidemic and ensure a whole-of-society response. Ensuring the participation of the private sector has been the recurring theme of many op-eds we have come across after the outbreak.

    Significance of private healthcare in India

    • According to the WHO, a critical lesson from the 2014-16 West African Ebola epidemic was that both the public and private sector need to work in tandem in responding to large-scale epidemics.
    • In the COVID-19 response in India, the private sector has to play an even more important role, as it is the dominant provider of health services in the country.
    • The private sector includes the for-profit and not-for-profit segments.
    • The dominance of the private sector in India: The NSSO 71st round data on social consumption of health show that private hospitals, clinics and nursing homes provide over 70 per cent of healthcare.
    • Data on the nearly 1 crore treatments received under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) corroborate this finding.
    • AB PM-JAY data shows that over half of all treatments are being availed of from private providers, accounting for over 60 per cent of total disbursements.

    UPSC asked about community-level healthcare intervention in 2018. So, pay attention to the significant role played by the private health sector in India.

    Following five are the areas in which cooperation with the private sector will be essential-

    1 Testing

    • Creating a large and accessible testing infrastructure is the first weapon in the armoury.
    • Countries like South Korea, Singapore, Germany and Japan have been successful at controlling the spread of COVDID-19 and reducing mortality through early detection and quick containment.
    • This has been possible only through widespread testing.
    • India has opened testing up to private labs.
    • Testing has been included under the AB PM-JAY as well.
    • We need to substantially expand testing capacity.
    • This cannot happen without the active participation of the private sector.

    2 Converting private hospitals into Covid-19-only hospitals

    • As the government deepens its containment efforts, the country will need to rapidly surge the numbers of quarantine units, isolation wards and ICU beds in COVID-19-only
    • It will also need to ensure increased and continued supply of essential medical products — from testing kits, masks and other PPEs to oxygen and ventilators.
    • According to a recent ICMR study, around five per cent of those infected will need intensive care and half of those in intensive care units will need mechanical ventilation.
    • These projections translate into large numbers that considerably exceed the capacity of the government health system.
    • Private hospitals with adequate infrastructure will need to convert in COVID-19-only hospitals.
    • There should be a clear policy framework of designated hospitals, reporting and referral systems and an appropriate payment system.
    • With many government facilities being converted into COVID-19-only hospitals, a large number of non-COVID-19 patients will need facilities and providers to take care of their other urgent, critical or continuing healthcare needs.
    • The AB PM-JAY has started a process to bring on board more hospitals to respond to such needs.

    3 Protecting healthcare workers

    • As more private providers join this fight, a major concern that will arise is keeping healthcare workers from becoming infected.
    • In addition to being at a high risk of contracting the virus, healthcare workers are also potential carriers.
    • Ensuring their protection is of paramount importance.
    • Increasing the production: Companies manufacturing essential medical products such as ventilators, masks will need to crank up their production.
    • Direct support from banks may be needed to keep production and supply chains going.

    4 The private sector has to support the ecosystem driving health system

    • The private sector will need to vigorously support the large ecosystem that drives the health system as the lockdown and ongoing epidemic restrict movement and normal economic activities.
    • Activities such as the production of essential drugs and medical products, logistics to maintain smooth supply need to not only continue but also accelerate.
    • Support for community activities such as night shelters and community kitchens will need to be strengthened.

    5 Collaborate to share knowledge on the epidemic

    • An adequate stage-wise response to the pandemic and its economic, social and political aftermath will require the rapid filling of the many knowledge gaps.
    • Government, private and not-for-profit research institutions need to collaborate to understand the nature of transmission of the virus.
    • They must understand the factors that slow its spread, the most at-risk communities, or the optimal quarantine period.

    In 2015, UPSC asked whether the private health sector could help bridge the gap in providing universal health coverage. A question can be asked based on the same theme but in reference to dealing with the pandemic.

    Conclusion

    The fight against COVID-19 is not a race to a hilltop. It involves the continuous management of an evolving public health crisis that threatens to spawn economic and social crises. These multiple dimensions will require a whole-of-society approach that goes beyond the government alone.

  • What is pooled testing, recommended by the ICMR?

    The Indian Council of Medical Research (ICMR) has issued an advisory for using pooled samples for testing of COVID-19 in order to increase the number of tests conducted by laboratories across the country.

    COVID-19 containment measures are pacing up across the country. However, it is argued that we are lagging in the number of tests to be carried out.  With certain limitations, pooled testing promises an edge over individual testings of suspected patients.

    What is pooled testing?

    • In a pooled testing algorithm, samples of multiple individuals are put together in a tube and screened through the PCR test.
    • In case the pooled test turns out to be positive, individual samples are tested, which is referred to as pool de-convolution.
    • If there’s no positive result, all individual samples in the pool are regarded as negative, resulting in substantial cost savings.

    What the ICMR has recommended?

    • ICMR has advised that while more than two samples can be pooled together, the number should not exceed five samples to avoid sample dilution, which can lead to false negatives.
    • This method can be used in areas where the prevalence of COVID-19 is low, which means a positivity rate of less than two per cent.
    • In areas with a positivity rate between two to five per cent, sample pooling of PCR screening may be considered in a community survey of surveillance among asymptomatic individuals.
    • Samples of individuals with known contact with confirmed cases or healthcare workers should not be included in the pooled samples.
    • Also, ICMR has said pooling of sample is not recommended in areas or population with positivity rates of over five per cent.

    Benefits of pooled testing

    • Using this method, substantial costs and testing kits are saved.
    • For instance, if a pooled sample consists of the samples of five individuals and it tests negative, the cost of four testing kits is saved and more number of people are covered with fewer resources.
    • Significantly, pooled screening can also help in tracking down the asymptomatic cases of the disease, thereby tracking community transmission.
    • But in case the sample tests positive, all individuals need to be tested separately.

  • Is the Centre’s lockdown different from a state’s lockdown?

    The central government has extended the 21-day nationwide lockdown by two more weeks. Before this, some states had already ordered to extend the lockdown till the end of this month.

    How do the two lockdowns differ?

    Newspapers are flooded up with news on lockdowns. The two lockdowns are fundamentally different from each other. Such difference sparks a thought in the mind of question framers.

    1) State lockdowns

    • As per the Constitution, subjects of law and order and public health lie with state governments.
    • Additionally, the Epidemic Diseases Act of 1897, which many states have invoked to order a lockdown, empowers them to prescribe temporary regulations to prevent the outbreak and spread of disease.

    2) Centre’s lockdown

    • The lockdown ordered by the centre is implemented under the Disaster Management Act, 2005.
    • The Union home ministry, in compliance with the NDMAs order can issue orders for the lockdown under Section 10(2)(l) of the DMA.

  • Taiwan: a role model for pandemic management

    As many nations struggle to keep COVID-19 infection numbers down, the island of Taiwan presents an example of how to be prepared in the event of a pandemic. As the global total of infections has neared 700,000, with over 30,000 deaths, Taiwan’s count stood at 300, with only 5 deaths.

    When you read through this article, try and map the best practices which could be incorporated in India. You might have to tweak a few. UPSC Mains may ask a question on “what could be done better etc.” and this is where you shine!

    Taiwan Model of Healthcare Management

    • Located less than 150 kilometres from the original viral source – China – Taiwan has seen far fewer cases of the coronavirus in the past month, with a much lower infection rate.
    • It is also worth noting the practices utilized by Taiwan’s hospitals as they seek to curb the virus and protect patients and medics.

    Following were the not so exceptional measures which helped Taiwan authorities contain coronavirus:

    1) Smaller staff groups

    • One of the early steps taken was the reduction of the workgroup sizes within medical facilities.
    • This reduces the risk of a community spread within the hospital emerging from infected patients being treated.
    • Depending on the size of the staff handling an area of the hospital, and the number of patients being overseen there, one infection could jeopardize the safety of an entire ward.

    2) Traffic control in hospitals

    • Hospitals were establishing separate entrances and exits for in- and out-patients to help prevent the spread of infection via regular hospital traffic.
    • In effect, hospital entry began to resemble airport customs, with visitors passing through a temperature checkpoint and showing IDs before admittance.

    3) Maintaining a high bed-per-capita ratio

    • Many countries have found that they do not have nearly enough hospital beds to care for patients suffering from a highly infectious disease like COVID-19.
    • In response, Taiwan has nearly 1,000 negative pressure isolation rooms (an isolation technique used in hospitals to prevent cross-contamination from room to room) available, with the capacity to add significantly more through room reconfigurations.
    • This is a remarkably high number, given the relatively small population of the island, and speaks to the country’s preparedness and advanced medical infrastructure.

    4) Best public health policy

    • Finally, Taiwan has benefited greatly from the close coordination between its hospitals and central government.
    • Within the country’s nationalized healthcare system, every citizen and resident is assigned a health card, embedded with a computer chip reflecting their identity and medical history.

    Significance of the Taiwanese model

    • Taiwan’s biggest success can be attributed to how ready the country and its hospitals were from Day-1, while other states were still assessing whether the virus was a threat to them at all.
    • Many of these countermeasures can be easily duplicated by India.
    • However, the willingness and effectiveness with which doctors and medical officials have worked to cooperate with each other and the public is a testament to the country’s smart and rational approach to healthcare and disease prevention.

  • India COVID-19 Emergency Response and Health System Preparedness Package

    The Centre has approved a centrally funded ‘India COVID-19 Emergency Response and Health System Preparedness Package’ with the objective of strengthening national and state health systems.

    About the Package

    • The package is 100 per cent centrally funded project under the National Health Mission.
    • It will be implemented in three phases from January 2020 to March 2024.
    • It aims at strengthening national and state health systems to support prevention and preparedness, procurement of essential medical equipment, consumables and drugs, etc.
    • The three phases of the project are Phase – 1 from January 2020 to June 2020, the second phase is from July 2020 to March 2021 and the third phase from April 2021 to March 2024.

    What are the major activities planned under this package?

    • The key activities to be implemented under Phase -1 includes support to states/UTs for the development of dedicated COVID-19 hospitals and other hospitals, isolation blocks, negative pressure isolation rooms, ICUs with ventilators, the oxygen supply in hospitals etc..
    • The central package will also assist the state/ UTs for the Procurement of Personal Protection Equipment (PPE), N95 masks and ventilators, over and above what is being procured and supplied by the govt.
    • The activities under the first phase also include the disinfection of hospitals, government ambulances, etc.

  • [pib] Kendriya Bhandar

    Kendriya Bhandar which functions under the Department of Personnel and Training (DoPT) has taken the unique initiative of providing “Essentials Kits” to needy families during the ongoing lockdown.

    About Kendriya Bhandar

    • The Central Govt. Employees Consumer Cooperative Society Ltd. is popularly known as Kendriya Bhandar.
    • It was set up in 1963 as a welfare project for the benefit of Central Govt. employees and public at large.
    • It is functioning under aegis of Ministry of Personnel, Public Grievances & Pensions and was registered with Delhi Registrar of Cooperative Societies.
    • Subsequently, it was registered with Central Registrar of Cooperative Societies, Govt. of India as a Multi-State Consumer Cooperative Society in September 2000.

  • Delhi’s ‘5T’ war against virus

    Delhi CM has announced a “5T plan” created by his government to contain COVID-19 spread in Delhi. These five Ts are testing, tracing, treatment, teamwork and tracking-monitoring.

    5Ts strategy

    1)Testing

    • Testing when done on a mass scale enables the actual data of people affected by novel coronavirus.
    • Like South Korea, Delhi will be testing on a large scale.
    • Through rapid testing, the government will also be able to identify COVID-19 hotspots and take necessary action.

    2)Tracing

    • The second T is tracing, which involves identifying and quarantining people who have come in contact with infected persons.
    • Delhi authorities are taking the help of police to trace whether the people who have been advised to self-quarantine are actually doing it or not.

    3)Treatment

    • The third component is the treatment.
    • Serious patients who are suffering from heart diseases and patients above 50 years will be isolated in hospitals and the rest with minor symptoms will be kept in isolation in hotels and dharamshalas.

    4)Teamwork

    • The fourth element of the five-point plan is teamwork and collective efforts are being made to fight the virus.
    • All State governments must learn from each other and work together.

    5)Tracking and monitoring

    • The fifth T is tracking and monitoring.
    • The state should ensure that all these measures are in place and all the systems are functioning smoothly.

     

    Also read:

    ‘Bhilwara Model’ for containment of coronavirus

  • ‘Bhilwara Model’ for containment of coronavirus

    Bhilwara in Rajasthan was one of the early hotspots of the COVID-19 outbreak. The government responded with extraordinarily aggressive measures — and the ‘Bhilwara model’. The success of the model is attributed to the fact that Bhilwara, which was the first district in Rajasthan to report most number of covid cases has now reported only one positive case since March 30.

    What is the Bhilwara Model?

    • The Bhilwara COVID-19 containment “model” refers to the steps taken by the administration in Rajasthan’s Bhilwara district to contain the disease, after it emerged as a hotspot for coronavirus positive cases.
    • Bhilwara district was among the most-affected places in India during the first phase of the COVID-19 outbreak.
    • The measures taken by the state govt. included imposing a curfew in the district which also barred essential services, extensive screening and house-to-house surveys to check for possible cases.
    • It went for detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected.

    What did the administration do as part of the containment strategy?

    • The “Bhilwara model” of tackling COVID-19 cases involves, simply, “ruthless containment”.
    • Within three days of the first positive case the district health administration in Bhilwara constituted nearly 850 teams and conducted house-to-house surveys at 56k houses and of 280k people.
    • Thousands were identified to be suffering from influenza-like illness (ILI) symptoms and were kept in home quarantine.
    • Intense contact tracing was also carried out of those patients who tested positive, with the Health Department preparing detailed charts of all the people whom they had met since being infected.
    • The state also took the help of technology, using an app to monitor the conditions of those under home quarantine on a daily basis along with keeping a tab on them through GIS.
    • The administration backed up the surveys by imposing a total lockdown on the district, with the local police ensuring strict implementation of the curfew.
    • The patients were treated with hydroxychloroquine (HCQ), Tamiflu and HIV drugs.

    What were the challenges the administration faced in imposing these extraordinary measures?

    • The biggest challenge that the administration faced was containing the rising number of cases after the initial outbreak.
    • The doctors of the private hospital who had tested positive had come into contact with numerous people including the staff and patients who visited the private hospital during the period when the doctors were already infected.
    • Some of these patients had come from other states and after the first case of COVID-19 was detected.
    • The government also had an uphill task ahead of them assembling the teams of doctors, auxiliary nurse and midwives and nursing students who went to conduct the house-to-house surveys.
    • Owing to the fact that Bhilwara, a thriving textile city with an estimated population of 30 lakh, it was also a difficult task for the government to strictly impose the curfew uniformly in all areas.

  • [pib] Centre for Augmenting WAR with COVID-19 Health Crisis (CAWACH)

    Department of Science & Technology has approved setting up of a Centre for Augmenting WAR with COVID-19 Health Crisis (CAWACH).

    What is CAWACH?

    • CAWACH will help to address various challenges faced by country due to severe impact of COVID-19.
    • CAWACH will identify up to 50 innovations and startups that are in the area of novel, low cost, safe and effective ventilators, respiratory aids, protective gears, novel solutions for sanitizers, disinfectants, diagnostics, therapeutics, informatics and any effective interventions to control COVID-19.
    • The CAWACH’s mandate will be to extend timely support to potential startups by way of the requisite financial assistance and fund deployment targeting innovations that are deployable in the market within next 6 months.
    • The Society for Innovation and Entrepreneurship (SINE), a technology business incubator at IIT Bombay supported by DST has been identified as the Implementing Agency of the CAWACH.
    • It will provide access to pan India networks for testing, trial and market deployment of these products and solutions in the identified areas of priority COVID-19 solutions.

  • What is Drive-through Testing?

    To work around the challenges of home-based testing in the country, a New Delhi based firm has offered ‘drive-through test’ for COVID-19.

    Drive-through Testing

    • Those who feel sick drive up to a test centre where nurses wearing protective gear collect a nose or throat sample from the car itself.
    • Results are mailed or messaged in a day.
    • This method of mass testing has allowed reduced contact between patients and healthcare workers, thereby lessening the chances of transmission.
    • South Korea has led the world in the number of tests per million to check for coronavirus infection through this method.

    Germany: leading through examples

    • Germany is conducting around 3,50,000 coronavirus tests a week, far more than any other country.
    • It means that more people with few or no symptoms are reported thereby increasing the number of known cases and adequate quarantines.

    Limitations (for India)

    • We have seen so far is that many are uncomfortable with the home collection process.
    • Some people are worried that lab personnel visiting home in full protective gear would scare the neighbours.
    • There are also instances when spouses of some healthcare personnel have separated for a while.