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Subject: Social Justice

  • Making the private sector care for public health

    Context

    As India enters the second week of a national lockdown imposed in response to COVID-19, it is still unclear how well prepared the healthcare system is in dealing with the pandemic.

    Need for roping in the private healthcare

    • No indication of an increase in expenditure on health: A preparedness plan has to address all levels of care in terms of infrastructure, equipment, testing facilities and human resources in both the public and private sectors.
    • However, so far, the Central and State governments have given little indication of bringing an increase in public expenditure on health.
    • So, an already overburdened public health system will be unable to meet the increase in moderate and severe cases of COVID-19 that would require hospitalisation.
    • Need for the comprehensive national policy: While some individual private sector companies have come forward with offers of creating capacity and making it available to COVID-19 patients, there is a need for a comprehensive national policy to ensure that private healthcare capacity is made available to the public.
    • Some states like Chhattisgarh, Rajasthan, Madhya Pradesh and Andhra Pradesh have already roped in the private sector to provide free treatment.

    What the government should do?       

    • Provide universal health service: The governments at the Centre and in States have to take responsibility for providing universal health services free of charge and accessible to all.
    • Tap into private sector capacity: This will require governments to not just expand the capacity within the public sector, but also to tap into the available capacity in the private sector.
    • Faced with a serious health emergency, the silence of the government on the expected role of the private sector is intriguing.
    • Include COVID-19 testing in PM-JAY: The National Health Authority has recommended that the testing and treatment of COVID-19 be included in the PM-Jan Arogya Yojana (PM-JAY) but this proposal is still awaiting clearance.
    • Form the central command: The governance of the health service system is clearly fragmented and has created anxiety among the public.
    • There is a lack of a visible central command, which should be created under the supervision of the Union Health Minister, aided by a team of experts.
    • They should be tasked to make policies as and when required and communicate them to State governments, taking into account an evolving situation.
    • Ensure that there is no cost to the patient: There have been some tentative measures taken by States to allow individuals seeking testing for COVID-19 to access private laboratories at subsidised rates.
    • At present, the government has put a cap on the cost at â‚č4,500 per test, which is a burden for even a middle-class patient.
    • The poor will clearly have no access to this and the government itself does not have adequate facilities to meet the increasing demand. It is here that the government needs to ensure that there is no cost to the patient.
    • Create adequate testing facilities: At this point, and certainly, before the lockdown is lifted, it is absolutely essential that adequate testing and quarantine facilities are created.
    • The Central government has already taken over some private hotels to accommodate persons quarantined for COVID-19.
    • One way of expanding such facilities would be for the government to ‘take over’ private corporate laboratories and hospitals for a limited period.
    • Standard treatment protocol: The political directive for such a move needs to come from the Central government while ensuring that the Ministry of Health provides standard treatment protocols for health personnel.

    Learning lessons from Spanish and British experience

    • The Spanish government issued an order bringing hospitals in the large private corporate sector under public control for a limited period.
    • This tough decision was taken with the understanding that existing public healthcare facilities would not be able to cope with the sudden, if short-term, rise in COVID-19 cases.
    • British trade unions have demanded that the government make the 8,000 beds in 570 private hospitals in the country available.
    • They have argued that while beds in private hospitals are lying empty, there is a severe shortage of beds in public hospitals.
    • The unions have also been critical of the U.K. government decision to rent these beds at an exorbitant cost to the exchequer.

    Way forward

    • Rope in the private healthcare sector: In India, private corporate hospitals have, in the past, received government subsidies in various forms and it is now time to seek repayment from them.
    • They are also well poised to provide specialised care and have the expertise and infrastructure to do so.
    • Bring in the universal public healthcare: Universal public healthcare is essential not only to curb outbreaks but also to ensure crisis preparedness and the realisation of the promise of the right to health.

  • BCG vaccine

    According to a  US-based research, a combination of reduced morbidity and mortality could make the Bacillus Calmette-Guerin (BCG) vaccination a “game-changer” in the fight against novel coronavirus.

    What is BCG Vaccine?

    • Bacillus Calmette–GuĂ©rin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB).
    • In countries where TB or leprosy is common, one dose is recommended in healthy babies as close to the time of birth as possible.
    • In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.

    How can TB vaccine help fight COVID-19?

    • The BCG vaccine contains a live but weakened strain of tuberculosis bacteria that provokes the body to develop antibodies to attack TB bacteria.
    • This is called an adaptive immune response, because the body develops a defense against a specific disease-causing microorganism, or pathogen, after encountering it.
    • Most vaccines create an adaptive immune response to a single pathogen.
    • Unlike other vaccines, the BCG vaccine may also boost the innate immune system, first-line defenses that keep a variety of pathogens from entering the body or from establishing an infection.

  • Telemedicine/Telehealth as a tool to fight COVID-19

     

    The Medical Council of India and the NITI Aayog have developed new guidelines released on March 25, 2020 for registered medical practitioners to deliver consultations to patients via telemedicine.

    Telemedicine

    • Telemedicine involves the use of telecom and virtual technology to deliver health care outside of traditional health-care facilities.
    • It is the essential delivery of health care services where distance is a critical factor — comes in.
    • At least one doctor is needed for a population of 1,000, according to WHO guidelines.
    • Telemedicine, thus, holds significance for countries like India that have low doctor-to-patient ratios.

    About the guidelines

    • The guidelines aim to empower registered doctors to reach out to patients safely using technologies for the exchange of valid information.
    • This information can be used for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for continuing the education of healthcare providers.
    • The guidelines have empowered medical practitioners. They have, however, also imposed many restrictions.
    • Registered medical practitioners, for instance, have to take the patient’s consent.
    • If the patient denies her consent, however, the practitioner cannot insist that the patient to go in for telemedicine.

    How telemedicine can help against COVID-19?

    • Telemedicine can help bridging the gap between people, physicians and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels.
    • It thus helps reducing the spread of the virus to mass populations and the medical staff on the frontlines.
    • It can help provide routine care for patients with chronic diseases who are at high risk if exposed to the virus.

    Limitations

    • The out-of-hospital management is has not been yet established in India. Perhaps a ‘crisis-based’ evolution of telemedicine can help find local testing centers and also manage the flow of patients seeking a test.
    • However, for a smaller subset of higher risk patients, the clinical course may not be consistent with conventional telemedicine.
    • These patients often present with a more serious condition require rapid hospitalization.
    • Telemedicine hasn’t traditionally been used in response to public health crises. Many health practitioners are not equipped to deliver care in this way.
    • Another issue is access to broadband – some hospitals struggle with running a quality connection within their facilities and now we are faced with taking this to potential new areas of care, such as an outside tent.

  • [pib] ArogyaSetu App

     

    The Government of India has launched a mobile app ArogyaSetu developed in a public-private partnership to bring the people of India together in a resolute fight against COVID-19.

    AarogyaSetu App

    • The App enables people to assess themselves the risk of their catching the Corona Virus infection.
    • It will calculate this based on their interaction with others, using cutting edge Bluetooth technology, algorithms and artificial intelligence.
    • Once installed in a smartphone through an easy and user-friendly process, the app detects other devices with AarogyaSetu installed that come in the proximity of that phone.
    • The app can then calculate the risk of infection based on sophisticated parameters if any of these contacts has tested positive.
    • The personal data collected by the App is encrypted using state-of-the-art technology and stays secure on the phone till it is needed for facilitating medical intervention.

  • A pandemic in an unequal India

    Context

    The official strategies to deal with the virus place the responsibility on citizens, a majority without privilege, to fight the virus.

    The poor disproportionately affected

    • If the COVID-19 pandemic lashes India with severity, it will not be just the middle class who will be affected.
    • India’s impoverished millions are likely to overwhelmingly bear the brunt of the suffering which will ensue.
    • Inequality and impact of a pandemic: The privileged Indian has been comfortable for too long with some of the most unconscionable inequalities in the planet.
    • But with the pandemic, each of these fractures can decimate the survival probabilities and fragile livelihoods of the poor.

    Inadequate capacity of the health system  

    • Low investment in public health: India’s investments in public health are among the lowest in the world, and most cities lack any kind of public primary health services.
    • A Jan Swasthya Abhiyan estimate is that a district hospital serving a population of two million may have to serve 20,000 patients, but they are bereft of the beds, personnel and resources to do this. Few have a single ventilator.
    • The poor left with meagre services: India’s rich and middle-classes have opted out of public health completely, leaving the poor with unconscionably meagre services.
    • The irony is that a pandemic has been brought into India by people who can afford plane tickets, but while they will buy private health services, the virus will devastate the poor who they infect and who have little access to health care.

    No planning and preparation by the state

    • Official strategies placing responsibility on citizens: Most of the official strategies place the responsibility on the citizen, rather than the state, to fight the pandemic.
    • No preparation by the states: The state did too little in the months it got before the pandemic reached India for expanding greatly its health infrastructure for testing and treatment.
    • This includes planning operations for food and work; security for the poor; for safe transportation of the poor to their homes; and for special protection for the aged, the disabled, children without care and the destitute.

    What must be done?

    • 25 day’s minimum wage: For two months, every household in the informal economy, rural and urban, should be given the equivalent of 25 days’ minimum wages a month until the lockdown continues, and for two months beyond this.
    • Pensions must be doubled and home-delivered in cash.
    • There should be free water tankers supplying water in slum shanties throughout the working days.
    • Double the PDS entitlement: Governments must double PDS entitlements, which includes protein-rich pulses, and distribute these free at doorsteps.
    • Provide cooked and packed food: In addition, for homeless children and adults, and single migrants, it is urgent to supply cooked food to all who seek it, and to deliver packed food to the aged and the disabled in their homes using the services of community youth volunteers.
    • Ensure prisons are safe: To ensure jails are safer, all prison undertrial prisoners, except those charged with the gravest crimes, should be released.
    • Likewise, all those convicted for petty crimes. All residents of beggars’ homes, women’s rescue centres and detention centres should be freed forthwith.

    Way forward

    • Commit 3% of GDP on health: India must immediately commit 3% of its GDP for public spending on health services, with the focus on free and universal primary and secondary health care.
    • Nationalise private healthcare: Since the need is immediate, authorities should follow the example of Spain and New Zealand and nationalise private health care.
    • An ordinance should be passed immediately that no patient should be turned away or charged in any private hospital for diagnosis or treatment of symptoms which could be of COVID-19.

    Conclusion

    While one part of the population enjoys work and nutritional security, health insurance and housing of globally acceptable standards, others survive at the edge of unprotected and uncertain work, abysmal housing without clean water and sanitation, and no assured public health care. Can we resolve to correct this in post-COVID India? Can we at least now make the country more kind, just and equal?

  • Regulating the Private Health Sector to Eliminate COVID-19

    Context

    The current COVID-19 crisis that India is battling has brought into sharp focus the public health system’s inadequacy to cope with it.

    Contradictory scenario between public and private healthcare delivery

    • The contrast between public and private: Hospitals with state-of-the-art equipment rivalling five-star hotels in their facilities are mushrooming mostly in cities even as the overburdened public hospitals are valiantly fighting to cope. 
    • Dismal picture in rural areas: As far as the rural areas are concerned, the community health centres and primary health centres and sub-centres present an even more dismal picture in terms of availability of medicine stock, trained para-medical staff, and doctors and nurses.
    • However, it is not as if urban hospitals offer patients excellent care. A common and widely held general misperception is that the private healthcare system is better than the public one.
    • Why private is not always better? Complaints of non-transparent billing, demanding exorbitant sums in advance even in a medical emergency, and cutting corners in services are all too familiar, as are cases of the denial of services.
    • In semi-rural areas and towns, the private sector is not necessarily similar to hospitals in cities.
    • The private hospitals in these areas are small and have basic infrastructure and limited medical and non-medical staff. Unlike the cities, the power and water supply in these areas also constitute a problem to the functioning of these hospitals.

    Problems in the public healthcare system

    • Within the public sector health system, there are a number of trends again that add to the dismal picture.
    • A high number of patients: Doctors in the public hospitals deal with an overwhelming number of patients majorly from the poor and marginalised sections.
    • Issue of contractual staff: Health activists have also pointed out that the growing trend of contractual hiring of paramedical and allied staff leads to an insecurity among them, and thus affects overall caregiving to patients.
    • Consequently, the poor patients’ families, frustrated by the lack of infrastructure and services, turn their anger upon the doctors and nurses.
    • What are the implications? The constant vilification of the public hospital staff coupled with starving these hospitals of resources has led to the view that the private hospitals are “much better” despite their exorbitant rates.

    State-wise variation in healthcare

    • States subject: Health is a state subject, and it is well known that the health delivery systems are not uniform across states.
    • Kerala a role model: Kerala is often held up as a role model generally, and even now in the manner in which it has dealt with the COVID-19 crisis.
    • The dismal system in North India: As it is, certain states in North India have abysmal healthcare systems, and a couple does not have any testing facilities, the media has reported.

    Getting the private sector involved in COVID-19 testing

    • Undoubtedly, at present, the private sector must be involved in screening, tests and treatment for COVID-19.
    • The highly trained professionals in this sector can contribute enormously by helping scale up the testing efforts.
    • Importance of large-scale testing: In South Korea too, it was large-scale testing that was instrumental in reducing mortality rates.
    • The pricing issue: Services across sectors must not be priced differently at a time like this. The media has reported that there is a difference of opinion between the government and private sector on the price of COVID-19 tests flowing from the prices of test kits.
    • Need for the protocol: A clear and non-negotiable protocol for the private sector must be established regarding the present crisis and how the government is going to help financially and otherwise in dealing with it.

    Way forward

    • Regulate the testing, screening and treatment facilities: The experience with the government offering subsidies to hospitals, especially in urban areas in terms of land and other concessions, has not borne out desired objectives such as better care for the poor.
    • Taking a cue from this, the testing, screening, and treatment facilities must be regulated in terms of pricing and quality.
    • Focus on strengthening the public health system: The Supreme Court has held healthcare to be a fundamental right under Article 21. The biggest lesson of the current crisis is that political will must focus on strengthening the public health system.

    Conclusion

    The finance minister has announced a package of `1.7 lakh crore to deal with this catastrophic situation. This is welcome, but long-term resource allocation to invigorate the public health system must be a continual and parallel process.

  • PM-CARES Fund

    Our PM has called for donations to the newly instituted PM-CARES Fund which has been formed on popular demand to help fight the novel coronavirus.

    PM-CARES Fund

    • The fund will be a public charitable trust under the name of ‘Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund’.
    • The PM is Chairman of this trust and members include the Defence Minister, Home Minister and Finance Minister.
    • Contributions to the fund will qualify as corporate social responsibility (CSR) spending that companies are mandated to make.
    • The Fund accepts micro-donations as well.

  • [pib] National Teleconsultation Centre (CoNTeC)

    The Union Ministry of Health & Family Welfare has launched the National Teleconsultation Centre (CoNTeC).

     About CoNTeC

    • The CoNTeC is a Telemedicine Hub established by AIIMS, New Delhi, wherein expert doctors from various clinical domains will be available 24×7 to answer the multifaceted questions from specialists from all over the country.
    • It is a multi-modal telecommunications hub through which 2 way audio-video and text communications can be undertaken from any part of the country as well as the world at large.
    • The modes of communication will include simple mobile telephony as well as two way video communications, using WhatsApp, Skype and Google Duo.
    • The CoNTeC is also fully integrated with the National Medical College Network (NMCN) to conduct a full fledged Video Conference (VC) between the 50 Medical Colleges.

    How to Contact the CoNTeC?

    • A single mobile number (+91 9115444155) can be dialled from anywhere in the coutnry/world by COVID-19 treating doctors to reach the CoNTeC which has six lines that can be used simultaneously at present.
    • This number of lines can be increased in future if needed.
    • The incoming calls will be picked up by the CoNTeC Managers, who will then handover the call to the appropriate expert doctors from the clinical domains as desired by the calling specialists managing the COVID-19 cases anywhere in the country.
    • The Managers will guide the callers in establishing a two way video call using the WhatsApp, Skype or Google Duo as preferred by the caller.
    • The callers from the NMCN network can connect anytime using the Telemedicine infrastructure at their end.

  • Home and nation

    Context

    A 21-day lockdown is extraordinary. Government, people must come together to ensure that supply chains and social trust must not break.

    An unprecedented move

    • A 21-day nationwide lockdown: The way we conduct ourselves in these 21 days will be critical in our fight against the coronavirus.” With these words, Prime Minister announced a measure unprecedented in India’s 72-year-old history.
    • Never have the people of the country been asked to stay within the confines of their homes for this long a period, not even when the country has fought wars.
    • Yet extraordinary times demand extraordinary measures. As the PM underlined, “stringent social distancing and staying within the Lakshman Rekha of our homes is the only prevention against the coronavirus”, the only way to break its transmission cycle.

    Challenges and consequences

    • There will be social and economic consequences and the PM did not equivocate on the challenges. He spoke of the vulnerable sections, and, as in last week’s speech, emphasised the imperative to be compassionate.
    • He lauded the frontline workers, doctors, nurses and other healthcare workers, expressed gratitude to safai karamcharis and praised the private sector and civil society.
    • A reworked social compact — more compassionate — will be necessary to confront the challenges posed by the lockdown.
    • It is now up to civil society, government agencies, the healthcare and corporate sectors to take their cues from the PM’s speech and ensure that the burden of fighting the pandemic does not fall too heavily on those at the margins, the migrant and daily wage labourers, the rickshaw pullers and others for whom these 21 days could prove to be the toughest.
    • Centre and state to work together: The Centre and state governments will need to work together, setting aside their political differences, to ensure that there is no shortage of essential commodities and the supply chains are not broken.

    Measures to mitigate the impact

    • Earlier in the day, Finance Minister Nirmala Sitharaman had announced a slew of measures that could soften the blow of a 21-day lockdown.
    • The deadline for filing of income taxes for the financial year 2018-19 has been extended, as has the last date for filing GST returns.
    • Sitharaman also announced that the threshold for taking companies through the insolvency and bankruptcy proceedings has been increased from Rs 1 lakh to Rs 1 crore.
    • This will prevent creditors from taking small and medium-sized companies, who may be facing temporary cash flow management issues due to the lockdown, and hence are unable to meet their obligations, through the IBC process.
    • The Centre has also advised state governments to transfer funds to construction workers from the cess fund collected by the labour welfare boards.

    Conclusion

    As the PM said, “21 days is a long period”. It’s now up to the authorities and the people to own and implement his message — to ensure that not just supply chains, but also social trust, isn’t broken.

  • Legal Provisions Used By Law Enforcement Agencies To Control The Spread Of Coronavris

    To enforce a full lockdown to contain the spread of COVID-19, law enforcement agencies have taken the help of various legal provisions in CrPC and IPC.

    • The orders issued to curb the spread of the coronavirus have been framed under the Epidemic Diseases Act, 1897, which lays down punishment as per Section 188 of the Indian Penal Code, 1860.
    • Similarly, Sections 269 and 270 IPC are being invoked against persons who malignantly do any act which is likely to spread the infection of any disease dangerous to life.

      Sections 269 and 270 of the IPC

      • Sections 269 (negligent act likely to spread infection of disease dangerous to life) and 270 (malignant act likely to spread infection of disease dangerous to life) come under Chapter XIV of the IPC.
      • The chapter is named ‘Of Offences Affecting The Public Health, Safety, Convenience, Decency and Morals’.
      • While Section 269 provides for a jail term of six months and/or fine, Section 270 provides for a jail term of two years and/or fine.
      • In Section 270, the word ‘malignantly’ indicates a deliberate intention on the part of the accused.
      • During the coronavirus outbreak, penal provisions, such as Sections 188, 269 and 270 of the IPC, are being invoked to enforce the lockdown orders in various states.

      Earlier instances of invocation

      • Both Sections have been used for over a century to punish those disobeying orders issued for containing epidemics.
      • The Sections were similarly enforced by colonial authorities during outbreaks of diseases such as smallpox and bubonic plague.

    What is Section 188 of the Indian Penal Code?

    • Section 3 of the Epidemic Diseases Act, 1897, provides penalties for disobeying any regulation or order made under the Act.
    • These are according to Section 188 of the Indian Penal Code (disobedience to order duly promulgated by public servant).
    • It is not necessary that the offender should intend to produce harm, or contemplate his disobedience as likely to produce harm.
    • It is sufficient that he knows of the order which he disobeys, and that his disobedience produces, or is likely to produce, harm.

    What happens if you violate the lockdown orders? 

    Under Section 188, there two offences:

    1) Disobedience to an order lawfully promulgated by a public servant, If such disobedience causes obstruction, annoyance or injury to persons lawfully employed

    Punishment: Simple Imprisonment for 1 month or fine of Rs 200 or both

    2) If such disobedience causes danger to human life, health or safety, etc.

    Punishment: Simple Imprisonment for 6 months or fine of Rs 1000 or both

    According to the First Schedule of the Criminal Procedure Code (CrPC), 1973, both offences are cognizable, bailable, and can be tried by any magistrate.

    Triable By: Any Magis­trate