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Daily Category  (Health)

A National Health Service in India

CONTEXT:

  • The current surge in COVID-19 infections has exposed problems amounting to near-chaos throughout Indian healthcare.

Coordinating measures to tackle COVID:

  • While those involved in the clinical response are clearly doing their often-desperate best — care staff are at high risk of contracting COVID-19.

  • The Central and State governments are now coordinating measures within and across their respective jurisdictions.

  • For example, the railways are running special trains carrying oxygen supplies.

  • The military is also involved in supply chains.

  • The Karnataka government has ordered private hospitals above a certain size to reserve 75% of their beds for COVID-19 patients who will be paid for under a public scheme.  

  • The Supreme Court has, suo motu, called for a national plan to deliver oxygen and vaccines.

    • Though Supreme Court’s call for a national supply plan has been publicly criticised in the political sphere.

Issues in Current Health System / Need of National Health Service:

  • India’s fragmented, often corrupt, urban-centred, elite-focused and wretchedly underfunded health infrastructure centres can look like no more than an accidental collection of institutions, staff, and services.

  • GDP on Health: India’s public spending on health is set to double in the 2021-22 financial year, but that is from a figure that has long been only a little over 1% of GDP.

  • Doctor-population ratio: In certain rural areas, the doctor-population ratio is over 1:40,000.

  • Huge Population: India’s healthcare providers, however, have the task of serving 1.4 billion people.

  • Medical expenses: It constitute the major reason for personal debt in India.

  • Episodic afflictions: Whether the causes are episodic afflictions or by environmental conditions which none can escape, such as air pollution.

    • Lancet Report says this accounted for 1.7 million deaths in India in 2019.

    • The annual business cost of air pollution is currently estimated at $95 billion, which is about 3% of India's GDP).

Merits of NHS:

  • Joseph Bhore Proposal: In 1946, the Civil Servant Sir Joseph Bhore submitted to the then government a detailed proposal for a national health service broadly modelled on the British National Health Service.

  • He went further by recommending that preventive and curative medicine be integrated at all levels.

  • Need in Britain: The fact of the Second World War, in the darkest hours of which a plan was prepared to transform Britain into a post-war social democracy with a comprehensive welfare state and a universal free public health service, may therefore have been catalytic rather than decisive in the creation of the NHS.

  • Mighty achievement: The result is a mighty achievement in public policy, politics, and the provision of top-class universal healthcare, including training, research, and changing engagement with the public as society changes.

  • Funding: The service is funded entirely from general taxation. The budget includes payment to general practitioners, most of whom remain private providers but are paid by the state for treating NHS patients.

  • No Charge: Items listed in general practitioners’ prescriptions incur no or neglibile charges in Britain.

  • Free Treatment: All hospital treatment and medicines are free, as are outpatient and follow-up appointments.

  • Cost Burden: The British public share the costs through their taxes, and almost without exception receive treatment solely according to their clinical needs.

  • Employment: With about 1.1 million staff, the NHS is the largest employer in the U.K.

  • GDP Share: Its current budget is about 7.6% of GDP, but despite its size and scale, it provides highly localised access to care.

Problems in the NHS

  • Among them are largely unintended inequalities in the time and attention given to patients of different social classes

  • Huge and frequent reorganisations imposed by Central government

  • Often ideologically driven underfunding.

Suggestions and Way Forward:

Burning Issue] India's Ailing Health Sector and Coronavirus – Civilsdaily

  • Unreserved support: Many senior hospital consultants who were opposed to a public health service when the NHS started have declared unreserved support for it in national conference resolution.

  • Most loved institution: An authority on the NHS has said that it is the most loved and trusted institution in the country and is held in even higher regard than the monarchy.

  • Serious health crisis: India now faces a very serious health crisis, possibly the worst since Independence.

  • The precise structure envisaged by Joseph Bhore may need some adaptation for today’s society and conditions.

  • But dealing effectively with the pandemic may itself require the urgent creation of an Indian National Health Service.

SOURCE: The Hindu

Intensified Mission Indradhanush (IMI) 3.0

CONTEXT:

  • The States/Union Territories (UTs) have rolled out the first phase of Intensified Mission Indradhanush (IMI) 3.0 to cover children and pregnant women who missed the routine immunisation during the COVID-19 pandemic.

INTENSIFIED MISSION INDRADHANUSH (IMI) 3.0:

Mission Indradhanush - General Awareness Study Material & Notes

  • Aim: The program, through a mission mode intervention, is aimed to accelerate the full immunisation of

    • Children And

    • Pregnant Women

  • IMI 3.0 campaign and Portal:  Was launched on February 19, 2021, along with operational guidelines for it and the awareness material as a part of the campaign.

  • States and district functionaries will reach to each and every child and attain maximum full immunisation coverage.

  • Two rounds Schedule: The campaign is scheduled to have two rounds of immunisation lasting 15 days (excluding the routine immunisation and holidays) starting from February 22 and March 22, 2021.

  • Conducted in: It will be conducted in pre-identified 250 districts/urban areas across 29 States/UTs in the country.

  • Classification of districts: As per the guidelines released for IMI 3.0, the districts have been classified to reflect

    • 313 as low risk,

    • 152 as medium risk, and

    • 250 as high-risk districts.

  • Staggered approach: States have been asked to follow the "staggered approach" to avoid crowding at the session sites and even plan break-up sessions if the approach is not effective to avoid crowding.

  • Mission IMI 2.0: From December 2019-March 2020, “to achieve targets of full immunization coverage among hard-to-reach and tribal populations.

MISSION INDRADHANUSH:

  • It is a health mission of the Government of India. It was launched in 2014.
  • 90 % target: The scheme this seeks to drive towards 90% full immunisation coverage of India and sustain the same by year 2020. \
  • Vaccination against 12 diseases: Vaccination is being provided against eight vaccine-preventable diseases:

  1. Diphtheria
  2. Whooping cough
  3. Tetanus
  4. Polio
  5. Tuberculosis
  6. Hepatitis b
  7. Meningitis and pneumonia
  8. Hemophilus influenza type b infections
  9. Japanese encephalitis (JE)
  10. Rotavirus vaccine
  11. Pneumococcal conjugate vaccine (PCV) and
  12. Measles-rubella (MR)
  • Vaccination against Japanese Encephalitis and Haemophilus influenzae type B is being provided in selected districts of the country.

INTENSIFIED MISSION INDRADHANUSH:

  • Year: It was launched by the Government of India in 2017.
  • Aim: To reach each and every child under two years of age and all those pregnant women who have been left uncovered under the routine immunisation programme.
  • Focus area: Greater focus has been given on urban areas.
  • It will target the districts which have immunisation coverage of 70% or below.

SOURCE: Business standards

Building a robust healthcare system

CONTEXT:

In the wake of the COVID-19 pandemic, there have been vociferous demands to strengthen the country’s public health system.

But Once the present crisis is over, however, public health will go into oblivion, as usual. Governments are already behaving as if things are fine and enough has been done on the health front.

Not surprisingly, the efficacy of the public health system varies widely across the country since it is a State subject.

Health Parameters: How good a public health system is can easily be judged just by looking at certain health parameters such as

  • Infant Mortality Rate,
  • Maternal Mortality Ratio and
  • Total Fertility Rate

for which annual surveys are conducted through the Sample Registration System.

POOR HEALTH INDICATORS:

  • Sustainable Development Goals-3: With the numbers given in the chart, it is doubtful whether India will be able to achieve Goal 3 (good health and well-being) of the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015.
  • Millennium Development Goals: India failed to achieve the earlier Millennium Development Goals because of the poor performance of the northern States.
    • It is surprising that the Government of India does not hold them responsible and accountable for poor performance but is satisfied with the average. Equally surprising and disappointing is that these State governments themselves are indifferent to their poor performance.
  • Health as State subject: Since health is a State subject, the primary onus lies with the State governments. Each State government must focus on public health and aim to improve the health indicators mentioned above.
    • It is disappointing that some of the States have skewed priorities such as cow protection and ‘love jihad’. More mothers are perhaps dying for want of care than cows.
  • Health the highest priority: Are these governments not concerned? Unless they give health the highest priority, rapid improvement is not possible.
    • Instead of talking in generalities, they must start looking at numbers. To start with, the above parameters are good enough. Their close monitoring at the highest level may improve things.
  • Vital health parameters: These data are revealing. The northern States are performing very poorly in these vital health parameters.
    • In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala.
  • In U.P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63. The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
  • Total Fertility Rate: Another vital parameter that has an impact on poverty, Total Fertility Rate, is very high in Bihar (3.2) against the stabilisation rate of 2.1.
  • Tamil Nadu and Kerala Model: have done so well that their population will decline over the years. This has been made possible thanks to the effective Maternal and Child Health and Family Welfare services provided by these States.
  • Comparable to the poorest countries: Some of these States are performing so poorly that they are comparable to the poorest countries in the world, pulling down the average for India.
    • The Government of India is just looking at the averages which are somewhat reasonable thanks to the excellent performance of well-governed States.

TAMIL NADU’S EXAMPLE:

  • Enlightened political leadership: How did the southern States achieve this? It is because of enlightened political leadership which was interested in the health and well-being of the people. I vividly remember the family planning drives and innumerable camps organised to eradicate cataract in the 1970s.
  • Healthy competition among the districts: The district administration was spearheading these health initiatives because of the government’s focus and drive. The government encouraged a healthy competition among the districts by giving prizes to the well-performing ones.
  • Family planning drives: By the 1990s, family planning drives were no more necessary, and all that was needed was some fine-tuning of the Maternal and Child Health programme. The result is that the Total Fertility Rate of Tamil Nadu is among the lowest in the country (1.6) comparable to that of Germany (1.57) and Japan (1.43).
  • Public and preventive health structure: In addition to a clear focus by the political executive, Tamil Nadu has the advantage of a public and preventive health structure. A good administrative structure could therefore deliver to the demands of the political executive, benefiting the people of the State.
  • Empowered Action Group States: The governments — both at the Centre and the Empowered Action Group States — should realise that public health and preventive care is a priority and take steps to bring these States on a par with the southern States.

GIVING HEALTH IMPORTANCE:

  • Invest in human capital: Unless we invest in human capital, FDI will not help. It will only increase the wealth of the already wealthy and accentuate income disparity.
  • Co-operative Federalism: Investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance.
  • Piecemeal schemes: Announcing piecemeal schemes may help to get publicity but will not make a lasting improvement. Improving health of such a large population requires concerted efforts over years. The southern States started early and are enjoying the benefits, but they can still do more to reach the level of developed countries.
  • Empowered Action Group States: It must start in earnest at least now. There are no short cuts; only persistent and focused efforts at the highest level of government will improve preventive care and primary healthcare.

Source: The Hindu

National Polio Immunization Drive Begins Across the Country

CONTEXT:

President of India Shri Ram Nath Kovind launched the National Polio Immunisation Day for 2021 by administering polio drops to children less than five years old at Rashtrapati Bhawan on 30th January 2021.

                                  IMG_256

NEWS IN DETAILS:

  • Polio Immunization so far: Polio National Immunization Day, also known as ‘’Polio Ravivar”. As per provisional report on day one, close to 89 lakh children (as per provisional data) under five years across the country were given polio drops today.
    • Vaccinations were conducted at close to 7 lakh booths which were staffed with around 12 lakh vaccinators and 1.8 lakh supervisors.
  • House-to-house surveillance: The booth activity will be followed by house-to-house surveillance (mop-up rounds) over the next two to five days to identify and vaccinate children who missed getting vaccinated at the booths.
  • Vaccination teams at every place:  have also been deployed at bus terminals, railway stations, airports and ferry crossing to vaccinate children in transit to ensure no child misses the life-saving dose.
  • Safety during Pandemic: All measures have been taken to ensure safety during the times of the pandemic by maintaining COVID-19 appropriate practices.

STATUS OF POLIO IN INDIA:

  • Polio-free status: Dr Harsh Vardhan said, “Maintaining a polio-free status for 10 years is a huge accomplishment in the history of public health in India.”
    • He also highlighted government efforts and actions to strengthen routine immunization to ensure that no child suffers from a vaccine-preventable disease.
  • Polio Free from 2011: India has been free of polio for a decade, with the last case of wild poliovirus reported on 13th January 2011.
  • Prevent re-entry from neighbours: The country, however, continues to remain vigilant to prevent re-entry of the poliovirus into the country from neighbouring countries of Afghanistan and Pakistan, where wild poliovirus continues to cause disease.
  • Nationwide Immunization: every year to maintain population immunity against wild poliovirus and to sustain its polio free status, India conducts for polio:
  1. One nationwide NID and
  2. Two Sub-National Immunization Day (SNIDs)

NATIONAL IMMUNIZATION DAY:

IMG_256

  • On 30th Jan 2021, India observed National Vaccination day, also known as Immunization day.
  • In 1995  first dose of Oral Polio vaccine was given in India.
  • Pulse Polio Campaign: To eradicate polio from the country  launched by the government.
  • Under this extensive drive, 2 drops of Oral Polio Vaccine was given to all children younger than 5 years of age.
  • The last reported case of polio in India was in West Bengal in January.
  • In 2014, India was declared polio-free.

POLIO: