Since its launch, PM-AASHA has significantly benefitted farmers, contributing to the procurement of 195.39 lakh metric tonnes (LMT) of agricultural commodities, valued at ₹1,07,433.73 crore, from over 99 lakh farmers.
Procurement Details:
In the Rabi 2023-24 season, 6.41 LMT of pulses, valued at ₹4,820 crore, were procured from 2.75 lakh farmers. This included:
2.49 LMT of Masoor
43,000 metric tonnes of Chana
LMT of Moong
In addition, 12.19 LMT of oilseeds, valued at ₹6,900 crore, were procured from 5.29 lakh farmers.
In the ongoing Kharif season, the government has procured 5.62 LMT of Soyabean, valued at ₹2,700 crore, benefiting 2.42 lakh farmers.
About the PM-AASHA Scheme
Details
Launched in 2018, PM-AASHA is an umbrella scheme encompassing various components to ensure farmers receive fair prices for their produce.
Aims and Objectives
Ensuringfair pricesfor farmers by providing price support when market prices fall below the Minimum Support Price (MSP).
Stabilize the prices of essential commodities, benefiting both farmers and consumers.
Addressing price fluctuations and ensuring sustainable agricultural practices for crops like pulses, oilseeds, and copra.
Structural Mandate and Implementation
Type: Central Sector Scheme (Fully funded by the Centre).
Nodal Ministry: Ministry of Agriculture & Farmers Welfare.
Fund Allocation: Rs. 35,000 crore during the 15th Finance Commission Cycle (up to 2025-26).
Central Nodal Agencies (CNA):
Guarantees to lender banks for extending cash credit facilities to agencies like NAFED (National Agricultural Co-operative Marketing Federation of India Limited) and NCCF (National Co-operative Consumer’s Federation of India Limited) for MSP procurement.
Department of Consumer Affairs (DoCA) will procure pulses at market price from pre-registered farmers on eSamridhi Portal of NAFED and eSamyukti Portal of NCCF when prices exceed MSP.
Key Components:
Price Support Scheme (PSS):
The PSS is the core component of PM-AASHA, operating through state governments to procure notified commodities at the Minimum Support Price (MSP) levels.
It provides financial relief to farmers when market prices fall below MSP, offering remunerative prices and promoting investment in agriculture.
The government fixes the MSP for 24 crops at 1.5 times the Cost of Production (CoP) to ensure a fair income for farmers.
Price Deficiency Payment Scheme (PDPS):
Under PDPS, farmers are provided direct payments if the market prices of oilseeds fall below the MSP.
It helps bridge the gap between MSP and market prices, ensuring that farmers still get a fair return.
Market Intervention Scheme (MIS):
The MIS provides financial assistance to states for price stabilization of perishable agricultural commodities like Tomato, Onion, and Potato, which are not covered under MSP.
This scheme helps manage price volatility and benefits both farmers and consumers by stabilizing prices.
PYQ:
[2020] In India, the term “Public Key Infrastructure” is used in the context of:
(a) Digital security infrastructure
(b) Food security infrastructure
(c) Health care and education infrastructure
(d) Telecommunication and transportation infrastructure
The National Mental Health Programme (NMHP) is a flagship initiative by the Government of India aimed at addressing the growing mental health challenges in the country.
About National Mental Health Programme (NMHP):
Details
Initiated in 1982 and restructured in 2003, the NMHP aims to modernize mental health facilities and upgrade psychiatric wings in medical institutions.
Features and Signficance
The program has 3 components:
1. Treatment of mentally ill
2. Rehabilitation
3. Prevention and promotion of positive mental health.
Aims and Objectives
Prevention and treatment of mental and neurological disorders and their associated disabilities.
Use of mental health technology to improve general health services.
Application of mental health principles in total national development to improve quality of life.
Structural Mandate
The District Mental Health Programme (DMHP), based on the Bellary Model, focuses on community mental health services at the primary healthcare level, spanning 716 districts.
DMHP provides outpatient services, counselling, psycho-social interventions, and support for severe mental disorders.
Priority given to mental morbidity and treatment.
Primary healthcare services at village and sub-center levels.
Services at the Primary Health Center (PHC) and District Hospital levels.
Facilities at Mental Hospitals and Teaching Psychiatric Units.
Back2Basics: The Mental Healthcare Act, 2017
It replaced the Mental Healthcare Act, 1987, which was criticized for failing to recognize the rights of mentally ill individuals.
It ensures the Right to Access to Healthcare and aims to ensure the rights and dignity of those with mental illness.
It decriminalized suicide, stating that attempts are presumed to be under severe stress and shall not be punished.
In February 2018, the Centre had launched the initiative to establish 1,50,000 Ayushman Arogya Mandirs (AAMs), formerly known as Ayushman Bharat Health and Wellness Centres (AB-HWCs), by December 2022.
As of 31st July 2024, 1,73,881 Ayushman Arogya Mandirs have been set up and are fully operational, exceeding the original target.
About theAyushman Arogya Mandirs (AAMs):
Details
Launched to provide comprehensive health services covering preventive, promotive, curative, rehabilitative, and palliative care for all age groups.
First AAM was launched in Bijapur, Chhattisgarh on April 18th, 2018.
In FY 2018-19, over 17,000 AAMs were operationalized, surpassing the target of 15,000.
Currently, there are 1.6 lakh such centres across India.
National Health Policy of 2017 envisioned AAMs as the cornerstone of India’s health system.
In 2023, the Union Health Ministry renamed AB-HWCs as Ayushman Arogya Mandirs with the tagline ‘Arogyam Parmam Dhanam’.
Aims and Objectives
To provide universal, free-of-cost, and accessible primary healthcare services to both rural and urban populations.
Features and Significance
Services provided include preventive, promotive, curative, palliative, and rehabilitative care.
AAMs offer a comprehensive 12-package set of services.
Sub-Health Centres (SHC) and Primary Health Centres (PHC) are being transformed to offer broader healthcare services.
Structural Mandate
Implemented via 2 Components:
Comprehensive Primary Health Care: The mission plans to establish 1,50,000 AAMs in rural and urban areas to provide comprehensive primary healthcare services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY): The scheme provides a health insurance cover of Rs. 5 lakh per year to more than 10 crore vulnerable families for secondary and tertiary care.
PYQ:
[2022] With reference to Ayushman Bharat Digital Mission, consider the following statements:
Private and public hospitals must adopt it.
As it aims to achieve universal health coverage, every citizen of India should be part of it ultimately.
It has seamless portability across the country.
Which of the statements given above is/are correct?
The Government has empowered Primary Agricultural Credit Societies (PACS) to operate Pradhan Mantri Bhartiya Jan Aushadhi Kendras (PMBJK), aiming to provide generic medicines at affordable prices to underserved rural areas.
AboutPradhan Mantri Bhartiya Jan Aushadhi Kendras (PMBJK) by PACS:
Details
PMBJKs were established in November 2008.
Government-established outlets that provide affordable, quality generic medicines.
Operated by PACS (Primary Agricultural Credit Societies) in rural areas.
PACS are empowered to run these Kendras to ensure accessibility in remote regions under the Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana (PMBJP).
Aims and Objectives
To provide affordable medicines, promote healthcare equity, and reduce medical expenses for farmers, while generating local employment and ensuring PACS’ financial sustainability through the sale of medicines and allied products.
Structural Mandate and Implementation
Administered by the Department of Pharmaceuticals under the Ministry of Chemicals and Fertilizers;
Bureau of Pharma PSUs of India (BPPI) is the implementation agency.
Implementation:
PACS receive technical and administrative support from the Department of Pharmaceuticals.
PACS leverage their existing infrastructure, including land, buildings, and storage, to run the Kendras.
PACS-run Kendras receive a 20% incentiveon monthly purchases, capped at Rs. 20,000 per month.
Kendra owners receive a 20% margin on MRP (excluding taxes).
They can sell allied medical products.
Features and Significance
Affordable Medicine Distribution: Ensures that generic medicines are affordable in rural areas.
Economic and Healthcare Benefits: Reduces medical costs and improves healthcare outcomes for farmers.
Alignment with National Health Policy: Supports equitable healthcare access, especially in remote areas.
Strengthening Rural Infrastructure: Utilizes PACS’ infrastructure to boost rural healthcare.
PYQ:
[2015] Public health system has limitations in providing universal health coverage. Do you think that private sector could help in bridging the gap? What other viable alternatives would you suggest?
December 3, International Day of Persons with Disabilities, promotes awareness of their rights, inclusion, and needs, emphasizing support for one of the world’s most marginalized and underrepresented communities.
What are the barriers faced by individuals with disabilities in accessing nutrition services?
Physical Accessibility: Many individuals with disabilities face challenges in accessing physical locations where nutrition services are provided, such as grocery stores or health clinics. This includes barriers like lack of ramps, inaccessible transportation, and inadequate facilities.
Lack of Knowledge and Skills: Individuals with disabilities may have limited knowledge about nutrition and cooking skills, which can hinder their ability to prepare healthy meals. This is often compounded by the need for assistance from caregivers who may not be well-informed about nutritional needs.
Financial Constraints: Economic factors play a significant role; many individuals with disabilities experience financial instability, limiting their ability to purchase nutritious food. This is particularly true in low-income households where resources are scarce.
Social Isolation and Stigma: People with disabilities often face social isolation and stigma, which can affect their access to community resources and support networks that provide nutritional assistance or education.
Complex Health Needs: Many individuals with disabilities have specific dietary requirements or face challenges related to feeding, swallowing, or digestion, making it difficult to meet their nutritional needs without tailored support.
Inadequate Public Health Support: In many regions, public health systems fail to provide adequate nutritional support for individuals with disabilities, particularly in low- and middle-income countries (LMICs) where resources may be limited.
How can nutrition programs be adapted to ensure they are inclusive of individuals with disabilities?
Tailored Nutritional Education: Nutrition programs should include educational components that cater specifically to the needs of individuals with disabilities, focusing on accessible cooking methods and meal planning that accommodate various dietary restrictions.
Accessible Service Delivery: Programs should ensure that nutrition services are delivered in accessible locations and formats, including home visits for those unable to travel or online platforms for remote consultations.
Community Engagement: Involving individuals with disabilities in the design and implementation of nutrition programs can help ensure that their unique needs are met. This could include feedback mechanisms to adapt services based on community input.
Training for Caregivers: Providing training for caregivers on the specific nutritional needs of individuals with disabilities can enhance meal preparation and dietary management at home.
Financial Assistance Programs: Implementing subsidies or financial assistance programs can help alleviate the economic burden on families caring for individuals with disabilities, enabling them to purchase healthier food options.
Integration with Health Services: Nutrition programs should be integrated with broader health services to provide comprehensive support that addresses both nutritional needs and overall health outcomes.
What role do Anganwadi workers play in promoting disability inclusion in their communities?
Early Identification and Referral: Anganwadi workers play a crucial role in the early identification of disabilities among children through monitoring developmental milestones and referring families to appropriate health services.
Community Education: They engage communities through initiatives like podcasts (e.g., “Nanhe Farishtey”) to raise awareness about disabilities and promote inclusive practices within local settings.
Nutrition Service Delivery: As frontline community nutrition providers, Anganwadi workers deliver vital nutrition services tailored to the needs of children with disabilities, ensuring they receive adequate dietary support.
Collaboration with Other Health Workers: Anganwadi workers collaborate with Accredited Social Health Activist (ASHA) workers to create a network of support for families dealing with disabilities, facilitating access to medical care and government benefits.
Capacity Building: Ongoing training on disability inclusion through protocols like the ‘Anganwadi Protocol for Divyang Children’ equips workers with the knowledge necessary to support children with disabilities effectively.
Advocacy for Rights and Resources: They advocate for the rights of persons with disabilities within their communities, helping families navigate available resources such as disability certificates and pensions.
Way forward:
Strengthen Inclusive Infrastructure and Services: Develop accessible infrastructure, including Anganwadi centres and transportation, while integrating nutrition programs with health services to provide tailored support for individuals with disabilities.
Empower Community and Frontline Workers: Enhance training for Anganwadi workers and caregivers, promote community engagement to address stigma, and ensure financial support for families to improve access to nutritious food and essential services.
Mains PYQ:
Q The Rights of Persons with Disabilities Act, 2016 remains only a legal document without intense sensitisation of government functionaries and citizens regarding disability. Comment. (UPSC IAS/2022)
The recent cardiac arrest and subsequent death of a Bengaluru Metropolitan Transport Corporation (BMTC) bus driver while on duty has sparked conversations about worsening health outcomes in urban areas.
What are the primary risk factors contributing to the rising NCD burden in urban areas?
High-Stress Work Environments: Many urban workers, including bus drivers, face high levels of stress due to long hours, erratic schedules, and demanding job conditions.
The BMTC study indicated that over 40% of its employees aged 45-60 are at risk for cardiovascular diseases, exacerbated by factors like continuous driving and poor eating habits.
Poor Nutrition and Lifestyle: Workers often lack access to healthy food options and exercise opportunities, leading to increased rates of obesity, hypertension, and diabetes.
The BMTC workforce has shown alarming rates of these conditions, which are often linked to lifestyle choices made under stressful work conditions.
Lack of Health Insurance and Support: Many informal workers do not have health insurance or access to regular health screenings. This lack of support can lead to delayed diagnosis and treatment of NCDs, increasing the risk of severe health events like heart attacks.
Socioeconomic Marginalization: A significant portion of the urban population lives in slums or informal settlements, where access to healthcare is limited. This socioeconomic status contributes to poor health outcomes and a higher prevalence of NCDs.
How can urban health systems be strengthened to effectively manage NCDs?
Improving Access to Primary Healthcare: Urban health systems must focus on making primary healthcare services more accessible to marginalized communities. This includes expanding facilities in underserved areas and ensuring that services are affordable and culturally appropriate.
Implementing Regular Health Screenings: Regular health evaluations for high-risk populations, such as bus drivers and other transport workers, should be mandated. These screenings can help identify risk factors early on and facilitate timely interventions.
Integrating Health Services with Employment Policies: Employers should collaborate with health departments to create programs that promote employee wellness, including stress management workshops and nutrition education tailored for their workforce.
Community-Based Health Promotion: Local organizations can play a crucial role in educating communities about NCD risks and promoting healthy lifestyles through workshops and outreach programs that engage residents directly.
What role do public awareness and community engagement play in combating NCDs?
Raising Awareness About NCD Risks: Public campaigns can educate individuals about the importance of regular health screenings and lifestyle changes that reduce the risk of NCDs. Awareness initiatives can empower communities to take charge of their health.
Encouraging Community Participation: Engaging community members in health promotion activities fosters a sense of ownership over their health outcomes. Community-led initiatives can effectively address local health issues by tailoring solutions to specific needs.
Utilizing Technology for Monitoring Health: Digital tools can facilitate real-time monitoring of health metrics for at-risk populations, enabling proactive management of conditions like hypertension and diabetes.
Creating Support Networks: Building networks among workers can provide emotional support and share resources for managing health issues collectively, which is particularly beneficial for those facing similar challenges in high-stress jobs.
Way forward:
Strengthen Urban Primary Healthcare: Expand access to affordable and culturally relevant primary health services, implement regular screenings for high-risk groups, and integrate wellness programs with employment policies for vulnerable workers.
Promote Community-Led Health Initiatives: Engage local organizations and residents to raise awareness about NCD risks, encourage healthy lifestyles, and utilize digital tools for real-time health monitoring and proactive care.
Mains PYQ:
Q “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC IAS/2021)
PYQ Relevance: Q) Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC CSE 2018)
Mentor’s Comment: UPSC Mains have always focused on ‘Inclusive Healthcare Infrastructure’ (in 2020), ‘Effective Implementation of Healthcare Policies’ (in 2017), ‘Universal Health Coverage Programs’ (in 2015).
Corneal blindness is a significant public health issue in India, contributing to approximately 15% to 20% of total blindness cases. With an estimated 1.2 million people affected and 20,000 to 25,000 new cases emerging annually, the urgency for effective solutions is paramount.
Today’s editorial explores the current challenges and proposes a comprehensive approach to address corneal blindness in India. This content can be used to present ‘Public Health challenges’ and to suggest some ‘innovative solutions to address Public Health’ in India.
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Let’s learn!
Why in the News?
The Report titled “India’s corneal blindness crisis” published by India Today, highlights the increasing incidence of corneal blindness, particularly in rural areas, and discusses the contributing factors such as limited access to healthcare and a shortage of donor corneas.
What are the key findings from these reports?
• Rising Incidence: Corneal blindness is increasing in India, with estimates of 20,000 to 25,000 new cases annually. This condition accounts for approximately 7.5% of total blindness cases in the country, significantly impacting rural populations where access to eye care is limited. • Demographics and Causes: The causes of corneal blindness have shifted from infectious diseases like keratitis to eye trauma and complications. Factors such as vitamin A deficiency, poor hygiene, and delayed medical interventions exacerbate the problem, particularly affecting children and working-age adults in rural areas. • Healthcare Disparities: Many individuals in rural regions lack access to quality eye care services, leading to irreversible corneal damage before they seek help. There is a notable gap in training and resources for healthcare providers, limiting their ability to effectively manage and treat corneal conditions. • Shortage of Donor Corneas: Despite a demand for around 100,000 corneal transplants each year, only about 25,000 to 30,000 corneas are donated annually. This shortage poses a significant barrier to treating those affected by corneal blindness. • Policy Considerations: Indian policymakers are considering implementing a ‘presumed consent’ model for organ donation to increase the availability of donor corneas. This approach aims to address the critical shortage and improve access to necessary treatments.
What are the primary causes and current statistics of corneal blindness in India?
Occupational Hazards: Injuries, particularly in industrial and agricultural settings, are increasingly recognized as a leading cause of corneal blindness. This shift highlights the impact of occupational hazards on eye health.
Historically, infectious diseases such as keratitis and trachoma have been significant contributors to corneal blindness.
However, the focus has shifted towards eye trauma and complications as major causes in recent years.
Nutritional Deficiencies: Widespread vitamin A deficiency is another critical factor exacerbating the incidence of corneal blindness, particularly among vulnerable populations such as children and working-age adults.
Healthcare Access Issues: Limited access to quality eye care services, especially in rural areas, leads to delayed treatment for conditions that could be managed effectively if addressed early.
Poor Hygiene and Delayed Interventions: Poor hygiene practices and delays in seeking medical help contribute to the worsening of corneal conditions, often resulting in irreversible damage.
Current Statistics
• Corneal blindness affects approximately 1.2 million people in India. • The country sees an estimated 20,000 to 25,000 new cases of corneal blindness each year. • Corneal blindness accounts for around 7.5% of the total blindness burden in India. • Children and working-age adults in rural areas are particularly susceptible due to malnutrition and frequent injuries, while elderly individuals face risks from degenerative eye conditions.
What are the barriers to effective treatment and prevention of corneal blindness?
Shortage of Donor Corneas: There is a significant gap between the demand for corneal transplants (estimated at 100,000 annually) and the actual number of donor corneas available (around 25,000 to 30,000). This shortage limits the ability to treat those suffering from corneal blindness effectively.
Healthcare Disparities: The distribution of specialized corneal services is uneven across India, with underserved regions lacking adequate facilities for the timely management of corneal diseases.
More trained corneal surgeons are needed to meet the annual transplant targets.
Although the Cornea Society of India has over 1,000 members, the exact number of surgeons performing keratoplasty regularly is unclear. This gap in training and availability affects surgical outcomes.
Data Gaps: Comprehensive data on the prevalence of corneal blindness and the number of individuals who could benefit from transplantation are lacking. Establishing a national registry for corneal blindness and transplants is essential.
Preventable Causes: Many cases of corneal blindness are avoidable through preventive measures such as addressing vitamin A deficiency, improving hygiene practices, and providing timely medical interventions for infections and injuries.
Public Awareness and Myths: Lack of awareness about eye health and misconceptions surrounding eye donation hinder corneal donation efforts. Myths about eye color change after donation or beliefs that only young people can donate deter potential donors.
What comprehensive strategies can be implemented?
Public Awareness and Education:Min of Health and Family Welfare (MoHFW) can lead nationwide awareness campaigns about eye health, corneal blindness, and the importance of eye donation.
Local health departments can conduct community outreach programs in schools and villages to educate people about eye care and the significance of corneal donation.
Enhancing Healthcare Access: The National Programme for Control of Blindness & Visual Impairment (NPCBVI) under the MoHFW, is responsible for improving eye care services across India, including establishing mobile eye care units.
District Blindness Control Societies (DBCS) that operate at the district level to implement eye care initiatives, can organize screening camps and facilitate access to surgical treatments for corneal blindness.
Training and Capacity Building: The Directorate General of Health Services (DGHS) and Regional Institutes of Ophthalmology (RIOs) can provide specialized training programs for eye surgeons and healthcare workers to enhance their skills in treating corneal conditions.
Policy and Research Initiatives: TheMinistry of Science and Technology can support research initiatives aimed at understanding the causes of corneal blindness and evaluating the effectiveness of interventions through funding and collaboration with research institutions.
For example, theNational Eye Bank Association of India can work on establishing guidelines for eye banks, promoting voluntary eye donations, and conducting research on best practices in eye banking
By implementing these strategies, India can make significant strides towards reducing the prevalence of corneal blindness and improving overall eye health across its population.
On International Diabetes Day (November 14), the Lancet shared a global study showing over 800 million adults have diabetes, and more than half aren’t receiving proper treatment.
What is the controversy over the numbers and the difference in Testing Methodology?
The Lancet study reported that diabetes was significantly higher in number than the Indian Council of Medical Research (ICMR) estimates (just over 100 million). This stark contrast raises questions about the accuracy and methodology used in both studies.
The primary reason for the discrepancy lies in the methodologies used to measure blood sugar levels:
The Lancet study utilized various methods including fasting glucose and HbA1C (a three-month glycated hemoglobin average) from data across 200 countries.
The ICMR study relied on fasting and two-hour post-prandial blood sugar tests using an Oral Glucose Tolerance Test (OGTT), which is considered the gold standard in India.
Experts argue that using HbA1C can lead to inflated numbers due to its sensitivity to factors like age and anemia.
For instance, a person without diabetes might still show elevated HbA1C levels based on their physiological characteristics, which can skew prevalence estimates.
What are the issues raised in the Lancet study?
Global Inequalities in Treatment: The study highlighted significant disparities in diabetes treatment access, particularly in low- and middle-income countries where treatment rates are stagnating despite rising diabetes cases. This raises concerns about long-term health complications for untreated individuals.
Rising Rates of Diabetes: The findings underscore that diabetes rates have increased dramatically, especially Type 2 diabetes, which poses a growing public health challenge. This trend is alarming given that many affected individuals are younger and at risk for severe complications.
Complications and Healthcare Burden: With a large number of individuals requiring treatment, there is a looming healthcare crisis regarding complications such as kidney failure, heart disease, and vision loss, which could overwhelm healthcare systems.
What steps need to be taken? (Way forward)
Enhanced Awareness and Education: There is a pressing need for widespread education on diabetes prevention through nutrition and physical activity. Public health campaigns should focus on promoting healthy lifestyles to mitigate risk factors associated with diabetes.
Policy Changes: Governments must implement policies that restrict unhealthy food options while making healthy foods more affordable. This includes subsidies for nutritious foods and initiatives to create safe spaces for physical activity.
Targeted Interventions for Vulnerable Populations: Special attention should be directed towards vulnerable groups, particularly women who may be at higher risk post-pregnancy or during menopause. Tailored interventions can help address specific risk factors prevalent in these populations.
Investment in Healthcare Infrastructure: To effectively manage the rising burden of diabetes, there must be significant investment in healthcare infrastructure, especially in low- and middle-income countries where resources are limited.
Long-Term Strategic Planning: A comprehensive long-term strategy is essential to combat the growing diabetes epidemic, requiring collaboration between governments, healthcare providers, and communities to ensure sustainable health outcomes.
Mains PYQ:
Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
Within just three weeks of its launch, over 10 lakh senior citizens have enrolled for the Ayushman Vay Vandana Yojana.
Note: Pradhan Mantri Vaya Vandana Yojana (PM-VVY) is a pension scheme and insurance policy for senior citizens in India. One must not get confused with Ayushman-VVY.
AboutAyushman Vay Vandana Yojana:
Details
Features and Provisions
• Cashless health coverage up to ₹5 lakh per year for senior citizens aged 70and above. • Beneficiaries receive an Ayushman Vay Vandana Card, which grants them access to free treatment in empaneled hospitals across India.
• Coverage includes medical consultations, treatments, pre- and post-hospitalization expenses, and complex procedures such as angioplasty.
Structural Mandate
• Administered under the PM-JAY framework, ensuring structured implementation and integration with India’s health insurance network.
• Implemented across empaneled hospitals in both urban and rural areas, ensuring nationwide reach.
• Centralized digital system tracks treatments, patient details, and expenses for transparency and accountability.
• Specifically designed for senior citizens, addressing their unique healthcare needs.
Aims and Objectives
• Universal healthcare for senior citizens, ensuring access to essential medical treatments without financial strain.
• Seeks to reduce out-of-pocket expenditure for elderly citizens and their families.
• Encourages preventive care and early medical intervention to address age-related health conditions.
Eligibility Criteria
• Open to all Indian citizens aged 70 and above.
• There are NO income/ family size restrictions, making it accessible to all senior citizens, regardless of their economic status.
• Beneficiaries must be Indian citizens.
• Seniors need to register under PM-JAY to receive the AVV Card and avail of the benefits.
Q) Public health system has limitations in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015)
Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC CSE 2022)
India’s Public Health System needs to focus on preventing and controlling non-communicable diseases like hypertension, diabetes, cardiovascular diseases, stroke, and cancer. These diseases affect people of all income levels, but the poor and old aged population is the most vulnerable.
In this scenario, Health Longevity is an evidence-based approach to help countries define prioritized, costed interventions and policy changes to save and extend people’s lives. According to World Bank, investing in healthy longevity could save 150 million lives in low- and middle- income countries.
Today’s editorial emphasizes the issues related to the health sector in India especially with respect to Non-communicable diseases.
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Let’s learn!
Why in the News?
The World Bank publishes an important and forward-thinking report on a key issue affecting people’s well-being. The report is Unlocking the Power of Healthy Longevity: Demographic Change, Non-communicable Diseases, and Human Capital, released in Washington D.C. in September 2024.
Key Findings of the Report:
● Aging and NCD Burden: Global aging is accelerating, with non-communicable diseases (NCDs) causing over 70% of deaths, especially in low- and middle-income countries. ● Potential Life Savings: Investing in healthy longevity could save 150 million lives and significantly improve productivity and economic growth by 2050. ● Life-Course Health Investments: Addressing health from maternal to elderly care, with a focus on NCD prevention, is essential for promoting healthier aging populations. ● Gender and Social Equity: Women, who often bear caregiving responsibilities and live longer with NCDs, require targeted health and social protections to ensure equity in aging.
Issues related to the Elderly Population in India:
Size of Elderly Population: India has the second-largest elderly population in the world, with approximately 140 million people aged 60 years and above.
Growth Rate: The elderly population is growing at a rate nearly three times higher than India’s overall population growth, indicating a significant demographic shift.
Aging Population Challenge: This rapidly aging population places considerable pressure on health services, social systems, and the economy.
What are the Disease Concerns in India?
Rise in Non-Communicable Diseases (NCDs): India is witnessing an increasing burden of NCDs, including heart disease, diabetes, cancer, and chronic respiratory diseases, which are now the leading causes of death.
Health Risks for the Elderly: As the elderly population grows, the prevalence of age-related diseases and NCDs is expected to surge, straining healthcare systems.
Impact on Public Health: The health challenges are compounded by the underdeveloped infrastructure for treating chronic diseases, particularly in rural areas.
Issues related to Hospital Expenses in India:
Rising Healthcare Costs: Medical expenses for elderly care, especially for chronic diseases and long-term care, are escalating. Private hospitals often charge exorbitantly, making healthcare unaffordable for many elderly individuals.
Inaccessibility of Healthcare: The elderly often face challenges in accessing healthcare facilities due to geographic and economic barriers, leading to delays in diagnosis and treatment.
Catastrophic Health Expenditure: Many elderly people, particularly in lower-income segments, face catastrophic health expenses that can push them into poverty. Even with government schemes, the out-of-pocket expenses remain high.
Steps taken by the Indian Government:
● National Programme for Health Care of the Elderly (NPHCE): This program aims to provide comprehensive healthcare services specifically tailored for older adults. ● National Social Assistance Programme (NSAP): Aimed at providing financial assistance to the elderly who are below the poverty line. ● Maintenance and Welfare of Senior Citizens Act, 2007: This act mandates maintenance and welfare provisions for senior citizens. ● Atal Vayo Abhyuday Yojana (AVYAY): A scheme focused on promoting the welfare of senior citizens through various support services. ● Elderline: A national helpline established to assist elderly individuals in accessing information and services related to their needs
Efficacy of Social Security Schemes:
Limited Coverage: India’s social security schemes, including pensions and health insurance, often do not adequately cover the elderly, especially those in lower income brackets or rural areas.
For example: Public health schemes like Ayushman Bharat aim to provide health insurance to underprivileged populations, but the coverage and access remain limited for the elderly.
Vulnerable Groups: The elderly in India, particularly those without formal employment or savings, remain highly vulnerable to financial distress from healthcare expenses and lack sufficient social security support.
Way forward:
Enhance and Expand Social Security Coverage: Strengthen existing social security schemes like Ayushman Bharat to ensure comprehensive health insurance and pension coverage for elderly populations, particularly in rural and low-income areas. This can help alleviate financial strain from healthcare costs.
Invest in Geriatric Healthcare Infrastructure: Improve healthcare facilities and services for the elderly, focusing on chronic disease management and accessible healthcare, especially in rural areas. This includes training healthcare workers in geriatric care and increasing the availability of affordable long-term care options.
Min. of Health and Family Welfare issued draft Guidelines for the withdrawal of life support in terminally ill Patients, aimed at implementing the Supreme Court’s 2018 and 2023 rulings that uphold the right to die with dignity for all Indians.
What is Passive euthanasia?
Passive euthanasia involves allowing a terminally ill patient to die naturally by withholding or withdrawing life-sustaining treatments, like ventilators when they no longer provide benefits.
What are the draft guidelines released by the Ministry of Health and Family Welfare?
The guidelines aim to operationalize the Supreme Court’s 2018 and 2023 orders, which recognize the right to die with dignity as part of Article 21 of the Indian Constitution.
Key Mechanisms Proposed:
Primary and Secondary Medical Boards: Hospitals are required to set up these boards to determine when further medical treatment for a terminally ill patient would no longer be beneficial.
Nomination of Doctors: District Chief Medical Officers will nominate doctors to serve on Secondary Medical Boards to confirm or reject the Primary Medical Board’s recommendations.
While India does not have dedicated legislation on withholding or withdrawing life-sustaining treatment, these guidelines and the Supreme Court’s judgments provide a defined legal framework to make these actions lawful.
What is meant by withholding/withdrawing life-sustaining treatment?
It refers to discontinuing medical interventions, such as ventilators or feeding tubes, when they no longer contribute to the patient’s recovery or only prolong suffering.
The intention is to allow the underlying illness to take its natural course while providing comfort care, focusing on symptomatic relief and palliative care.
The right to refuse medical treatment is recognized under common law and is considered part of India’s fundamental right to life and personal liberty (Article 21).
Is Withholding/Withdrawing treatment akin to giving up on the patient?
Withholding or withdrawing treatment does not mean the doctor is giving up on the patient. It is an acknowledgment that continued medical intervention may no longer be beneficial and could cause unnecessary suffering.
The process involves shifting the focus from life-sustaining measures to palliative care to manage pain and ensure the patient’s comfort.
Often, doctors practice “discharge against medical advice” because of misconceptions about the legality of withholding/withdrawing treatment. This practice leads to patients suffering without appropriate care.
What medical procedure is laid down by the SC and reaffirmed by the guidelines?
Primary Medical Board assessment: A hospital-level board, including the treating doctor and two experienced experts, evaluates the patient’s condition to recommend withholding/withdrawing treatment.
Secondary Medical Board review: A different board, nominated by the district Chief Medical Officer, reviews the Primary Board’s decision for an additional level of checks.
Consent and Judicial notification: Consent from the patient’s surrogate decision-makers or advance directive nominees is required, and the decision must be notified to the local judicial magistrate.
Way forward:
Public Awareness and Training: Educate the public and healthcare professionals about the legal framework for end-of-life care, emphasizing the distinction between withholding treatment and euthanasia, to reduce misconceptions.
Strengthen Palliative Care Services: Expand access to palliative care across hospitals and healthcare facilities, ensuring that terminally ill patients receive compassionate and effective pain management and comfort care.
October 24 is recognized as World Polio Day, a commemoration established by Rotary International to honor the birth of Jonas Salk, who spearheaded the development of the first vaccine against polio in the 1950s.
What key strategies contributed to the successful eradication of polio in India?
Comprehensive Vaccination Campaigns: India implemented large-scale vaccination drives starting in 1972, which expanded under the Universal Immunisation Programme (UIP) in 1985.
Community Engagement and Awareness: Targeted awareness campaigns were crucial, utilizing local health workers to administer oral polio drops, which made vaccination accessible.
Effective Messaging: The slogan “do boond zindagi ki” (two drops of life) resonated well with the public. Utilizing celebrities like Amitabh Bachchan and integrating health messages into popular media further amplified awareness.
Robust Surveillance System: A multilayered surveillance mechanism was developed to monitor acute flaccid paralysis (AFP) cases, enabling prompt immunisation of affected populations. This system involved local informers, including community health workers and doctors.
Targeted Interventions for High-Risk Areas: By 2009, efforts were concentrated in specific regions, particularly in Uttar Pradesh and Bihar, where most cases were reported. This targeted approach was critical in reducing transmission rates.
Collaboration with International Agencies: The eradication campaign was supported by various international bodies such as WHO, UNICEF, and the Bill and Melinda Gates Foundation, ensuring financial and logistical backing.
How did India address the challenges of vaccine hesitancy among specific communities?
Engagement with Community Leaders: To address religious concerns and misinformation, influential figures such as imams and local leaders were involved. Their endorsements played a significant role in countering myths about the vaccine.
Targeted Communication Strategies: Awareness efforts were tailored to specific communities, focusing on dispelling myths surrounding the vaccine, such as fears about impotence and cultural taboos against its ingredients.
Culturally Sensitive Messaging: Messaging was crafted in local languages and through community-specific narratives, ensuring that it resonated with the cultural context of various groups.
What lessons can be learned from India’s polio eradication efforts for future public health campaigns?
Importance of Community Involvement: Engaging local leaders and community members is vital for building trust and addressing vaccine hesitancy effectively.
Flexibility in Implementation: Tailoring vaccination drives to accommodate local cultural practices, work schedules, and geographic challenges can enhance participation rates.
Sustained Awareness Efforts: Continuous education and awareness campaigns are essential, especially in the face of evolving misinformation and cultural resistance.
Data-Driven Decision Making: The use of robust surveillance systems and data analytics to identify and target high-risk areas can help streamline public health interventions.
Collaboration with Multiple Stakeholders: Building partnerships between government agencies, international organizations, and local communities can strengthen public health responses and resource mobilization.
Conclusion: Need to establish sustainable platforms for continuous dialogue between healthcare providers and community leaders to address health concerns, build trust, and ensure community-specific health initiatives are effectively communicated and implemented.
After decades of steady increases in human life expectancy due to advancements in medicine and technology, recent trends suggest that these gains are starting to slow down, according to a new study.
The Key Findings of the Study:
Slowing of Life Expectancy Gains: After decades of rising life expectancy due to medical and technological advancements, the pace of these increases has slowed significantly. The study suggests that human life expectancy has nearly plateaued, with dramatic extensions unlikely without breakthroughs in anti-aging medicine.
Regional Analysis: The study analyzed life expectancy data between 1990 and 2019 from regions with the longest life spans, such as Australia, Japan, and Sweden.
Even in these regions, life expectancy increased by only 6.5 years on average over the 29-year period.
Challenges of Radical Life Extension: Researchers found that while people live longer due to improvements in healthcare, the human body’s aging process—marked by the declining function of internal organs—limits life span. Even if diseases like cancer and heart disease are eliminated, aging itself remains a barrier.
Low Probability of Reaching 100: The study estimates that girls born in the longest-living regions have only a 5.3% chance of reaching 100 years, while boys have a 1.8% chance. Thus, despite medical advancements, reaching 100 years remains rare without interventions to slow aging.
Aging as the Primary Barrier: Researchers argue that extending average life expectancy dramatically will require breakthroughs that slow the aging process rather than just better treatments for common diseases.
Some experimental drugs, like metformin, have shown potential in animal studies, but human trials are needed.
India’s Present Status:
Lower Life Expectancy: As of 2024, India’s average life expectancy is around 70 years, In contrast, countries like Japan and Switzerland boast life expectancies exceeding 83 years.
Healthcare Advancements: While India has made significant progress in combating infectious diseases and improving maternal and child health, chronic illnesses and lifestyle diseases (such as heart disease and diabetes) are emerging as leading causes of death.
What Needs to Be Done: (Way forward)
Focus on Anti-Aging Research: India must invest in research on aging and regenerative medicine, exploring ways to slow down the aging process rather than just treating diseases.
Strengthening Healthcare Systems: Expanding access to quality healthcare and preventive medicine to manage age-related diseases can enhance the quality of life in later years, even if life expectancy does not rise dramatically.
Policy Support for Longevity Research: There is a need for policies supporting medical research into life-extension technologies, including drug trials and clinical studies focused on aging.
Public Health Interventions: Improved public health measures targeting lifestyle diseases (obesity, diabetes) and better management of age-related conditions can enhance life span and overall well-being.
Mains PYQ:
Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)
Q). Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC CSE 2021)
Q) The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015)
Mentor’s Comment: In July, a 26-year-old executive from a multinational consulting firm ended her life due to immense work pressures, shedding light on a critical issue affecting millions of working Indians. In September, a 38-year-old software engineer in Chennai also took his life, battling depression caused by work-related stress.
Despite outwardly successful careers, these tragic losses highlight India’s growing mental health crisis, where success is often tied to relentless productivity and material wealth. With over 197 million people suffering from mental health disorders, according to the Lancet Psychiatry Commission, India’s economic growth has increased societal pressures, neglecting mental well-being and fostering disconnection from community and self-awareness. In today’s editorial, we will dive more into the causes and impacts of Mental Health in Indian Society.
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Let’s learn!
Why in the News?
This year’s theme for World Mental Health Day (October 10) focuses on ‘prioritizing mental health in the workplace. India faces a mental health crisis driven by urban stress, financial instability, and intense competition.
Key points related to Mental Health issues as per WHO:
• According to WHO, India has a significant burden of mental health issues with 2443 Disability-Adjusted Life Years (DALYs) per 100,000 population. • India’s age-adjusted suicide rate is 21.1 per 100,000, among the highest globally. • The economic loss due to mental health conditions between 2012-2030 is estimated to be USD 1.03 trillion.
What are the reasons behind the rising stress and anxiety?
Mental Health Epidemic: India is facing a growing mental health crisis, with millions suffering from disorders like depression, anxiety, and stress.
Pressures of Urban Living: Urban life, financial instability, and intense competition contribute significantly to rising stress.
Material Success vs. Well-being: Despite material success, many people feel isolated and disconnected from their communities, leading to a sense of purposelessness.
Consumerism and Social Comparison: In urban areas, consumerism fosters a culture where wealth and luxury goods define status, causing feelings of inadequacy and stress.
Fear of Insignificance: As per Ernest Becker’s theory, much of human behavior is driven by the fear of impermanence. People chase material wealth for social validation, but this pursuit neglects self-awareness and deeper emotional needs.
Mental Health Policy and Legal Frameworks by Govt:
• National Mental Health Policy, 2014: Promotes a rights-based and participatory approach for quality service delivery. • Mental Healthcare Act, 2017: Provides a legal framework that aligns with the UNCRPD (United Nations Convention on the Rights of Persons with Disabilities), focusing on protecting the rights of individuals with mental illness, decriminalizing suicide, and ensuring access to mental health services.
Collective Action, Community as Solutions:
Shifting focus to Collective Well-being: The emphasis needs to move from individual success to collective well-being. Strong social connections, supportive communities, and meaningful work are critical to mental health.
Examples from other Countries: Initiatives like Brazil’s community gardens promote shared responsibilities, fostering a sense of belonging and combating isolation.
Value of Community Living: Community living provides a sustainable alternative to individualistic consumerism by promoting shared responsibility and collective purpose, strengthening social support networks, reducing competition, and offering a sense of purpose.
Way forward:
Strengthen Community-Based Mental Health Programs: Focus on building strong social connections and support systems through community-based initiatives, promoting collective well-being over individual competition, and addressing isolation.
Enhance Accessibility to Affordable Mental Health Services: Expand access to cost-effective, quality mental health care at the primary health care level, ensuring services are available to all, especially in underserved areas.
On October 9, 2024, the Union Cabinet approved extending the free fortified rice supply under welfare programs until December 2028.
Why Rice Fortification is needed?
Widespread Micronutrient Deficiency: India faces a significant public health challenge with micronutrient deficiencies, particularly iron, Vitamin B12, and folic acid. Anaemia, caused by iron deficiency, is a persistent issue affecting large segments of the population, including children, women, and men.
Rice as a Staple Food: Given that 65% of India’s population consumes rice as a staple, it is an ideal vehicle to deliver essential micronutrients to combat these deficiencies, helping improve overall health, productivity, and cognitive development.
Process of Rice Fortification:
Fortified Rice Kernels (FRK): The process involves producing fortified rice kernels that are enriched with essential micronutrients such as Iron, Folic Acid, and Vitamin B12.
Blending with Regular Rice: These fortified kernels are then blended with regular rice at a ratio prescribed by FSSAI (Food Safety and Standards Authority of India).
Typically, fortified kernels make up 1-2% of the total rice, ensuring consistent delivery of micronutrients without altering the taste or cooking properties of the rice.
How the Fortification Initiative has fared so far?
The rice fortification scheme was implemented in three phases between 2022 and March 2024, with the target of achieving universal coverage in all government schemes by March 2024 successfully met.
Fortified rice is now supplied under major welfare programs like the Targeted Public Distribution System (TPDS), Integrated Child Development Service (ICDS), and PM POSHAN in all states and Union Territories.
The initiative is fully funded by the central government, highlighting its commitment to tackling malnutrition and ensuring inclusive nutritional security across the country.
How can food fortification help reduce malnutrition in India?
Combats Micronutrient Deficiencies: Fortifying staple foods with essential nutrients like iron and vitamins helps reduce widespread deficiencies that cause anemia and poor health.
Wide Reach: Through existing public programs (PDS, ICDS), fortified food reaches vulnerable populations, ensuring consistent nutrient intake for large segments of society.
Cost-Effective: It offers a scalable, affordable solution to malnutrition, improving health outcomes without significant changes in diets or eating habits.
Way forward:
Strengthen Monitoring and Quality Control: Implement robust monitoring mechanisms to ensure the consistent quality of fortified rice and its proper distribution across welfare programs to maximize nutritional benefits.
Raise Awareness and Promote Consumption: Conduct awareness campaigns to educate the public on the health benefits of fortified rice, ensuring higher acceptance and consistent consumption to address widespread micronutrient deficiencies.
Four years after the onset of Covid, an expert group formed by NITI Aayog has proposed the establishment of a comprehensive framework to handle future public health emergencies or pandemics effectively.
Lessons Learned from COVID-19:
Gaps in Legal Frameworks: Existing laws like the Epidemic Diseases Act (1897) and National Disaster Management Act (2005) were insufficient for handling large-scale health emergencies. These laws lack clarity on definitions of epidemics and provisions for managing public health crises, drug distribution, and quarantine measures.
Delayed Response and Coordination: The COVID-19 pandemic exposed weaknesses in coordination between central and state governments, highlighting the need for a more organized response mechanism.
Inadequate Surveillance: Insufficient disease surveillance and early warning systems delayed the identification of threats. The role of zoonotic diseases, especially viruses linked to bat species, underscored the need for better monitoring of human-animal interactions.
What specific recommendations does the NITI Aayog report make?
Enactment of PHEMA: Introduce the Public Health Emergency Management Act for a more robust legal framework to manage pandemics and other health emergencies.
Empowered Group of Secretaries (EGoS): Establish a central committee to oversee pandemic preparedness, governance, R&D, surveillance, and response efforts.
Strengthened Disease Surveillance: Create a national biosecurity and biosafety network and monitor human-animal interfaces, especially for zoonotic diseases.
Emergency Vaccine Bank: Develop a stockpile of vaccines for rapid access during health crises, sourced domestically or internationally.
Early Warning and Research Network: Build a forecasting and modelling network, along with Centres of Excellence (CoEs) to advance research on priority pathogens and preparedness.
How can India enhance its pandemic preparedness framework? (Way forward)
Strengthening Legal and Institutional Frameworks: Enact a Public Health Emergency Management Act (PHEMA) and establish an Empowered Group of Secretaries for coordinated pandemic response.
Enhancing Surveillance and Early Warning Systems: Build a robust disease surveillance network, biosecurity system, and epidemiology forecasting for early detection and response to outbreaks.
Investing in Health Infrastructure and Vaccine Stockpiles: Develop public health cadres, boost healthcare infrastructure, and create an emergency vaccine bank for rapid deployment during health crises.
The “Arogya Sanjeevani Policy” serves as a reference point for choosing health insurance for hospitalisation.
AboutArogya Sanjeevani Policy:
Details
Launch Date
April 2020
Issued by
Insurance Regulatory and Development Authority of India (IRDAI)
Objective
To provide basic and affordable health insurance coverage to all citizens
Sum Insured
₹1 lakh to ₹5 lakh per policy year
Coverage
Hospitalization, pre and post-hospitalization expenses, daycare procedures, AYUSH treatments, COVID-19 coverage
Pre-Existing Conditions
Coverage after 4 years of continuous policy renewal
Co-Payment
5% co-payment on all claims
Premium
Varies based on age, sum insured, and insurer
Waiting Period
30 days for new policies; 48 months for pre-existing diseases
Daycare Procedures
Covers over 50+ daycare treatments
Room Rent Limit
Up to 2% of the sum insured per day (maximum ₹5,000 per day)
ICU Room Rent
Up to 5% of the sum insured per day (maximum ₹10,000 per day)
AYUSH Treatments
Covers Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy treatments
Maternity Coverage
Not covered
Network Hospitals
Cashless facility in network hospitals
Eligibility
Individuals aged 18 to 65 years
PYQ:
[2019] Performance of welfare schemes that are implemented for vulnerable sections is not so effective due to the absence of their awareness and active involvement at all stages of the policy process – Discuss.
Primary care remains underdeveloped, while the private sector has seen significant growth in secondary and tertiary care.
What are the major necessities in Public Health?
Diseases of Poverty: This includes health issues predominantly affecting the poor and vulnerable populations, such as tuberculosis, malaria, undernutrition, maternal mortality, and illnesses caused by food and water-borne infections like typhoid and diarrheal diseases.
Addressing these needs is critical not only from a health perspective but also as a matter of human rights.
Middle-Class Health Concerns: The second category focuses on health issues related to environmental pollution, including air and water quality, waste management, and food safety.
These issues are often exacerbated by inadequate infrastructure and poor market regulations, leading to chronic illnesses and road traffic accidents.
Curative Care Needs: The most visible public health needs are those related to curative care, which is divided into three levels: primary, secondary, and tertiary care.
The poor often rely on public primary health care for affordable services, while secondary care remains historically neglected.
Tertiary care is primarily addressed through government schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat, aimed at providing coverage for serious health issues.
How do the private hospitals become a real beneficiary in present times?
Limited Coverage: India’s health insurance primarily covers only hospitalisation expenses, leaving out outpatient and primary care services. This benefits private hospitals as they can monopolise high-cost medical treatments, while the larger uninsured population faces commercialised care at market rates.
Weakening of Public Health Sector: The government’s shift in focus from strengthening public sector health care to outsourcing via insurance schemes like PMJAYindicates a failure to build adequate secondary and tertiary public health services.
Threats to Public Healthcare:
Neglect of Secondary and Tertiary Care: The inadequate investment in strengthening secondary- and tertiary-level health care in the public sector, leads to a reliance on private hospitals.
Transformation of Primary Health Centres (PHCs) and Sub-centres: The conversion of sub-centres and PHCs into Health and Wellness Centres (HWCs) has undermined their original role in preventive and promotive health care.
Loss of Trust in Public Healthcare: Due to overcrowding, poor infrastructure, and inadequate funding, public health institutions are losing credibility. Coupled with the commercial interests of private providers, this creates a dual crisis of access and quality in the healthcare system.
Rebranding of Health Centres: The recent renaming of HWCs as “Ayushman Arogya Mandirs” raises concerns about cultural relevance and secularism in public health institutions, especially for non-Hindi-speaking populations, further undermining trust in the system.
Way forward:
Strengthen Public Healthcare Infrastructure: Invest in enhancing secondary and tertiary care facilities in the public sector to reduce dependence on private hospitals.
Integrate Health Insurance and Primary Care: Expand health insurance coverage to include outpatient and primary care services, and ensure that public health centers retain their focus on preventive and promotive care.
Mains PYQ:
Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
The recent brutal rape and murder case in Kolkata has sparked widespread calls for the death penalty for the accused.
The Justice J.S. Verma Committee, formed in response to the 2012 Delhi gang rape, recommended against the death penalty for rape, even in the rarest of rare cases, arguing that it would be a regressive step.
Deeper problem in the Health Care Sector:
Healthcare Violence: The protests by resident doctors stem from a series of violent attacks against medical personnel. This violence often arises from disgruntled patients and their families who perceive poor healthcare services.
Corruption in Healthcare: The World Health Organization estimates that corruption claims nearly $455 billion annually, which could otherwise extend universal health coverage globally.
In India, this corruption manifests in various forms, including bribery and sextortion, further undermining the healthcare system’s integrity.
Ineffective Responses: Traditional responses to healthcare violence, such as enhancing security and legal measures, have proven inadequate. These knee-jerk reactions fail to address the root causes of the violence.
What does the Justice K. Hema Committee reportsay on the Culture of Assault?
On Sexual Assault and Consent: Instances of sexual assault are not isolated events but are rooted in societal practices that undermine women’s autonomy and consent.
The National Crime Records Bureau reported 31,516 cases of rape in India in 2022, indicating a significant prevalence of sexual violence against women.
The Justice Hema Committee report emphasizes that rape is a manifestation of a culture that views women as objects rather than individuals with rights.
On Workplace Harassment: The Vishaka guidelines established in 1997 aimed to protect women from workplace harassment, leading to the Sexual Harassment of Women at Workplace Act, 2013, which mandates the formation of Internal Complaints Committees (ICC).
The report argues that ICCs are inadequate for the film industry due to potential biases and influence from abusers, advocating for an independent government forum to address these issues.
Need to Rethink Violence in Healthcare:
Understanding the Multi-faceted Nature of Violence: Violence in healthcare settings is not limited to patient assaults on healthcare workers, it also includes institutional and managerial violence. This encompasses horizontal violence among healthcare providers and the systemic issues that create a hostile work environment.
Implementing Comprehensive Safety Measures: While immediate responses such as improving security and legal protections are necessary, they must be part of a broader strategy that includes training healthcare workers on conflict resolution, mental health support, and creating a culture of safety within healthcare institutions.
About Justice J.S. Verma Committee Recommendations
Recommendations on
Explanation
Rape
• It recognized rape as a Crime of Power, not just passion.
• Expand definition to include all forms of non-consensual penetration.
• Remove marital rape exception; marriage should not imply automatic consent. (European Commission of Human Rights in C.R. vs U.K)
Sexual Assault
• Broaden definition to include all non-consensual, non-penetrative sexual acts.
• Penalty: Up to 5 years of imprisonment or fines.
Verbal Sexual Assault
• Criminalize unwelcome sexual threats.
• Punishable by up to 1 year in prison or fines.
Sexual Harassment at Workplace
• Include domestic workers under protections.
• Replace internal complaint committees with Employment Tribunals.
• Employers to compensate victims of sexual harassment.
Acid Attacks
• Propose a 10-year minimum punishment, separate from grievous hurt.
• Establish a compensation fund for victims.
Women in Conflict Areas
• Review AFSPA; exclude government sanction for prosecuting sexual offenses by armed forces.
• Appoint special commissioners to monitor offenses.
Trafficking
• Comprehensive anti-trafficking laws beyond prostitution.
• Protective homes for women and juveniles overseen by High Courts.
Child Sexual Abuse
• Define ‘harm’ and ‘health’ in the Juvenile Justice Act to include both physical and mental aspects.
Death Penalty
• Opposed chemical castration and death penalty for rape.
• Recommend life imprisonment.
Medical Examination of Rape Victims
• Ban the two-finger test; victim’s past sexual history should not influence the case.
Reforms in Case Management
• Set up Rape Crisis Cells, increase police accountability, allow online FIR filing.
• Encourage community policing and increase police personnel.
Need for a Comprehensive Approach:
National Task Force: Improving hospital security and infrastructure alone may not be sufficient to address the problem. The national task force constituted by the Supreme Court should devise a comprehensive road map to prevent and arrest medical corruption, particularly in the public sector.
Need Expertise: The task force should include experts from public health, medico-legal, and other allied fields, along with the participation of the larger governing and administrative community.
Note: Recently some states have taken steps to empower women. For example, the Himachal Pradesh Assembly passed a Bill on Tuesday to increase the minimum marriage age for women from 18 to 21 years.
Mains PYQ:
Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC CSE 2018)
Q We are witnessing increasing instances of sexual violence against women in the country. Despite existing legal provisions against it, the number of such incidences is on the rise. Suggest some innovative measures to tackle this menace. (UPSC CSE 2014)
The Supreme Court of India denied permission to the parents of Harish Rana, a 32-year-old man in a vegetative state for 11 years, to remove his Ryles tube which is a device used for feeding.
A Ryles tube, also known as a nasogastric (NG) tube, is a medical device used for various purposes related to nutrition and gastric management. It is inserted through the nose, passing through the nasal cavity, down the esophagus, and into the stomach.
Recent Supreme Court Judgment:
The Bench headed by CJI D.Y. Chandrachud observed that the Ryles tube is not a life support system and therefore could not be withdrawn.
This decision has stirred legal and ethical debates, as the Supreme Court’s 2018 judgment permits the withdrawal of life support in terminal cases under the concept of “passive euthanasia.”
Passive euthanasia involves the withdrawal of medical treatment with the intention of hastening the death of a terminally ill patient.
The Supreme Court initially legalized this practice in 2018, allowing patients to create a “living will” to refuse life-sustaining treatment when they are unable to communicate their wishes.
Ethical Challenges:
Question of whether the decision benefits the patient: The judgment raises concerns about whether the decision benefits the patient, as prolonging life in such a condition may increase suffering.
Prolonged suffering: The principle of not causing harm is challenged since keeping the patient in a vegetative state with artificial feeding may lead to prolonged suffering for both the patient and their caregivers.
Against Right to Life and Death: The patient’s rights to a dignified life and death may be compromised which is addressed in various judgments like Common Cause v. Union of India (2018). This judgment recognised the right to die with dignity as part of the right to life under Article 21.
Autonomy: The patient’s right to choose, which is central to the concept of dignity, has been overlooked. The judgment did not consider the wishes of the patient or their family in determining the course of action.
Need for Legal Clarity:
Distinguishing Euthanasia from Withdrawal of Life Support: There is a pressing need to legally clarify the difference between euthanasia and the withdrawal of futile life-sustaining interventions.
Involvement of Medical and Ethical Experts: The decision-making process in such sensitive cases should involve palliative care physicians and ethical experts to ensure that medical and ethical considerations are fully addressed.
Advance Care Planning: Promoting Advance Medical Directives and Advance Care Planning is crucial to empower individuals to have control over their end-of-life decisions, ensuring that their rights to a good quality of life and death are respected.
Systemic Reforms: The judgment highlights the need for systemic reforms to avoid forcing families into legal battles and to ensure that patients’ rights are safeguarded with appropriate legal frameworks.
Conclusion: The recent Supreme Court judgment highlights the urgent need for legal clarity, ethical considerations, and systemic reforms to protect patient rights and ensure dignity in end-of-life decisions.
Mains question for practice:
Q Discuss the need for legal clarity and systemic reforms to uphold the dignity and rights of patients in end-of-life decisions. (150 words) 10M
