Mar-17SI Flashcards
Mar-17SI-Index
7.1. Maternity Benefit Amendment Bill, 2016
7.2. Mental Healthcare Bill
7.3. Draft Indian Medicine and Homoeopathy Pharmacy
Central Council Bill, 2016
7.4. Medical Termination of Pregnancy (Amendment) Bill,
2014
7.5. Community Radio
7.6. Elderly in India-Emerging Challenges
7.7. OECD Report on Employment in india
7.8. Vision Zero Conference: Occupational, Safety and
Health
7.9. Human Development Report 2016
7.10. Drug Addiction
7.11. National Strategic Plan for Tuberculosis Elimination
2017-2025
7.12. Partha Mukhopadhyay Working Group on Migration
7.1. MATERNITY BENEFIT AMENDMENT BILL, 2016
Why in news?
Maternity Benefit Amendment Bill, 2016 was passed by the Parliament.
Analysis of the Provisions
Raising of Maternity Benefits from 12 weeks to 26 weeks
It will be in line with the World Health Organisation recommendation that children must be exclusively breastfed by the mother for the first 24 weeks. This will improve survival rates of children and for the healthy development of both mother and child.
As absence of inadequate maternity leave and income security is one of the reasons for women dropping out of the labour force, this will provide protection to women.
On the other hand, increasing maternity leave from 12 to 26 weeks could have an adverse impact on the job opportunities available for women as the Bill requires the employer to pay full wages during maternity leave. It could increase costs for employers and result in a preference for hiring male workers.
Also, the increase in costs could impact the competitiveness of industries that employ a higher proportion of women workers.
Whether Employers Should Bear the Cost?
It could be argued that since maternal and child health is a public good, it would be appropriate for the government to finance such social security measures.
Unorganised women workers not covered under the Act
About 90% of working women are in the unorganised sector and are not covered by the 1961 Act. But, even after the Law Commission’s recommendation to cover women working in the unorganised sector also, the Bill fails to cover all women.
Currently, such women may claim maternity benefits under the Indira Gandhi Matritva Sahyog Yojana, a conditional cash transfer scheme.
Way Forward
Increasing maternity benefit is a welcome step but the government should devise some mechanism to ensure that competitiveness of the private sector is not affected.
[Note: For provisions of Maternity Benefit Bill, 2016, please refer August, 2016 issue]
7.2. MENTAL HEALTHCARE BILL
Why in news?
Parliament has passed the Mental Healthcare Bill, 2016 that will repeal the Mental Health Act, 1987
Background
The Bill has been passed to harmonise the country’s mental health laws to the UN Convention on Rights of Persons with Disabilities, to which the country is a signatory.
Important provisions of the Bill
Rights of person with mental Illness- every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government at an affordable price, free for homeless and BPL.
Advance Directives: given by mentally ill person regarding her treatment and who shall be her nominated representative Central and State Mental Health Authority: These bodies are required too register, supervise and maintain a register of all mental health establishments, o develop quality and service provision norms for such establishments, o maintain a register of mental health professionals o train law enforcement officials and mental health professionals on the provisions of the Act, o receive complaints about deficiencies in provision of services, and o Advise the government on matters relating to mental health. Suicide is decriminalized- person attempting suicide will be treated as mentally ill and will not be treated under IPC Mental Health Review Commission: will be a quasi-judicial body that will periodically review the use of and the procedure for making advance directives and advice the government on protection of the rights of mentally ill persons. Mental Health Review Board to protect the rights of persons with mental illness and manage advance directives.
The Bill also specifies the process and procedure to be followed for admission, treatment and discharge of mentally-ill individuals.
A person with mental illness shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anesthesia.
Significance of the Bill
It is a rights-based approach for the health of mentally ill patients providing various rights such as access to health care facilities and providing advance directives for their treatment.
It is a step forward in making heath as a fundamental right.
Decriminalisation of suicide implies that the government has accepted that the people trying to commit suicide needs help and not punishment
Bringing depression and mental illness into public discourse which is considered as a taboo in India will help in early detection of the patients and can decrease in chances of suicide.
Challenges
The amount spent on mental healthcare is just 0.06% of health budget is very low to provide for infrastructure as envisaged in the Bill.
Moreover, India has just 3 psychiatrists per million (global norms is 56 per million) is very low to look for very high and ever increasing number of cases. Also there is lack of counselling centres.
Poor infrastructure at district and sub-district level will create burden on state government and the Implementation will vary across states with Bihar and UP are expected to lag behind.
Advance directives clause will be an issue as in many cases patients will not be able to take rational decisions The bill does not focus on health and condition of existing patients in different mental institutions across the country.
Box–The Bill defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs.
7.3. DRAFT INDIAN MEDICINE AND HOMOEOPATHY PHARMACY CENTRAL COUNCIL BILL, 2016
Why in News?
The Ministry of AYUSH has decided to introduce ‘The Indian Medicine and Homoeopathy Pharmacy Central Council Bill, 2016’
The draft Bill has been circulated in all States &UTs and comments have been invited from all stakeholders. Background
Alternative system of medicine which includes Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy is an integral part of the healthcare system in India.
A regulatory framework for education in medicine is therefore a must. Two Acts: Indian Medicine Central Council (IMCC) Act, 1970 and Homoeopathy Central Council (HCC) Act, 1973 were constituted with the same objective.
Two statutory bodies: Central Council of Indian Medicine (CCIM) and Central Council of Homeopathy (CCH) were formed.
The present draft bill is set to replace the two existing Acts. Objectives
The Bill is to set up regulatory framework at the Central as well as State level for standardization and quality control of education, practice of pharmacy in Ayurveda, Siddha, UnaniTibb and Homoeopathy To maintain registers of the pharmacists. Key Features of the Bill Making appointments of regulators through election rather than selection.
A new institutional set up for regulation of education for Indian Systems of Medicine and Homeopathy.
o An Advisory Council for Indian Systems of Medicine and Homeopathy respectively having representation both from the States and UTs to develop a national agenda on education in concerned fields. o National Commission for Indian Systems in Medicine (NCISM): Policy making body for medical education in Indian System of Medicine o National Commission for Homeopathy: Policy making body for medical education in Homeopathy.
Inclusion of Yoga and Naturopathy in NCISM.
Transitionary provisions have been included for smooth transition of CCIM and CCH to NCISM and NCH. Creation of five mutually independent and autonomous Boards with sharp demarcation of functions.
To provide National Licentiate Examination for practice by medical professionals. To allow profit-institution to establish colleges. Earlier only not-profit was allowed
Significance It will help to form a regulatory body for Ayurveda, Siddha, Unani, Tibb and Homoeopathy. It will streamline the Central councils on issue of membership. Will bring transparency in granting permissions to colleges, practices, ethics as well as standards in AYUSH medical education
7.4. MEDICAL TERMINATION OF PREGNANCY (AMENDMENT) BILL, 2014
Why in News?
In February 2017, the Supreme Court of India declined the plea of a woman to abort her foetus detected with Down syndrome. The whole issue set a debate about a woman’s right to choice over her body and termination of foetus, which is considered as a life after a certain period of pregnancy in Medical Termination of Pregnancy Act 1971.
Issue Involved
Medical Termination of Pregnancy Act 1971 (MTP Act), allows a woman to terminate her foetus till the 20th week of pregnancy. However, in certain exceptional circumstances, court relaxes the aforesaid time period and allows termination of pregnancy only if the foetus poses danger to the woman’s life or is detected with an abnormal deformity.
To detect any abnormality in foetus, a pregnant woman can undergo the medical test only after 18-week period of her pregnancy. However, the report of the test itself can take 2-3 weeks to arrive; meanwhile, the pregnant women would have crossed the time limit allowed to opt for abortion.
Medical professionals are of the opinion that approx. 2-3 percent foetus out of 26 million new lives, can be detected to be abnormal even after 20 week period and therefore, the cap on the time period for termination of pregnancy should be relaxed.
Due to rigid framework of the Act and myriad aspects of social stigma (pregnancy before marriage, complication in abortion etc.) attached to the issue, around 10 women every minute in India die due to pregnancy-related complications.
Moreover, MTP Act 1971 is indifferent to the institutional services for delivery; for example, there are grave shortages of gynaecologists at Community Healthcare Centres. This compels the rural women to choose expensive and unsafe methods of abortion.
Significance of the Medical Termination of Pregnancy (MTP) (Amendment) Bill 2014
Medical Termination of Pregnancy (MTP) (Amendment) Bill 2014 is intended to extend the legal limit for abortion from the present 20 weeks to 24 weeks and will also allow for abortions-on-demand up to 12 weeks.
The earlier act (MTP 1971) was guided by the objective of population control and preventing high mortality related to pregnancy; whereas, the new amended law would take into consideration a woman’s choice and autonomy over her body by extending the time limit to go for abortion.
The proposed bill would amend certain clauses by including special ground of ‘substantial foetal abnormalities’ for termination of foetus.
The amended bill would cut the role of judiciary in case of any abnormality found in the foetus after the 20 week time period and would authorise the health care provider to terminate pregnancy
Furthermore, the proposed bill has amended the definition of ‘termination of pregnancy’ by differentiating the medical and surgical methods. This would allow women to use and procure abortion-related medicines.
Way ahead
In the proposed amendment, all the stakeholders must be consulted so that sex selective abortion and high mortality rate can be curtailed due to rigidity of the law.
Since the passage of the MTP Act in 1971, the socio and medical circumstances have undergone various changes; therefore, the law governing this aspect must address the medical and social realities of the present context.
Till now, abortion is seen from medical and legal perspective, rather than a matter related to meanings of the family, the state, motherhood and sexuality of younger woman. Therefore, need of the hour is to look at the proposed law through a broader lens, where the right to choice of women over her body and the right of the foetus to be born, would be justified.
7.5. COMMUNITY RADIO
Why in News?
Recently, Ministry of I&B
increased the subsidy for setting
up Community Radio Station
from 50% to 90% in the North
Eastern States and 75% in other states subject to a maximum limit of Rs 7.5 lakh.
Universities & NGOs have been permitted to set up Community Radio (CR) stations in India.
Need
The Constitution provides the citizens of the country with the Right to Information as per Article 19 (1)(a). The community radio is tool to augment this.
The need to promote last mile
connectivity for government
awareness programmes dictates the
need to set more Community Radio
stations.
Background
India is host to about 170 community
radio stations.
The movement for community
broadcasting had its roots in the late 1990s after a 1995 Supreme Court judgement that declared airwaves
to be public property.
Community broadcast was opened to educational institutions in 2003-04.
In 2006, government released guidelines on community radio, opening it up to Krishi Vigyan Kendras and non-profit organizations also.
In 2013-14 TRAI gave recommendations on community radio (see box).
In 2015 Government ordered the community radio stations that broadcast about 8 to 20 hours, to mail their
content every day for security reasons.
Significance
The most significant advantage of community radio station is that it
is run by local communities in native languages. This helps in
getting a better informed citizenry.
Community radios broadcast mostly to low-income audiences and
their content is development oriented. This acts a tool of
empowerment of socio-economically backward class.
Challenges
TRAI says that there is a scope of broadcasting misleading information in the guise of local news which can threaten internal security of India.
Community Radio stations find themselves to be economically unsustainable as advertisers do not find them to be attractive. Therefore there is a need for alternative revenue source.
As the community radios communicate in local languages, there is a need for expert manpower and better technology for monitoring them.
The monitoring needs to be real time and not post facto as is today.
Political interference sometimes force the community radio stations to become government mouthpiece leading to a loss of their autonomy.
Way Forward
If a community can be allowed to operate a FM station then allowing community radio should also not be a problem. With a better online monitoring mechanism and a provision for self-regulation of community radio, promoting community radios can be a step towards maximizing governance in India.
Box–1-Community Radio
It is a type of broadcasting service which caters to the community interests rather than focus on commercial interests. E.g. Focus on eradicating social evils in the community etc.
Usually it is run by members of the same community that it serves.
Box–2-TRAI recommendation on Community Radio (2013-14)
Content:
oAllow re-broadcast news from All India Radio.
oAllow translation of news into local language without distorting the content.
License Renewal:
oIncumbent stations can be given 5 year renewal.
oFurther extension would be subject to self-evaluation reports.
Regulation: An e-governance enabled single window mechanism for applicants to overcome cumbersome and bureaucratic processes.
Box–3-Guidelines on Community Radio (2006)
It gave a Community Radio license for five years.
There was no mention of a mechanism for extension/renewal of licenses of existing radio stations.
7.6. ELDERLY IN INDIA-EMERGING CHALLENGES
Why in News?
A recent study has identified that less than 1% of elderly population in India has health insurance.
Background
Although India’s demography is still inclined towards youth population, it is estimated that by 2050, 20% of the Indian population would be above 60 (presently it is only 6%).
India already has the second largest elderly population in the world.
Government projections suggest a feminization of the elderly population occurring, with 51% of the total likely to be women by 2016.
NSSO data suggests that incidence of diseases as well as hospitalization rates are much higher in older people than the total population.
Some Government initiatives
Government is implementing Integrated Programme for Older Persons (1992) to provide senior citizens with basic amenities like shelter, food, healthcare and entertainment opportunities.
Ministry of Rural Development implements Indira Gandhi Old Age Pension Scheme giving a monthly pension of -
o Rs.200 for BPL in the age group of 60-79 years.
o Rs. 500 for BPL above 80 years of age.
Challenges
Infrastructure regarding elderly population is poor. Eg. Very low numbers of Government run elderly recreation homes.
Lack of social security and pensions for majority of the elderly population.
Migration and displacement for work by the youth population from the rural to the urban areas leads to changing demography in rural areas with increasing solitary elderly population.
There is a supply shortfall in affordable senior care homes.
Even though the Maintenance and Welfare of Parents and Senior Citizens Act gives the police a major role, they are overburdened and insufficiently trained to handle elderly cases.
Loneliness is a big cause of elderly right to dignified life being violated.
Data on elderly living in a region is not available thus hindering any disaster management activities related to elderly. For eg. Chennai disaster.
Innovative steps
UberHealth offers preventive health care packages at an annual subscription rate of Rs 14000 apart from one-time doctor visits which are cheaper. The facilities include –
o Booking doctors’ appointments
o Picking up the elderly parents and dropping them back
o A representative accompanies them for doctors’ feedback, sent online to the NRI children abroad.
Way forward
To provide healthcare to abandoned elders participation from NGOs that have trained professionals is the need of the hour.
Government can also adopt Public Private Partnership model to set up palliative care centres in every town, inside hospitals, for the needs of elderly and terminally ill patients.
Old-fashioned social relationships with friends and neighbours should be promoted by building multigenerational homes (as in Germany) where working class can leave their children with elders, thus utilizing time of both.
Create a network of social contacts along with maintaining a registry of senior citizens area-wise so that the most vulnerable like the elderly are rescued in time during any emergency.
7.7. OECD REPORT ON EMPLOYMENT IN INDIA
Why in news?
On 28 February 2017, Organisation of Economic Cooperation and Development (OECD) released India Economic Survey 2017 under title of ‘Strong reforms and boosting inclusive growth’.
Highlights of the report
India’s economy will grow at 7% in the current fiscal year, which is strongest amongst G-20 countries. However, the growth rate of employment generation shows negative trend since last decade.
Over 30 percentage of youth, aged 15-29 in India are not in employment, education or training (NEETs)
Government spend nearly 3.8 percent of the GDP on education. This low level of spending reflects in low employment capability of youth of the country. Thus, the focus of the government needs to be shifted toward spending on enhancing the quality of education and vocational training.
The report pointed out that due to complex and strict labour laws in India, corporates rely heavily on temporary contract labour system and maintains substitute labour.
Moreover, non-availability of data pertains to labour market trends, delays the microeconomics policy initiatives of government, for instance, the last NSSO round was held in FY2011-12 and data on total employment of country available only every five years.
Furthermore, the report lauded the India’s structural reform of GST (Goods and Service Tax) for reducing the tax cascading and increase market competitiveness.
It is mentioned that there is a need to make income and property taxes more growth-friendly and redistributive. So that the need of social and physical infrastructure of local level can be fulfilled.
7.8. VISION ZERO CONFERENCE: OCCUPATIONAL, SAFETY AND HEALTH
Why in news?
Government of India, Ministry of Labour and Employment with the collaboration of Germany social security organised the world first Global conference on 15-17 March 2017 on theme of ‘Vision Zero conference on Occupational safety and health’.
What is Vision Zero?
It is an emerging effective tool for improving the occupational safety and health of the worker by achieving the Zero-Accident at workplace.
The tools involve the safety manual, network and alliance for Ground Level Corporation, protective equipment, industrial hygiene, and environment protection at workplace.
Issue involved
Accidents and occupational disease claims the lives of millions of worker, for instance, 8 accidents in every second took place in industrial space and this rate of accidents are even higher in developing countries.
Providing safety and protective environment to worker is mandated by International labour Organisation.
To achieve these goals International Social Security association set seven golden rule and describe the measure to achieve them.
The whole ideas of the initiative is based on four fundamental principle, viz., Life is non-negotiable, human are fallible, tolerable limits are defined by human physical resistance, people are entitle to safe workplace.
7.9. HUMAN DEVELOPMENT REPORT 2016
Why in news?
The latest Human Development Report, 2016 was released in March 2017 by United Nation Development Program (UNDP).
Background
First Human Development report was published in 1990.
This approach was developed by economist Mahbub Ul Haq
and Nobel Laureate Amartya Sen. It introduced a new approach called Human Development Approach which is about expanding the richness of human life (focus on their health, education, etc) rather than simply the richness of the economy (GDP) in which human beings live.
Three dimensions of Human Development
First is Decent Standard of Living which is calculated though
the Gross National Income Per Capita.
Second is Long and healthy life which is calculated through
Life Expectancy at Birth.
Third is Access to Knowledge which is calculated through
mean years of education among the adult population and
expected years of schooling for children.
HDR report also includes four other indices
Inequality Adjusted HDI: It adjusts the Human Development Index (HDI) for inequality.
Gender Development Index: measures gender gaps disparities between women and men in three dimension of human development namely health, knowledge and living standards.
Gender Inequality Index: It was introduced in 2010. It is index for measurement of gender disparity using three dimensions
Reproductive health for women: It uses maternal mortality rate and adolescent birth rate.
Empowerment: It uses proportion of parliamentary seats occupied by females and proportion of adult females and males aged 25 years and older with at least some secondary education.
Economic status: It is measured by labour force participation rate of female and male populations aged 15 years and older.
Multidimensional Poverty Index: It also measures deprivations across the three dimensions as used for HDI namely health, knowledge and living standards.
Major Highlights of the report
Norway is ranked 1st (score: 0.949) in HDR 2016 report followed by Australia at 2nd (score: 0.939) and Switzerland at 3rd (score: 0.939).
As per the report 1.5 billion people still lives in multidimensional poverty. 54% of them are concentrated in South Asia only and 34% in Sub-Saharan Africa.
Moreover South Asia has the highest level of malnutrition in the world (38%) and lowest public health expenditure in the world as a percentage of GDP (1.6%).
Even the largest gender disparity in development was in South Asia, where the female HDI value is 20% lower than the male value.
India related Facts
HDI: With HDI value of 0.624, India is ranked at 131st/188 countries. In 1990 India’s HDI value was 0.428 (witness an increase of 45.8% over 25 years). This improvement is second among BRICS countries after china (Improvement of 48%). Last year India was ranked at 130th position.
It is placed in “medium human development” category alongside countries such as Congo, Namibia and Pakistan, Bangladesh, Myanmar, Kenya, etc.
Among the SAARC countries, India is behind Sri Lanka (ranked 73rd) and the Maldives (ranked 105th), both of which figure in the “high human development” category.
Inequality: When India’s HDI is adjusted for inequality its value drops by 27%, from 0.624 to 0.454.
Health: India’s life expectancy at birth is 68.3 years. For very high human development countries average life expectancy at birth is 79.4 years.
Education:
India’s expected years of schooling is 11.7 years while the very high human development countries have an average of 16.4 years.
India’s Mean years of schooling is 6.3 years while the very high human development countries have an average of 12.2 years.
Gender:
India’s Gender Development Index value is 0.819 and it is ranked below Bangladesh (0.927), Nepal (0.925), Bhutan (0.900).
India’s Gender Inequality Index value is 0.530 (ranked 125th) again falling behind Bangladesh, Nepal and Bhutan among others.
Multidimensional Poverty Index: Its value is 0.282.
Maternal Mortality Rate for India is 174 (deaths per 100,000 livebirths). For very high human development countries average is 14.
Infant Mortality Rate for India is 37.9 (per 1000 live births) while for very high development countries have an average IMR of just 5.4.
Overall Between 1990 and 2015, India’s life expectancy at birth increased by 10.4 years, mean years of schooling increased by 3.3 years, expected years of schooling increased by 4.1 years and Gross National Income per capita increased by about 223.4%.
HDR report applauded India’s progressive laws, especially Right to Information, National Food Security, and Right to Education Act.
The report also praised India’s reservation policy though it could not eradicate caste based exclusions.
It even commended the Indian grassroots group Mazdoor Kisan Shakti Sanghatan for popularising social audits of government schemes.
Box–What is Human Development Report?
It is an annual report released by UNDP.
It provides an annual ranking of countries based on the Human Development Index.
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7.10. DRUG ADDICTION
Why in news?
As per the recent data, compiled by National Crime Records Bureau and tabled in Rajya Sabha, Drug Abuse problem is not restricted to North Indian States only.
Highlights of the report
As per the report India, witness on an average 10 suicides per day due to drug abuse.
There were 3,647 such suicide cases in India in 2014. In 2012 more than 4000 cases were reported while in 2013 it was more than 4500.
However, going against the popular belief Punjab witnessed just 1.4 suicides per million as compared to Kerala which had 14.2 suicides per million.
Though Maharashtra reported the highest suicides (1372/3647), Kerala topped the list in terms of incidence rate. Delhi reported 2 cases of suicides per million people.
As per the NCRB more than 25,000 people committed suicides due to drug abuse last 10 years.
Factors responsible for drugs abuse
Social factors: Easy availability of drugs; Unstable home environment like regular fighting among parents resulting in child getting detached with parents; inadequate parents supervision – both parents either ignorant/working spending less time with their children; use of drugs by peer groups/friends. Sometimes teenagers consider it cool to use drugs as it will enhance their prestige among their peer groups. Lastly, highly competitive environment in schools and colleges makes teenagers more susceptible towards drug abuse.
Economic factors: Poverty and unemployment (lack of other viable employment opportunities) also sometimes push an individual towards drug addiction.
Political factors: Drug business is very lucrative. Hence even political leaders are involved with drugs mafia in providing drugs to susceptible group especially young generations. This is what is happening in Punjab where political leaders themselves where involved in drugs business.
Other factors: Sometimes people resort to drug abuse to overcome various problems like stress, anxiety disorders, physical ailment or even other form of mental disorder. Also pain relieving opioids and sedatives are easily available from chemists without prescriptions.
Impact
Social
Drug abuse results in family violence, divorces, abuses and related problems.
On a larger scale it is a threat to social fabric of society as it results in increase in crime rate. For example drug abusers indulge in various kinds of crimes: petty crimes (like snatching money for buying drugs) or even heinous crimes (rape, murder under the influence of drugs).
Patients including their family members go through mental trauma, feel stigmatized and often are ostracized by the society.
Lucrative nature of drug trafficking fuels crime as rival drug gangs fight for control of the drugs business. Economic
One of the most important is the cost of government drug enforcement policies. This money could have been used for various social welfare programs.
It also results in lost human productivity, such as lost wages and decreased production that results from illnesses and premature deaths related to drug abuse.
Family member has to spend a lot of resources including time and money for rehabilitation of their beloved ones.
Physiological
Physiological effects of drug abuse vary by the type of drugs.
Drugs like Amphetamines, though elevate a person’s mood, but high amounts can cause dealy in sleep, nervousness and anxiety in the user.
With prolonged use of some drugs, especially narcotics such as opium or heroin, the user body build a tolerance towards it. Now over the time, the body requires higher doses to maintain the same effect causing vicious cycle of drug abuse.
If abuser stops taking the drug, the body experiences withdrawal symptoms, such as feeling weak, sick, getting hyper and aggressive.
Solutions Youths are the asset of the country and no nation cannot afford to see them falling to drug abuse. Hence strict multi-pronged strategy is required to curb this menace. Following integrated approach at De-addiction centre by providing treatment using not only through allopathy but also through homeopathy, Ayurveda, acupuncture.
Effective and affordable rehabilitation centres should be open up across the country especially in states with high prevalence incidence of drug abuse.
Focus on high-prevalence drug groups such as sex workers, transportation workers and street children and focus on their rehabilitation. Creating awareness among various stakeholders through workshops, conference, nukkad naatak, especially among parents, school students, other susceptible groups about the ill effects of drug abuse, prevention methods, that it can be cured through regular de-addiction counseling and monitoring, etc. Including a subject in school curriculum about ill effects of drug abuse and preventive methods will go a long way in solving this issue. Maintaining a strict vigil at major transit route on international border in lucrative drug smuggling trade. Like easily availability of drugs in Punjab is because it shares border with Pakistan and Afghanistan.
A zero-tolerance policy towards drug cartels, syndicates and peddlers. Lastly common people must understand that anybody can become drug abuser. Hence society must not ostracize and abuse drug abusers, rather they must intervene positively by atleast bringing the patient to de-addiction centre.
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7.11. NATIONAL STRATEGIC PLAN FOR TUBERCULOSIS ELIMINATION 2017-2025
Why in news?
On the World TB day (24 March, 2017), Union Minister of Health and Family Welfare announced the National Strategic Plan for Tuberculosis Elimination 2017-2025.
Background
TB accounts for more than 4.8 million deaths per year in India. Moreover, more than 1.2 million cases of TB are reported in studies every year that are not notified by government and most of them remain either undiagnosed
Nearly 75,000 cases of Multi drug-resistance (MDR) have been reported annually during the treatment stage.
Of the total MDR cases, 1.5% is related to more dangerous extensively drug-resistant TB (X-DR TB).
Moreover, the increasing density of population and growing urban environment facilitates the transmission
of TB cutting across all economic strata, which is perpetuating the age-old cycle of transmission and risk.
Why needed a new strategy?
Joint Management Mission Report of 2015, finds out that despite increasing expenditure under Revised National Tuberculosis Control Programme (RNTCP), there was a gap between the allocation of funds and the minimum investment required to reach the goals of the Plan.
The existing TB surveillance system lacks the capacity to count the large pool of privately diagnosed and treated TB cases.
Within the public sector, there is heavy dependence on an insensitive diagnostic test (heavily relied on sputum test) and incompetence to diagnose drug resistance cases.
There has been limited progress in the form of special action plans for tribal populations.
In the urban areas, however, there is no established health structure owing to the slow progress of the National Health Mission in the urban areas.
Features of National Strategic Plan
The action plan aims to achieve active case finding of TB to 100% by 2020 and complete elimination of TB by
2025.
The aim of this Action Plan is to do away with the earlier strategy of self-reporting where few patients get themselves tested; and rather, focus on detecting more cases, both drug-sensitive and drug-resistant, by government itself reaching out to patients.
The requirements for moving towards TB elimination have been integrated into the four strategic pillars of “Detect – Treat – Prevent –
Build” (DTPB).
It is a vision document designed to address co-morbidity of TB with HIV by strengthening care such as joint management of TB/HIV co-infected patients, TB/DM management etc.
Implementation will be a combined effort of all stakeholders such as NGOs, local -governments, state welfare schemes and machinery working towards the same goals.
For the first time, the TB control programme talks about having in place patient-friendly systems to provide treatment and social support, which would encompass the reducing out of pocket expenditure such as; cost of treatment, cost of travels, cost of diagnosis and wage loss.
The plan conceives a shift from regulatory approach to partnership approach (Synergy) with the largely unorganized and unregulated private sector.
It seeks to make the daily regimen universal by moving away from the thrice weekly regimen, followed by RNTCP.
Moreover, new anti-TB drug Bedaquiline has been introduced under Conditional Access Programme (CAP).
Under the ‘Make in India’ thrust of the Government of India, it is proposed to explore the possibility of developing capacity to produce first-line drugs for RNTCP in the public sector.
IT based E-Nikshay platform has been made user friendly so that Private Doctors find it easy to notify.
Swasth E-Gurukul TB and myriad TB Awareness Media Campaigns would not only focus on awareness but also on fighting stigma and discrimination prevalent against the TB patients.
The strategic plan envisions a TB Corpus Fund
maintained by Bharat Kshay Niyantran Pratishtan’ (India TB Control Foundation).
Furthermore, this document calls for effective linkages between Central Tuberculosis Division, AADHAR, Social Walfare Scheme, Pradhan Mantri Jan Dhan Yojana and Nikshay Platform.
Way ahead
National Strategic Plan for Tuberculosis Elimination 2017-2025, is the need of the hour, when we are racing against time in front of growing bacterium resistance against health problems.
India has managed to scale up basic TB services in the public health system. However, the rate of decline in TB cases and treatment of more than 10 Million TB patients is too slow to meet the 2030 Sustainable Development Goals (SDG) and World Health Organization’s (WHO) End TB Strategy.
Box–1-DTPB Pillars
Detect: Find all the drugs sensitive and drugs resistant patients by:
oScale-up free, high sensitivity diagnostic tests and algorithms.
oScale-up effective private provider engagement approaches.
oUniversal testing for drug-resistant TB.
oSystematic screening of high risk populations.
Treat: Initiate and sustain all patients on appropriate anti-TB treatment with:
oFree TB drugs for all TB cases.
oPatient-friendly adherence, monitoring and social support to sustain TB treatment.
oElimination of catastrophic costs by linkages of eligible TB patients with social welfare schemes including nutritional support.
Prevent: Emergence of TB in susceptible population through:
oScale up air-borne infection control measures at health care facilities.
oTreatment for latent TB infection in contacts of bacteriologically-confirmed cases.
oAddress social determinants of TB through inter-sectorial approach.
Build: To build and strengthen enabling policies, empowered institution and human resources with enhanced capacity such as:
oBy establishing National TB Elimination Board and National TB Policy and Act.
oRestructure RNTCP management structure and institutional arrangement (National State and District level).
oScale up Technical Assistance at national and state levels by organising a dedicated staff for TB surveillance network in the country.
oBetter synergy with other health related programme so that duplication of efforts can be avoided.
Box–2-Synergy with Private Sector Health Care
Increase Private Health Provider Engagement.
Decentralized drug resistant TB services.
Free drugs and diagnostic tests to TB patients in private sector.
Increasing support for patients seeking care in the private sector.
Enhance Surveillance and Quality improvement.
Expand ICT support and Build management capacity.
Box–3-What is Swasth E-Gurukul?
Swasth-e-gurukul is an e-learning initiative of World Health Organization.
It is a single repository for training material for all disease programmes such as TB, AIDS, leprosy, malaria, diabetes etc.
The Initiative provides information to all health care providers.
Box–4-What is NIKSHAY?
It is an IT tool which facilitates monitoring of universal access to TB patients database.
Developed jointly by the Central TB Division of the Ministry of Health and Family Welfare and National Informatics Centre (NIC).
Implemented at national, state, district and Tuberculosis Unit (TU) levels.
Utilises SMS technology for communication with TB patients and grassroots level healthcare services providers as well as health and family welfare policy makers.
Moreover, the tool establishes a correlation between TB & HIV, leading to outcome analysis of treatment.
7.12. PARTHA MUKHOPADHYAY WORKING GROUP ON MIGRATION
Why in news?
The Working Group on Migration (headed by Partha Mukhopadhyay) set-up by the Ministry of Housing and Urban Poverty Alleviation (HUPA) in 2015, submitted it report to the government by recommending various policy matters for social welfare measures and administrative actions for the development of migrants.
Issue Involve
Economic Survey 2016, pointed out that there are 9 million people annually migrate within the country, whereas Census 2011 and National Sample Survey Organisation has highlighted that migrants constitute 30 percent of national population as well as total working force.
In order to exercise the constitutional right of freedom of movement, migrants could not get the benefits of welfare schemes if they migrate to other states for example around 45 percent of total migrants exclude form PDS (Public Distribution System), financial inclusion, and Sarva Shiksha Abhiyan
Recommendation of the working Group
Caste based enumeration of migrants should be adopted, so that they can avail the attendant benefits in the States to which migration takes place. For example, a migrant of Scheduled Tribe community of Arunachal Pradesh can avail the intended benefits in Punjab and Haryana by interstate operability of PDS
States should move away from the requirement of domicile status to prevent any discrimination in work and employment for the migrants.
The vast network of the Post Offices, banking system and Payment Banks, need to be strengthen in order to reduce the cost of transfer of money and to avoid informal remittances channels.
To achieve the financial inclusion goals, banks must simplify the documentation procedure and follow the guideline of RBI with regards to Know Your Customer norms (KYC).
Furthermore, underutilised Construction Workers Welfare Cess Fund should be used to promote rental housing, working Women Hostels for the benefits of migrants.
Construction Worker Welfare Cess Fund
This fund is maintained by Construction Workers welfare Boards under Construction Workers Welfare Cess Act, 1996, for which a welfare board was created by Central and state government concern.
The major source of the fund to the Board is collection of cess @ one percent of the cost of construction incurred by the employer under the act.
The construction workers are basically unskilled, migrant, socially backward, uneducated with low bargaining power. Moreover, their work has inherent risk of life and health. Thus the fund is for the various welfare measure of workers.
