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List of Contents
Mitigating the third wave requires a focus on DOTS
Source: The Hindu
Syllabus: GS 2 – Issues relating to development and management of Social Sector/Services relating to Health
India is witnessing a softening of the second wave. Nonetheless, the anticipation of the 3rd wave is quite high. Therefore, it is imperative for India to focus on reducing the reproduction number (R). This in turn calls for focusing on its determinants i.e. DOTS for Mitigating the third wave
- India witnessed a brutal impact of the second wave of the pandemic in May 2021, with cases crossing the 4 lakh mark in one day.
- The situation has now eased and the number of cases has come down below the 1.5 lakh mark. The second wave appears to be abating due to a reduced reproduction number.
About Reproduction number (R):
- It refers to the average number of new infections arising from one infected individual.
- R greater than 1 implies that infected individuals infect more than one person on average, and we observe increasing cases. When it is less than 1, cases are declining.
- It is dependent on Four Factors, summarised by the acronym DOTS:
- Duration a person is infectious
- Opportunities for infected individuals to spread the infection to others;
- the probability of Transmission of infection if given an opportunity
- the average Susceptibility of a population or subpopulation
What led R to increase earlier this year resulting in a second wave?
- Susceptibility: It was quite high at the start of the year. This is evident from the results from a national seroprevalence survey done in December 2020 and January 2021. They indicate roughly 25% of the population had antibodies to the virus that causes COVID-19.
- Further, less than 1% of the total population had received two doses of the vaccine till March 2021.
- Opportunity for Transmission: By January 2020, people perceived that they had won the battle over the pandemic. They were eager to get back to life and work. Eventually, this increased the social mixing and the occurrence of large gatherings that might have facilitated a second wave.
- Probability of Transmission: A fall in Covid-19 appropriate behaviour was witnessed in early 2021 like not wearing masks in public, not properly sanitizing oneself etc. Further new variants with higher transmissibility potential emerged.
- For instance, B.1.617.2 (the delta variant) is known to possess higher transmissibility potential, twice than the Covid-19 variants circulating in 2020. It has emerged as the dominant variant in India and UK during their second wave.
- Duration of infectiousness: It may have enhanced with the emergence of new variants however more research is needed on this front.
Therefore, it is now imperative that we need to focus on DOTS for Mitigating the third wave.
Suggestions for Mitigating the third wave:
- The government must build well-designed seroprevalence surveys to understand how much of the population remains susceptible and where they reside. These should accommodate the complexities of new variants and the occurrence of reinfections.
- The focus should be on increased use of face masks and improved ventilation for reducing the transmission. The country can learn from the Bangladesh model in which the distribution of free masks coupled with community monitors delivered positive results.
- Temporary solutions like lockdowns and a ban on mass gatherings should be used to focus on slowing the transmission rate.
- The magnitude of the susceptible population can be brought down by substantially increasing the immunisation coverage. Currently, only 3% of the population has received both doses.
- The isolation and quarantining guidelines should be revised periodically as per the changing duration of infectiousness.
Prudent Approach towards the Downward Trajectory of Second Wave
Source: The Indian Express
Syllabus: GS 2 – Issues relating to development and management of Social Sector/Services relating to Health
India has witnessed a decline in Covid-19 cases since the last month, thereby indicating a downward trajectory of the second wave. It presents an opportunity to effectively prepare for the upcoming third wave through universal vaccination and accommodative reforms.
- The second wave of pandemic left a more brutal impact on India than the first wave, with cases touching the 4 lakh/day mark. Rural India was hurt significantly and many districts reported higher fatality rates than the national average.
- However, the cumulative Covid-19 cases have now declined by 72 % from the peak in May.
Understanding the Downward Trajectory of Second Wave:
- The decline is mainly caused by a decrease in urban cases while the rural cases are still on the rise as shown by the 14-day moving average of the top 20 districts.
- The percentage of daily new cases from rural areas is still at 52.8 percent. A high prevalence of cases in the rural area indicates that:
- The GDP loss due to the current wave will be much lower than that in the first wave. This is because these rural districts account for a lower share of economic activity.
- There is also a subtle change in India’s vaccination policy. Now India is prioritising people receiving the first dose.
- This would bring down the magnitude of serious cases in the country and ensure better preparation for the 3rd wave.
Suggestions to capitalise the downward Trajectory of Second Wave:
- The government should step up the vaccination drive as currently, around 16% of people have received the first dose and only 3% have been fully vaccinated. For the US, these numbers are 89.4 and 44.1 respectively.
- India must opt for an advanced procurement strategy like that adopted by developed nations to inoculate its remaining population, especially the 12-17 age bracket.
- There should be a centralised vaccine procurement along with a centralised pricing strategy.
- The rollout of a compassionate fiscal policy at both the central and state levels is also desired for reducing the stress of the common man and businesses. This would include rationalisation of fuel prices, tax holidays, electricity rebates for MSMEs etc.
- There should be prudent adoption of the best administrative practices at state and local level. The Centre should now collect and collate such systems and make them available to state governments to strengthen the health infrastructure. This includes:
- “Mumbai model” of oxygen distribution under the able administrator, Iqbal Chahal.
- “Ernakulam’s war room model” that oversees the entire city and allows for resources to be shifted swiftly between hotspots.
- Telephone-based triaging systems of Tamil Nadu and Karnataka.
- Triage systems are methods for systematic prioritizing of patients’ treatment according to how urgent they need care.
- The operations of local bodies should be digitalised to ensure better resource allocation and greater accountability.
Why foster care in India needs to be expanded?
Source: click here
Syllabus: GS 1
Synopsis: Foster care is a feasible, suitable substitute to adoption and institutional care in light of the trouble being faced by Covid-19 orphans.
Orphaned children in the second wave of Covid-19 are being sent to local shelter homes. But, is it the optimum solution?
The negative impact of institutional care
- Every child has a right to be raised in a family and that’s why there is a push for non-institutionalized (foster) care solutions for orphaned children.
- A research highlighted that physical and mental development in overcrowded and under-resourced shelter homes is delayed. This also increases the likelihood of social and behavioural problems.
What is foster care?
Foster care is an arrangement whereby a child lives, usually on a temporary basis, with unrelated family members. While placing a child in foster care, preference shall be given to those families that share similar cultural, tribal and /or community connection.
What is the difference between foster care and institutionalized care?
The state of orphaned children in the country has brought the focus back to the issue of foster care versus institutional care.
- Fostering has yet to gain credibility as a recognized method of child protection in India. Under this system, foster parents have custody rights only. Foster parents are responsible for raising the child in a secure and personalized family setup.
- The family has no control over the child’s assets, nor is it compulsory to share inheritance rights over its own assets to the foster child.
- Whereas, the adopted child becomes a legal member of the family in the adoption system and is entitled to property rights.
What is the state of adoptions in India?
India has almost 30 million orphaned and abandoned children. The legal adoption of these children is a challenge. Adoption processes are very lengthy; this results in just a fraction of kids finding a home.
- Firstly, the yearly adoptions enabled by the Central Adoption Resource Authority (CARA) are just 3,000-4,000.
- Secondly, there is a reluctance to adopt because in foster care there is a life-long commitment and adopted children have enforceable legal rights.
- Thirdly, foster care comparatively offers a more flexible ecosystem. Regular follow-ups can be done to check on the well-being of the child. In legal adoption, there is little or no follow-up.
Problems that need resolution
- No legal framework: A legal framework to encourage foster care in India was presented by the central government through the enactment of the Juvenile Justice (Care and Protection of Children) Act. But the Act left it to the states to make rules for purposes of carrying out the scheme. This resulted in uneven implementation.
- Lack of awareness of legal provisions: Many Child Welfare Committees (CWCs) are not aware of the applicable legal provisions. Many avoid the duty of choosing foster families, approving childcare plans, and conducting compulsory monthly reviews to help check misuse of the foster system for abuse and exploitation.
Measures to improve the foster care system
- State governments should promote foster care where association care is unavailable.
- States should go beyond the declaration of aid packages. They should ensure that the district child protection machinery is promoted to chart the promising territory of foster care.
- Foster parents should be financially supported by the state for child care. This model is followed in many countries. Foster parents can provide a socio-cultural environment similar to when the child was born.
- In India, district agencies get annual funds to support foster care, but they go unutilised. These funds should be utilized in an optimum manner.
- Clear, crisp rules and visibly managed budgets for fostering
- Committed and sensitive citizens can be expected to come forward to open their homes and hearts to children in need.
How can India address its mental healthcare problem?
Source: The Hindu
Syllabus: GS2 – Issues Relating to Development and Management of Social Sector/Services relating to Health
Synopsis: Evaluation of India’s state of mental health care and suggestions to improve them.
- Recent reports published in Lancet revealed that one in seven people in India had a mental disorder ranging from mild to severe in 2017.
- Mental illnesses include anxiety disorders, psychotic disorders, mood disorders, substance use disorders, personality disorders and eating disorders.
- Despite having the necessary components to address the mental healthcare issues, more needs to be done in the context of COVID-19 that has exacerbated mental illnesses.
The mental healthcare situation in India
- The situation is bad especially in the southern states as compared to the northern states due to the nature of development, modernization, urbanization etc.,
- Sharp gender divide: Depressive disorders are more prevalent among females than males due to sexual abuse, gender discrimination, stress due to antenatal and postnatal issues etc
Why mental healthcare situation is bad in India?
- Inadequate public spending on Mental Health: India spends around 1.3% of total health expenditure on mental health, whereas, in developed countries, it ranges from 3% to 15%.
- Inadequate infrastructure for Mental Health: For Instance, the share of mental hospitals per 1,00,000 population is as low as 0.01 according to the WHO.
- Similarly, India fares poorly in the distribution of mental health units, mental health outpatient facilities, community residential facilities etc.,
- Inadequate Mental health resources: Nurses, social workers and psychologists working in the mental health sector in India are way less compared to other countries. For instance, leading countries have 222.6 psychologists per 1,00,000 population whereas India has only 0.069, per 1,00,000 population.
Why Mental Health needs to be given priority?
- One, Causative factor for suicides. The majority of suicides in the world are related to psychiatric problems or mental illnesses. India’s suicide rate was 16.3 per 1,00,000 in 2016 that is very high compared to the Global suicide rate of 10.6 per 1,00,000 population.
- Two, a significant contributor to the total disease burden in India. For instance, the proportional contribution of mental disorders to the total disease burden had doubled between 1990 and 2017.
- Three reduces longevity. According to the World Health Organization (WHO), there is a 10-25-year life expectancy reduction in patients with severe mental disorders.
Government measures on mental health care
- India has rightly enacted the following policies to cater to the needs of the population suffering from Mental illness:
- The National Mental Health Policy (NMHP) in 2014,
- Rights-based Mental Healthcare Act in 2017,
- National Adolescent Health Programme
- Ayushman Bharat
More needs to be done.
What more steps can be taken?
In order to further address mental health issues and promote mental healthcare, India needs to do the following,
- One, reduce the treatment gap for mental disorders. For instance, Telemedicine can be promoted to reduce the gap.
- Two, increase the number of personnel in the mental healthcare sector.
- Three, remove stigmatization by reducing discriminatory attitudes.
- Four, devise an integrated approach for detecting, treating, and managing patient needs.
- Five, increase counselling facilities, especially in rural areas, with special support for women through the provision of women doctors.
- Six, leverage the benefits of technology. The application of big data and crowdsourcing ideas can help to make informed decision-making.
- Seven, focus on community-based programmes. For Instance, School-based programmes on mental health can improve the mental health of children.
- Eight, create mental health awareness through traditional media, government programmes, the education system, industry, and social media.
China warns Bangladesh on joining QUAD
Source: The Hindu
Syllabus: GS2 – Bilateral, Regional and Global Groupings and Agreements involving India and/or affecting India’s interests.
Synopsis: In the wake of the growing momentum of Quad, China’s aggression is expected to grow in the Indo-Pacific and States are likely to push back Chinese “cheque-book diplomacy”.
- Recently Chinese ambassador warned Bangladesh that there will be “substantial damage” to bilateral relation if it joins the USA backed anti-China coalition “Quad”
- However, Bangladesh categorically replied that Bangladesh is an independent sovereign nation and practices an independent foreign policy.
- In this context, the USA said, it respects Bangladesh sovereignty and the right to make independent foreign policy.
What is the significance of this episode?
- Firstly, it reveals the fault lines in South Asia and in the Indo-Pacific. It shows that major powers are changing their moves to change the power balance in the Indian Ocean.
- Secondly, it shows the growing relevance of the Indo-Pacific. “Quad” with all its weaknesses is becoming reality in the Indo-Pacific despite China’s attempt to suppress it.
- Thirdly, it reveals that Quad’s success can be challenging for China strong-arm tactics (use of threats and force). Quad can become an alternative for the regional states.
- Fourthly, it is clear China wants to send a clear message to regional states that they should remain away from joining Quad.
- It further signifies that as the relevance of Quad will grow, Chinese aggression in the Indo-Pacific will grow.
What are the major limitations with Quad?
- Firstly, Quad members are not able to figure out any cohesive agenda or any plan of expansions in the region.
- Secondly, there is no credible platform to work with a like-minded nation such as China’s Belt and Road initiative.
- Thirdly, no countries have shown any interest to join the coalition as China has called it “Asian NATO”.
India and other regional states will have to come up with more clear-cut foreign policy choices to counter China’s aggressive diplomacy.
Also read: Quadrilateral Security Dialogue