Q1. According to the latest Global Burden of Disease Study, India has the 154th rank, much below China, Sri Lanka and Bangladesh. According to the above statement, discuss the major concerns and its solution regarding the deteriorating status of Indian Public Health System.
- India’s public health-care sector has been ailing for decades.
- According to the latest Global Burden of Disease Study, India has the 154th rank, much below China, Sri Lanka and Bangladesh.
What is Public Health Care System?
- Public health Care systems are commonly defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction.”
- This concept ensures that all entities’ contributions to the health and well-being of the community or state are recognized in assessing the provision of public health services.
What are the major concerns?
- Abysmally low spending on Public Health – meagre 1.2% against WHO recommendations of 5% public spending on Health.
- Neglect of health care institutions at lower strata i.e. PHCs.
- The focus has been on building AIIMs like institutions at all India level but PHCs and CHCs don’t get much attention.
- Poor infrastructure and inadequate human resource at all levels in hospitals.
- Doctor patient ratio is meager 1:1661, and at lower levels, the necessary equipment are not available, even the buildings are not in a proper condition.
- That is why people often go to public hospitals only for the smaller diseases, and not for the grave ones in which they have to get admitted in hospitals.
- The focus of policymakers has been to address the demand-side issues rather than the supply-side inefficiencies.
- This is evidenced by the focus on improving hygiene and environmental concerns to prevent the spread of ailments and diseases.
- Governance deficit and regulatory capture arise due to myriad laws and regulations which impede the normal development of this sector.
- Many alternative healthcare practices exist and have been serving people since ages but it has not got adequate attention of the government since long.
- Disparity in rural-urban areas. IMR is 46/1000 in rural areas whereas it is 28/1000 in urban India.
- The inefficiency in the sector also creeps up with the widespread corruption that ails both the public and the private sector.
- Private sector is also not efficient enough. Many of them indulge in malpractices by selling substandard and even counterfeit medicines, prescribing unnecessary drugs and tests, receiving commissions for referrals, requiring unnecessary hospital admissions and manipulating the length of stay.
What are the solutions?
- Top priority should be given to primary health care services, including early management of health problems and better quality of care.
- Strengthening primary health care delivery by ensuring the basics such as universal immunization can greatly reduce morbidity and lower the costs of curative care.
- It will lower the burden of higher strata of hospitals where the cost of treatment is high.
- India requires an integrated action on health care to make it universally accessible and affordable at the same time.
- This will also have a positive impact on poverty and growth.
- Recognizing the massive need for expanding the reach of health care services, the government needs to evolve new and innovative ways of engaging the private sector especially in the provision of tertiary care.
- A National Health Regulatory and Development Framework needs to be made for improving the quality (for example registration of health practitioners), performance, equity, efficacy and accountability of the health care delivery across the country.
- It should put out standard treatment guidelines for public and private providers, frame a patients’ charter of rights, engage with professional associations and civil society, and establish a regular audit system.
- India needs to increase its expenditure on health sector as a percent of GDP (1.2% now), with active participation of state governments who bear close to two-third of public expenditure on health sector.
- Focus needs to be on preventive health measure and successful implementation of immunization.
- The potential of alternative health care should be recognized and there should be more focus on research in these areas.
- Efforts should be put towards successful implementation of government schemes related to health sector.
Q2. Days after the resolution of the Doklam stand-off with India, China said that it is ready for talks to reopen the Nathu La pass. Around five years after the 1962 war, India and China had clashed militarily in Nathu La. Elaborate on the events during the Nathu La pass standoff of 1967 between India and China. Do you think India gave a strong response back then? Discuss.
The last time India and China were engaged in a major military stand-off in Sikkim was in 1967.
- Around five years after the 1962 war, India and China had clashed militarily.
- It took place at Nathu La, not far to the northwest of the Doklam plateau.
- More than 300 Chinese were killed in four days, while India lost 65 soldiers. By comparison, in the monthlong war in 1962, China lost only 722 soldiers.
- Nathu La, 1967 was the last military conflict between the two countries.
Events that occurred during Nathu La standoff
- Nathu La is an important pass on the Tibet-Sikkim border through which passes the old Gangtok-Yatung-Lhasa trade route.
- Chinese and Indian soldiers were deployed barely 30 metres apart, the closest they are anywhere along the 3,488 km Sino-Indian border.
- The Chinese hold the northern shoulder of the pass; India holds the southern shoulder.
- In 1966 and early 1967, China continued its tactics of propaganda, intimidation and attempted incursions into Indian territory.
- Indian Soldiers in the open were mowed down by Chinese machine gun fire. The Indians responded with artillery fire, and pummelled every Chinese post in the vicinity.
- Taken aback by the strong Indian response, the Chinese threatened to bring in warplanes.
- Having sent its message militarily, India, delivered a note to the Chinese offering an unconditional ceasefire across the Sikkim-Tibet border.
- This was rejected, but the situation remained largely peaceful for some days.
- Chinese handed over the bodies of Indian soldiers with arms and ammunition, saying they were acting in the interest of “preserving Sino-Indian friendship”.
Thus, India did gave a strong response to China during the Nathu La standoff.
On October 1 the same year, another skirmish erupted at Cho La, but the India again repulsed the Chinese. At Nathu La and Cho La, the failures of 1962 had been laid to rest.
Q 3. Briefly explain what is Antimicrobial resistance and how is posing a serious threat to India. Also discuss the ways through which India is trying to get rid of it. (GS3)
- Antibiotic resistance is a subset of antimicrobial resistance (AMR), which is a wider category that covers resistance in all micro-organisms bacteria, parasites, viruses and fungi to drugs.
- Some 700,000 people die of resistant infections every year globally, a number that is estimated to rise to 10 million by 2050.
- Antibiotic resistance has become a global crisis that threatens the management of infections, both in the community and in hospital practice.
Antimicrobial resistance a serious threat to India
- India, because of its sheer numbers, poor literacy and awareness, and lax controls over medical practices, is on the frontlines of the global AMR public health crisis.
- A 2015 WHO multi-country survey recorded “widespread public misunderstanding” about antibiotic use in India.
- The Health Minister J P Nadda, in April 2016, highlighted antimicrobial resistance as a “serious threat to global public health”.
- As per the National Action Plan on Antimicrobial Resistance (NAP-AMR), the crude mortality from infectious diseases in India is 417 per 100,000, and India is among countries with the highest burden of bacterial infections.
- Two, an Indian company, Bangalore-based Bugworks Research, has received an Initial fund of $ 2.6 million for its work on a new class of antibiotics to fight what is known as the “ESKAPE”.
- ESKAPE is group of pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species).
- ESKAPE pathogens are considered the leading cause of nosocomial (hospital-born) and hospital acquired infections throughout the world.
- India has formed a National Surveillance System for AMR, and issued National Guidelines for use of antibiotics.
- A national policy for containment of antimicrobial resistance was formulated in 2011.
- Health Minister J P Nadda released a multi-sectoral National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017-21 earlier this year.