Health

Child mortality

 Types of child mortality

o Under five mortality – before fifth birthday
o Infant mortality – before first birthday
o Neonatal mortality – before the first month
 On fifth of the global neonatal deaths occur in India
 Wide variations among states in India. E.g., Infant mortality rate in Madhya Pradesh was 6 times the rate in Kerala
 Higher mortality rates in rural areas than urban areas
 Reasons for child mortality
o Preterm births – born too early – before 37 weeks of pregnancy are completed – India has a higher
burden of preterm births
o Stillbirths – a baby who dies any time after 22 weeks of pregnancy but before or during the birth
 Problems
o Lack of reliable data from block, district and state levels; data on stillbirths and preterm births are scarce
o Poor implementation of guidelines related to maternal and perinatal deaths surveillance
o Aggregate mortality rates hides the inequities in health outcomes and the brunt of those inequities borne
by the poorest and marginalised families
 Solution
o Increasing access to family planning services
o Improving antepartum services such as health and nutrition including the intake of iron folic acid by
pregnant mothers
o Providing counselling on the importance of a healthy diet and optimal nutrition
o Prevent, detect and manage diseases which put mothers at high risk such as diabetes, hypertension,
obesity and infections
o Kangaroo mother care for preterm infants
o Early initiation of exclusive breastfeeding
o Need to identify hot spot clusters of stillbirths and preterm births for local and targeted interventions
o Poor budget allocation for health

PM Ayushman Bharat Infrastructure Mission (PM-ABHIM)

 Government provides financial assistance to states and UTs to set up and upgrade health infra under National
Health Mission
 PM ABHIM was launched in addition to it to fill the gaps in health infra especially in critical and primary care
facilities

PMBJP – PM Bharatiya Janaushadi Pariyojana

 Pradhan Mantri Bharatiya Janaushadhi Kendras – more than 9000 stores selling cheap generic medicines
 Priced 50% to 90% lower than their branded variants

Disabled

 Moving away from a charity approach to rights based approach

 More disabled friendly digital ecosystem – everything digital must be accessible to everyone
 Web Content Accessibility Guidelines should be followed during design and development of apps
 Rights of Persons with Disabilities Act 2016 and Mental Healthcare Act 2017
 Inspection by District social welfare officer, child protection officer and disability welfare officer
 Should establish block level committees for effective monitoring as all homes in a district are to be monitored by
one district level social welfare officer
 A compendium of all government run homes and NGOs should be prepared

Mental Health

 India has the highest number of suicides in the world

  Need for better penetration of mental health insurance
 Reasons for poor mental healthcare
o COVID pandemic – long periods of isolation, fear of loosing loved ones, financial difficulty
o Stigma on mental disorder – Creates ignorance and disorders go untreated
o Lack of trained specialists hinders cost effective intervention
o Insufficient budget allocation for mental health patients
o Mental illness are excluded from ailments covered by insurances
o Mental health insurance is expensive and beyond reach
o Reducing family size, increasing life expectancy and poor institutional support
 Government measures
o National Mental Health Programme
o Decentralised District Mental Health Programme
o Mental Healthcare Act 2017 mandates to treat mental disorders on par with physical disorders for
insurance coverage
o Ayushman Bharat provides coverage for mental disorders

Ayushman Bharat Digital Mission

 Introduced scan and share service for faster Outpatient Department registrations
 QR code enabled registration reduced long queues
 Enables paperless registration and instant token generation
 Saves time and health facility is able to optimise the need for resources deployed for registration
 Enables patient’s health records getting digitally linked to Ayushman Bharat Health Account which they can
manage and access from phone anytime anywhere

PM Jan Arogya Yojana (PM JAY)

 Largest cashless health insurance scheme

 Implemented by National Health Authority
 Provides health cover of 5 lakh per family per year for secondary and tertiary care hospitalisation
 Beneficiary – 12 crore families; Target is 50 crore beneficiaries
o But currently only less than 25 crores have been verified which is less than 50% of the targeted
beneficiaries
 Aiming to 70% coverage of population
 Implemented in 33 states and UTs
o Except Delhi, Odisha and West Bengal
 Vision – to achieve Universal Health Coverage
 Approximately 49% of Ayushman card recipients are women

eSanjeevani app

 Medical sevices to people living in far flung areas like hills through videoconferencing

Alma Ata Declaration 1978

 Underlined the importance of primary healthcare for achieving Health for All
 declared health a human right for all
 India was a signatory to the Alma Ata Declaration in 1978 that assured ‘health for all’ by the year 2000.
 Astana Declaration 2018 – reiterated in strengthening primary health care

POSHAN tracker app

 One Nation One Anganwadi programme

o Migrant labourers can receive benefits to children under 6 years, pregnant and lactating women in their
host states
 POSHAN tracker app
o To facilitate service delivery of Anganwadi workers
Nutritional Security

 2 important schemes
o ICDS and POSHAN
 Fortified rice under ICDS and PM POSHAN
o Improvement in haemoglobin levels and reduction in prevalence of anaemia
 POSHAN Abhiyan - 2018
o Overarching scheme for holistic nutrition
o September – Rashtriya Poshan Maah or National Nutrition Month across country
 POSHAN 2.0
o Launched in 2021 to tackle malnutrition
o Leverage on traditional knowledge systems
 PM POSHAN – midday meal scheme
 PM Matru Vandana Yojana – 2017
 Scheme for Adolescent Girls
 National Food Security Act 2013
 National Nutrition Policy 1993
 National Nutrition Mission 2018
 Anaemia Mukt Bharat – 2018
 Food fortification
 Millets
 Way forward
o Adopting rainbow diet – meal plan with multicoloured fresh fruits and vegetables – tuber based rainbow
diet

FSSAI

 Discussing on possibility of front of pack labelling

 Indicating if a food product was high in fat, sugar and salt (HFSS)
 Allow consumers to make informed choices
 Indian Nutrition rating – star rating system for packaged foods based on ingredients and degree of processing
 Eat right campaign
o Health ministry has asked states to develop 100 eat right food streets in 100 districts
o Aim – to encourage safe and healthy practices to reduce food borne illness

Druge abuse

 Aim – to make India drug free by 2047

 Nodal Agency – Narcotics Control Bureau
 Measures
o Destroying poppy and cannabis cultibvation fields
o Cash reward for voluntarily destroying cultivated poppy
o Hybrid vegetable seeds and saplings of horticultural crops to such farmers
o Use of drones in destruction of illegal crops in remote areas
o Sharing satellite images with affected states
o Sub group on counter terrorism portal, Multi Agency Centre has been crated to share iputs on use of dark
net and crypto for trade in narcotics
o All states have dedicated Anti Narcotics Task Forces
o NIDAAN database of photo, fingerprint and details of all suspects and convicts arrested under NDPS Act
o National Narcotics Coordination Poral – source and designation of seized drugs are highlighted

Central Government Health Scheme

 CGHS is a comprehensive healthcare scheme provided by the Central Government to its employees, pensioners,
and their dependents.
Challenges in healthcare

 Wages given to front line healthcare workers in public sector are not competitive enough to attract qualified
candidates

Three major interventions for maternal health care

 Going for antenatal care (ANC) visits during pregnancy

 Having a skilled attendant at birth
 Receiving postnatal care (PNC - after childbirth) within first two days after birth
 Education by health workers about complications during pregnancy and labour and after child birth
 Access to micronutrient supplementation (iron and folic acid) to prevent anaemia
 Treatment for hypertension; immunization against tetanus and other endemic diseases

Palliative care

 Approach to improve the quality of life of patients and families confronting life threatening illness such as cardio
vascular diseases, cancer and chronic obstructive pulmonary disease
 2018 Lancet Commission on palliative care and pain relief
o Such conditions serious health related suffering
o Requiring physical, social, spiritual and emotional support alongside medical intervention
 Need for Palliative care in India
o 80% of individuals with serious health issues are from middle income countries
o Rise of non communicable diseases in India
o Ageing population of India
 State of palliative care in India
o Only 4% coverage for palliative care
o Unevenly centred around mega cities
 Best practice
o Kerala’s palliative care model
o 90% of palliative care sites of India is in Kerala

Adolescent Girl nutrition

 Significance of focussing on adolescent girl nutrition

o Increases female labour force participation rate in long term
 Better nutrition improves women ability to participate in productive activities
o Make India reap demographic dividend
 Since women account to half of India’s population
o Help break intergenerational poverty
 As well nourished girls have healthy children
 Provide better care for their families
 Reasons for undernutrition in girls
o Vulnerable to under nutrition and anaemia
 Due to onset of menstruation
o Cultural norms affects nutrition uptake
 Lack of gender neutral environment within household
 Problems caused by undernutrition
o Leads to cognitive impairment
 Affecting one’s academic performance
o Lower educational attainment
 Limits opportunities for employment and economic self sufficiency
o Higher risk of chronic diseases and pregnancy complications
 Leading to higher healthcare burden on families and government
 Causing financial instability and increased poverty
o Less likely to participate fully in society
  By being less healthy and less educated
 Measures taken
o Convergence of government initiatives
 Scheme for Adolescent Girls (SAG) within umbrella of PM’s overarching scheme for Holistic
Nutrition Programme (POSHAN) 2.0
o Rashtriya Kishor Swasthya Karyakram (RKSK)
 Targeted adolescent oriented schemes
 Measures to be taken
o Adopt a life cycle approach
 Ensuring that no girl is left behind
o Social and Behaviour Change Communication (SBCC)
 To adopt good practices and high nutrition for young girls
o Routine training of health workers
 For effective implementation and monitoring of various schemes