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(The Gist of Kurukshetra) A Step Towards Health Security

(The Gist of Kurukshetra) A Step Towards Health Security
[July-2020]

A Step Towards Health Security

Introduction:

The World Health Organization or WHO has defined global public health security as "the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries".
Health Security does not exist in isolation— it is dependent on food and nutrition security, economic/financial security as well 3s the societal support and many other factors. It requires safe and healthy environment, good infrastructure for physical activity and an all-round security (including psychological aspects) for the individuals to lead a healthy, happy and contented life.

National health security:

National health security is fundamentally a weak link all around the world. None of the nations is fully prepared to handle epidemics or pandemics; every country has many of its major gaps to be addressed for amicably handling the adverse situations arising out of such incidents.
Disparities in the nation’s capacities and a lack of attention by the leaders exacerbate the preparedness gaps towards the biological threats.
India’s National Health Policy framed in 1983 was re-formulated by the Ministry of Health and Family Welfare in 2017, to address the current emerging challenges necessitated by the changing socio-economic and epidemiological conditions.
It focuses on preventive and promotive health care and the primary healthcare which is comprehensive and universal. It promotes patient centric approach providing quality care, inter-sectoral convergence as well as easy access, affordability with appropriate use of technology as its salient features.

Prime Minister outlined the four major pillars of healthcare which need to be focused:

Preventive Healthcare
Affordable Healthcare
Improvements in the supply of equipment and medicines
Mission mode interventions

A public charitable trust:

‘Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund’ (PM CARES Fund)’ has been created to address the issues relating to emergency/distress situations and calamities be these manmade or natural.
Ayushman Bharat -Government of India’s flagship scheme recommended by the National Health Policy (NHP-2017) was launched to achieve the vision of Universal Health Coverage (UHC). It has been designed to meet the Sustainable Development Goals (SDGs) and its underlining commitment - ‘leave no one behind’. It attempts to move from sectoral/segmented approach to a comprehensive need-based health care service delivery.
Further, it aims to undertake path-breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary levels. It adopts a continuum-care approach, comprising of two inter-related components:
Health and Wellness Centres (HWCs) to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the residence of masses. These centres cover both – maternal and child health services as well as noncommunicable diseases; and provide free essential drugs/diagnostic services.
Pradhan Mantri Jan Arogya Yojana (PMJAY) is the world’s largest health insurance/ assurance scheme fully financed by the government. It provides coverage of 5 lakh INR/family/year for secondary and tertiary care hospitalization across public and private empanel led hospitals in the country.
Within a period of two years, this initiative has impacted the lives of more than one Crore people. To date, more than 20,700 HWCs have become operational and are providing services across the country.
Pradhan Mantri Gareeb Kalyan Yojana-a relief package of Rs 1.70 Lakh Crore was declared on 26th March, 2020 for the poor to help them fight against Corona Virus.

Under this package:

Women Jan Dhan account holders (20 crore) to get Rs. 500 per month for the next three months.
Nearly 80 crore poor people to get 5 kg wheat or rice and 1 kg of pulses and other food items (free of cost) every month for the next three months.
8 crore poor families to be provided free of cost LPG cylinders for 3 months w.e.f 1st April 2020.
Increase in MNREGA wages from Rs. 182/day to 202/day benefitting nearly 13.62 crore families.
Insurance cover of Rs 50 Lakh per health worker fighting COVID-19 to be provided under the Insurance Scheme.
Pradhan Mantri Ujjawala Yojana promotes the use of LPG keeping in view its health benefits (particularly women/children), environmental safety and enhanced economic productivity of women. By May 2020, nearly 804 Lakhs LPG connections (clean cooking fuel) have already been given to the poor households.

POSHAN Abhiyaan/National Nutrition Mission (NNM):

It is the Prime Minister’s overarching scheme for holistic nutrition, to improve nutritional outcomes of the children, pregnant women and nursing mothers.
Under this Abhiyan’s Home Based Young Child Care programmes, ASHA workers are to make 5 additional visits to the homes of children aged up to 15 months, to specially counsel on nutrition and Early Childhood Development. For this initiative, Rs. 217 Crore has been sanctioned to the States/UTs.
Similarly, for the Anaemia Mukt Bharat programmes (under POSHAN Abhiyan), Rs. 425 Crore has been allocated by Government of India to all States/UTs for implementing the tests, treatment and counselling of anaemic patients so as to achieve a 3 percent reduction in anaemia.
Pradhan Mantri Matru Vandana Yojana: This scheme provides cash incentives to pregnant women and nursing mothers to improve health outcomes of the mother and the new-born.
Pradhan Mantri Surakshit Matritav Abhiyan is conducted on the 9th of every month (like Pulse Polio Programmes); and within 3 months, nearly 9.64 lakh Ante-Natal Check-ups have been conducted. To ensure dignified motherhood, 317 labour rooms/operation theatres have been certified to provide quality services under LaQSHYA (Labour Room Quality Improvement Initiative).
Maternity Benefit Amendment Act: Government’s new maternity policy raises the duration of paid maternity leave for women employees to 26 weeks so as to promote breast-feeding and infant care.
Mental Healthcare Act (2017) adopts a rights based statutory framework for mental health
in India and strengthens equality and equity in providing mental healthcare services to
protect the rights of people having mental health problems. Further, it ensures that they
receive optimal care and are able to live with respect and dignity.

National AIDS Control Programme:

In India, HIV/AIDS was first reported in 1986. Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 aims to end this epidemic by 2030.
It also emphasises that the people living with AIDS are not given unfair treatment at the employment/ educational establishments or in providing healthcare and insurance services.
In June 2016, the MHFW reiterated India’s commitment at the UN High-Level Meeting on AIDS towards the goal of ‘ending the AIDS epidemic as a public health threat by 2030’, as per the Joint UN Programmes on HIV/AIDS (UNAIDS) Fast Track targets for 2020 and the SDGs for 2030.
This approach has been articulated in the NHP and its implementation framework (adopted in 2017) to be implemented by NACO (National AIDS Control Organization) through a seven year National Strategic Plan on HIV/AIDS and STI (Sexually Transmitted Infection), 2017-24. NSP will herald the country to the midpoint of the 2030 goals. The next seven years are, therefore, critical and investments made now will result in substantive gains towards ‘Ending of AIDS’.
NACO’s vision is ‘Paving the way for an AIDS free India’ through ‘attaining universal coverage of HIV prevention, treatment and care through continuum of services that are effective, inclusive, equitable and adapted to needs’. The goals remain the ‘Three Zeros’ -zero new infections, zero AIDS-related deaths and zero discrimination - forming the basis of this strategic plan.

Revised National Tuberculosis Control Programme:

India has been engaged in Tuberculosis control activities for more than 50 years yet it continues to be India’s severest health crisis; nearly 4,80,000 Indians die of TB every year.
National Strategic Plan for tuberculosis elimination (2017-2025) proposes bold strategies with commensurate resources to rapidly curb TB in the country by 2030 in line with the global ‘End TB targets’ and SDGs to attain TB-free India. The four strategic pillars of TB elimination include "Detect - Treat - Prevent - Build" (DTPB). NIKSHAY - the web based TB reporting has enabled to capture/transfer individual patient data from remotest health centres in the country.
Elimination of Communicable diseases- Action plans to eliminate Leprosy by 2018, Measles by 2020 and Tuberculosis by 2025 are being implemented.

E-Health:

Under the Digital India campaign, E-Health initiative was launched in July 2015 with the broad aim to provide effective, economical and timely healthcare services to all individuals; especially the ones with little access to healthcare services.
Affordable and Quality Health-Care for All (availability of cheaper medicines): Nearly 1054 essential medicines, including lifesaving drugs has been brought under the Price Control regime after May 2014. The AMRIT (Affordable Medicines and Reliable Implants for Treatment) pharmacies provide drugs for cancer and cardiovascular diseases along with cardiac implants at a 60-90 percent discount.
Employees’ State Insurance Scheme (ESIS) was launched under the Employees’ State Insurance Act (1948) to protect health interests of the workers and their immediate dependents. It is a contributory scheme on the patterns of social health insurance. The existing wage limit for coverage under the Act is Rs. 21,000/- per month.

Rashtriya Swasthya Bima Yojana:

It was launched in October 2007 by the Ministry of Labour and Employment to provide health insurance coverage for BPL families.
Under Health Minister’s Discretionary Grant, financial assistance up to Rs. 1,25,000 is available under this scheme for poor indigent patients to defray a part of the expenditure on hospitalization/ treatment in Government hospitals where free medical facilities are not available.
Rashtriya Arogya Nidhi was set up in 1997 for providing financial assistance to patients from BPL families suffering from major life threatening diseases receiving medical treatment in Government Hospitals.

National Organ Transplant Programme:

Apex level National Organ & Tissue Transplant Organisation (NOTTO) has been set-up for establishing country-wide network of transplant and retrieval hospitals and tissue banks. Five Regional Organ and Tissue Transplant Organizations (ROTTO) have been established in Tamil Nadu, Maharashtra, Assam, West Bengal and Chandigarh. Drug Regulation efforts provide risk-based classification, licensing and regulation of medical devices.

National Tobacco Control Programme (NTCP):

From April 2016, specified health warnings on tobacco products made more prominent covering nearly 85 percent of the principal display area of the packs. Further, quit-line number has been included in new specified health warnings w.e.f. September 2018. Inclusion of Bidi in Tax Net: Bidi has been kept along with all tobacco products and, thus, fetches 28 percent Goods and Service Tax (GST). As per the Global Adult Tobacco Survey (2016-17), tobacco usage has gone down from 34.6 percent (2009-10) to 28.6 percent (2016-17).
National Vector Borne Disease Control Programmes is one of the most comprehensive and multi-faceted public health programmes in the country; and deals with the prevention and control of vector borne diseases namely Malaria, Dengue, Chikungunya, Japanese Encephalitis (JE), Acute Encephalitis Syndrome (AES), Kala-azar and Filariasis.
To support the 2030 Agenda for Sustainable Development and the 2016-2025 UN Decade of Action on Nutrition, WHO works with Member States and partners towards the goal of a world free from malnutrition. The SDGs provide a bold and ambitious agenda for the coming future. WHO’s core mission is to promote health.
In addition to keeping the world safe and serving the vulnerable, it works to ensure healthy lives and promote well-being for all at all ages, leaving none behind. It targets one billion more people to enjoy better health and well-being by 2023.