TOPIC: General Studies 2
- Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Global TB Report 2016 and India
The Global TB Report 2016, recently released, has revised the estimates for the tuberculosis (TB) burden in India upwards. The country has 27 per cent of the global burden of incident tuberculosis and 34 per cent of global TB deaths. As per the 2015 estimate, the number of TB deaths has doubled to 4,78,000 — making TB one of the leading causes of death in India.
As a result the World Health Organisation (WHO) has decided to have the the first United Nations General Assembly session on the disease on lines similar to HIV-AIDS wherein the member states adopted a political declaration to fast-track progress in combating the HIV-AIDS epidemic.
Lack of political will has been cited as the primary reason by WHO to hold the special assembly session. There is a need to mobilise the government machinery effectively and efficiently. As per WHO, the inclusion of Minister of Health only has not proved to be very effective and hence it highlights the need to include Minister of Justice and Minister of Finance from the nations with high disease burden such as South Africa, India and Russia.
Reasons for the rising crisis
The number of deaths caused by TB and the incidence rate had been consistently dropping from the historical highs globally, but there has been a recent increase uptick that is much larger than previously estimated. In addition to the failure of political machinery, the other major reasons for this are as follows:
- Shortage of drugs
- Increasing Multi-Drug Resistant TB (MDR-TB) and Extensive Drug Resistant TB (XDR-TB)
- Total Drug Resistant TB acting as an assured death warrant
- Inadequate prescription by doctors and inadequate follow up of proper prescription by patients is aggravating the problem of antibiotic resistance
- Disease becoming expensive and difficult to treat
- Poor quality serological tests for diagnosis
- Delay in implementation of critical programmes under the Revised National TB Control Programme (RNTCP) such as expansion of the GeneXpert pilot programme, scaling up of drug sensitivity testing, and the introduction of a child-friendly paediatric TB drug.
- Poor quality treatment by medical practitioners
India’s Initiatives – Past and Present
Revised National TB Control Programme (RNTCP)
RNTCP was originally started in 1997 and then upgraded to be implemented for the period 2012-2017. It has the following components:
- Inclusion of the private sector
- Integration of HIV-AIDS along with TB eradication
- Maintenance of National TB Register to include the details of TB cases
- Use of WHO recommended Direct Observation Treatment Short Course (DOTS) and DOTS-Plus
- Focus on MDR-TB and XDR-TB
Project Nikshay is a web-based solution for monitoring the effectiveness of RNTCP. The app attempts to make the notification process simpler to reach more patients and doctors.
90% reduction in incidence, mortality and catastrophic health expenditure by 2035. This has to be ensured by reliable data and evidences.
Bedaquiline is being introduced at six tertiary care centres across India and will be given to patients with MDR-TB.
Cartridge-Based Nucleic Acid Amplification Test (CBNAAT)
A revolutionary rapid molecular test which detects Mycobacterium tuberculosis and rifampicin drug resistance, simultaneously. This test is fully automated and provides results within two hours. It is a highly sensitive diagnostic tool and can be used in remote and rural areas without sophisticated infrastructure or specialised training.
Diagnosis: The rising menace of TB can be solved by early recognition of people having TB symptoms and put them on appropriate first line of drugs and there by eliminate it in first instance. The national TB programme has failed in identifying the people who show early symptoms.
Private Sector: The private sector has a very crucial role to play in checking the the rise of TB. Strict guidelines need to be followed to report cases of TB to government and private hospitals needs to be penalised for failure to report early TB cases to government. This will enhance the accountability of the private players.
Technology: Technology has to be introduced and utilized in the most effective manner to ensure early access and monitoring.
Citizen Awareness: There need to be in place awareness program that let people know as to what constitutes early symptoms of TB and measures to be taken in a timely manner.
Connecting the dots :
- Highlight the causes for rising problem of TB in India and the causes for failure in India to check the rise.
- Tuberculosis can be one of the major hurdles in converting the human capital in India to Demographic Dividend. Highlight the reasons for the rising TB problem and suggest measures to eliminate the problem.
General Studies 2
- India and its neighbourhood- relations.
- Effect of policies and politics of developed and developing countries on India’s interests
General Studies 3
- Security challenges and their management in border areas
- Role of external state and non-state actors in creating challenges to internal security.
Involvement of game theory in declaring surgical strikes
In news: It’s been a month since surgical strikes happened across LOC on terrorist launch pads. This has resulted in continuous firing from the other side of LOC and rising militant attacks which has claimed more lives of Indian soldiers. This brings forward the question if what could have been in government’s mind to declare such strategic operation.
- India’s leadership might have been in dilemma of — to speak or not to speak — with regard to the recent surgical strikes.
- Hence a question arises if Game Theory — the study of decision-making in interdependent situations, i.e. situations in which the outcomes and the pay-offs of a “player” (a person, firm, or country involved in the situation) depend not just on what the player does but also on what others do — offer any answers?
- In this mathematical model, it defines a game as consisting of a set of players, each with a set of strategies, and a pay-off (success) table specifying the pay-offs. It means that it will determine the gains and losses to each player from the adoption of any combination of strategies, one for each player.
- The game theorists base their analyses on two assumptions
- Rational players– they aim to maximize their pay-offs.
- Common knowledge– the elements of the game (players, strategies, pay-offs) are “common knowledge”, i.e. known to everyone, known to be known, known to be known to be known…ad infinitum.
Game theory in declaring surgical strikes
- News reports confirm that India’s recent surgical strikes in response to militant attacks in Uri may not have been the first ones.
- The new aspect of this situation is that India has made its retaliation common knowledge by declaring there has been a strike.
- This changes the interaction between the “players”—the Indian and Pakistan governments and civil society and the global leadership.
- The announcement now makes it clear to India and the world at large that the Pakistan government knows there has been a surgical strike.
- This will make Pakistan incumbent to respond which they have done by denying of such strikes taking place.
- Next, they have stepped up their militant attacks and cross-border firing which indicates that the response has begun and will continue.
Pakistan has to act
- The declaration and the consequent disapproval of terrorism by world leaders is also a possible tool in the hands of the political elite of Pakistan in their ongoing power struggle with the military and militants.
- This is happening at an opportune time when the present army chief’s tenure is coming to an end.
- The reported differences between Shahbaz Sharif (Pakistan politician) and the ISI head indicate that the politicians have initiated their moves.
No more patience
- It signals to the Pakistan public and civil society that India’s patience is running out and it no longer feels the need for “deniability” of its counter-terror operations.
- This is likely to strike a chord as the people of Pakistan are themselves victims of terrorism.
- The triggering of a mood against terrorism in Pakistan depends on its people having the impression that India has been a tolerant onlooker to past attacks and has acted only when the provocation snowballed to unbearable proportions.
Impact on Indians
- The announcement were supposed to have impact on the Indians who are about to vote in critical state elections.
Certain results which was not expected (and not appreciable)
- The claim by the government that the Indian Army has recognized its strength for the first time through these strikes is unfortunate.
- An army operation is being tried to give extreme political colours which is not acceptable neither a good example.
- Also, the revelations by the opposition that India has engaged in such strikes in the past damages India’s ability to claim the high ground.
- Similarly, the Prime Minister’s sympathy for the cause of Baloch separatists, may make India’s alleged involvement common knowledge but it does so to the detriment of India’s cause in Kashmir.
- Amongst various reactions within India, the announcement prompted countries around the world to come out in the open about their stands on cross-border militancy in Kashmir.
- The support of countries such as the US and Russia, though muted, is welcome.
- China’s stonewalling is expected, for instance on the declaration of Masood Azhar as a terrorist, given the US’ emerging tilt towards India and China’s alignment with Pakistan.
- Finally, India’s foreign policy has shown its focus where it aims to identify and propagate the fight against terrorism by collectivising the countries which share the same views as India on counter-terrorism.
Connecting the dots:
- How was game theory utilised by India in declaring surgical strikes across LOC? Explain the varied impacts.
An invitation to peace-mongering
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