Issues relating to development and management of Social Sector/Services relating to Health
Development processes and the development industry the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders
Hospital Acquired Infections
Health care in India is in a dismal state with issues ranging from affordability, accessibility and availability. In this light a serious concern is hospital acquired infections which are life threatening. The biggest problem is lack of awareness and apathy of the officials.
A large number of patients who go to hospitals come back with something more serious. According to the World Health Organisation, at any given time over 1.4 million people across the globe suffer from a hospital-acquired infection (HAI). HAIs account for 2 million cases and about 80,000 deaths a year.
A 2015 study finds that the rates of hospital-acquired infections and antimicrobial resistance were markedly higher in India than those reported by the CDC in the U.S.
Key findings and challenges:
The first step to combat this situation is to improve hygiene practices and implement standard operating procedures at each step.
According to the president of the International Nosocomial Infection Control Consortium (INICC), Victor D. Rosenthal, who has been studying the problem for several decades- “Most HAIs are caused due to [a] lack of compliance with infection control guidelines, such as hand hygiene, [and] use of outdated technology,” he says.
The most common types of HAIs are bloodstream infection, pneumonia, urinary tract infection and surgical site infections.
A study published in 2015 by the INICC led by Dr. Rosenthal, studied the rate of device-associated infection rates in 40 hospitals from 20 Indian cities over a 10-year period from 2004.
The study, which collected data from 236,700 intensive care unit (ICU) patients for 970,713 bed-days, found that rates of HAIs and antimicrobial resistance were markedly higher in India than the rates reported by the Centers for Disease Control and Prevention, the leading national public health institute in the United States.
The study found an incidence rate of 7.92 central line-associated bloodstream infections per 1,000 central line-days, 10.6 catheter-associated urinary tract infections per 1,000 urinary catheter-days and a ventilator-associated pneumonia rate of 10.4 per 1,000 mechanical ventilator-days in adult ICUs.
The study reports that these high rates could reflect “the typical ICU situation in hospitals in India”.
The situation is further emphasised by the fact that administrative and financial support in public hospitals is insufficient to fund full infection control programmes, which invariably results in extremely low nurse-to-patient staffing ratios — which have proved to be highly connected to high HAI rates in ICUs — and hospital overcrowding
Issue of overcrowding
Acknowledging India’s serious problem of overcrowding of hospitals which leads to many basic hygiene processes being given the go by limited manpower is an important risk factor.
Having one nurse for three beds in an ICU is an important risk factor. With limited resources, there are limitations on providing a good enough manpower, proper guidelines, proper training, proper education, good behaviour, and right technology.
Today more than ever, pathologists are constantly in “catching up” mode trying to counter microorganisms rapidly mutating and adapting to existing known methods of treatment.
And the persons most susceptible to infection are those whose immune system is already compromised, say after a surgery or a prolonged visit to the hospital.
Referring to the overuse of antibiotic drugs, Dr. Rodenthal sounds a sharp warning to the overuse of antibiotics: “The misuse and excess use of antibiotics increase resistance. The approach should be to prevent infections and in the process bring down the HAI rate together with bacterial resistance, rather than waiting for infections and then treating them with antibiotics.”
Prevention is better than cure is an old adage but as relevant as ever. In a country where we still have a long way to make health a basic right accessible to all the least government can do is to raise awareness about HAIs and curb them through mandated best practices.
Connecting the dots:
Hospitals are more seen as dens of disease breeding than cure especially with reports on hospital acquired infections. Enumerate the probable lapses leading to the same. Also chart a solution to the same.
TOPIC:General Studies 3
Indian Economy and issues relating to planning, mobilization of resources, growth, development and employment.
Defence status and Budget 2017-18
In Budget 2016-17, the FM did something different from the past- he entirely skipped mentioning defence spending in his speech.
In Budget 2017-18, he did make a passing reference to defence where he mentioned about a defence travel system and an online pension disbursement system.
He has allocated a sum of Rs. 2,74,114 crore including Rs. 86,488 crore for defence capital for defence expenditure excluding pensions.
The first thing left unsaid was that the budget estimate of defence pensions this year is a whopping Rs. 86,000 crore.
When defence pensions are included, the overall defence budget amounts to Rs3.59 trillion, or 2.1% of GDP. When they are excluded, it drops to a meagre 1.6% of GDP.
Falling defence expenditure is a critical concern in the present times.
The china has been increasingly confrontational, US with its new President is becoming more insular about American interest and Russia is growing its friendship with Pakistan.
Hence, there is a necessity to increase defence expenditure in few years.
On the capital acquisition front, the situation remains the same. The government had slashed 9% in the revised estimate compared to budget estimate.
In present budget, there is a nominal increase of 10% in the capital acquisitions budget over last year —but this is a net reduction in capital spending once inflation and slashed expenditures in the revised estimate are accounted in.
Though Rs. 86,000 crore on capital acquisitions might sound like a large number, close to 90% of it is allocated to paying off instalments of money for past purchases such as Sukhoi fighter craft, aircraft carrier Vikramaditya, transport planes like the C130J Super Hercules and more. Thus, the available budget for future acquisitions will be about Rs. 10,000 crore and no more.
In addition to it, the FM chose to refer to two quite mild schemes, the Centralised Defence Travel System and the interactive Pension Disbursement System instead of mention of important policy issues like the strategic partnership scheme and defence technology fund.
More than 50% of the total expenditure on defence is expected to go to salaries and pensions which ironically will anyways not give satisfaction to the personnel.
Making a case for modernisation
The paucity of funds in defence will adversely affect modernisation of the armed forces.
But unfortunately, repeated underutilisation of the capital budget has weakened the case for higher allocations for new acquisitions.
This makes it common to hear that there is underutilisation of the capital budget. One of the reason is that finance ministry rarely approves big contracts so that it can withdraw huge sums from the MoD to meet the fiscal target.
Hence the MoD has to address the problem before it goes out of proportion. Simultaneously it is also true that the allocated amount would be insufficient if all contracts in the pipeline get signed during the next fiscal.
But it is not as serious as the issue of insufficient allocation for maintenance of equipment currently in use.
This maintenance of equipment in use, war wastage reserves including ammunition stock require sufficient funds to be managed.
Thus sufficient funds and long term vision is required to maintain the armed forces for any unforeseen circumstances.
Outside the budget, the liberalizing of FDI to 100% in defence with any FDI up to 49% foreign ownership under the automatic route is an encouraging route.
This step aims to help in providing competition to a declining public defence production sector— and avoiding an excessively high defence import bill.
However, with barely Rs. 10,000 crore allocated towards new capital acquisitions, Make-in-India-Defence might remain a slogan and nothing more.
Hence with squeezed budget, it is necessary to kick-start defence reforms in the country.
The Indian Armed Forces and especially the Indian Army is too person-heavy and needs some force reconciliation.
Even China decided to reduce its troop size by 300,000 people in 2015.
Raising more troops is an old mindset which needs to be changed. Recently India raised a troop of 80,000 strong Mountain Strike Corps directed against China.
Just like railways, the defence ministry needs to urgently adopt accrual accounting.
The true pension liabilities of the Indian Armed Forces are unknown.
Even the Armed Forces need a good reckoning of their assets and liabilities to be prepared for future conflict.
Hence, the recommendations of successive standing committees on defence for accrual accounting and zero-budgeting should be heeded now.
The focus on “Make in India” in defence needs to be revived.
Since its introduction, no development contract has been signed so far for any “Make” project.
A small allocation of Rs 44.63 crore for assistance to prototype development is not finding any takers.
Hence, there should be projects that can be undertaken by Indian industry for indigenous design and development of prototypes of defence products with government funding.
Defence reforms and reorganisation is not limited to just budget. The defence minister can introduce new policies over the years for a better defence performance
The meagre increase of 6% in the official defence budget is grossly inadequate. Today there exists vast void in military capability and the diminished and incremental effect on modernisation and operational preparedness.
There is a need to augment resources substantially, particularly under ‘stores and capital’ procurement which have come under severe pressure in the last several years with a huge negative consequence on India’s defence preparedness.
From the MoD’s perspective, while the demand for higher allocations is a genuine one, it must also be fully geared up to utilise the available resources in a time-bound manner. An outcome-oriented monitoring of utilisation of outlays is needed as recommended by the standing committee in 2016. It is the only way to ensure that the focus shifts from ensuring full utilisation of funds to spending these wisely on the desired outcomes. There is hardly any merit in asking for more resources while the present capacity to utilise the available resources, particularly those under the capital head, is constrained.
Connecting the dots:
What are the defence needs of Indian armed forces? Critically analyse.