General Studies 2
- Issues relating to development and management of Social Sector/Services relating to Health.
General Studies 3
- Inclusive growth and issues arising from it
Price Control of Cardiac Stents
Health is a sector of concern in India’s growth story. India still has a long way behind in making it a fundamental right. Especially in terms of non-communicable diseases which are emerging as silent killers Indians have shown high vulnerability. In this background it is necessary to make health care and delivery affordable and accessible by government of India.
- Capping the prices of medical stents, which are used to treat coronary artery disease, by the National Pharmaceutical Pricing Authority (NPPA) is an extreme regulatory measure necessitated by the market failure that afflicts the overall delivery of health care in India.
- Rising costs have led to impoverishment of families and litigation demanding regulation.
- Given the overall dominance of private, commercial, for-profit health institutions, and the asymmetry confronting citizens, correctives to bring about a balance are inevitable.
- Two important pointers to the need for cost regulation are available from research published in The Lancet in December 2015:
- Nearly two-thirds of the high out-of-pocket expenditure on health incurred by Indians went towards drugs;
- Even the meagre research data available showed that there was irrational use of medical technologies, including cardiac stents and knee implants.
- Regulated prices can, therefore, be expected to make stents more accessible to patients who really need them, helping them avoid using up the weak insurance cover available, while also reducing the incentive for unethical hospitals to use them needlessly.
- It is worth recalling that there are over 60 million diagnosed diabetics in the country, and the average age at which the first heart attack strikes Indians is 50, a decade earlier than people in developed nations.
- At appropriate prices, and with a health system that pools the cost among all citizens, it would be possible to provide access to stents and other treatments for all.
Health-care providers often demand market-determined pricing of medical technologies on the ground that newer ones will not be available under a regulated regime.
- In the case of cardiac stents, this argument does not hold water since stakeholder consultations held by the NPPA in January revealed that there are ‘huge unethical markups’ in the supply chain.
- It would serve the cause of medical innovation if costing is transparent, and a system of risk pooling is introduced to help patients get expensive treatment without high out-of-pocket spending.
- It was estimated five years ago by the Planning Commission’s expert group on universal health coverage that raising spending on public procurement of medicines to 0.5% of GDP (from 0.1%) would provide all essential medicines to everyone.
- What is necessary, then, is for a two-pronged approach to improve access to medicines and technology.
- The Centre should monitor expenditures jointly in partnership with the community, use regulation where needed
- Raise public spending on health
- Several developing countries have moved ahead on this path.
Well-considered price control is a positive step, but more needs to be done. The latest measure provides an opportunity to expand the availability of stents, and by extension angioplasty procedures, in the public health system. District hospitals should offer cardiac treatments uniformly. This should be a priority programme to be completed in not more than five years.
Connecting the dots
- The recent measure of price control on medical devices is seen as anti-market practice. Critically discuss the need for such measures in a welfare state like India. Will it inhibit innovation in the field? Justify.
HEALTH AND SANITATION
General Studies 1
- Social empowerment
- urbanization, their problems and their remedies
General Studies 2
- Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Faecal sludge management in cities
- When the city planners believed that once people use safe sanitation in their homes, the problem is resolved.
- However, the phrase of ‘flush and forget’ has resulted in a dire emergency.
- The reason is lack of proper faecal sludge management system.
- As per Centre for Science and Environment, between 70-90% of human waste goes untreated into the environment in the 75 cities surveyed.
Need for faecal sludge management
- Faecal sludge is any human excreta and water mixture that bears disease-carrying bacteria and pathogens that need to be safely treated before disposal into the environment.
- Faecal sludge management is the system in citiesthat safely collects, transports and treats faecal sludge and septage from pit latrines, septic tanks or other on-site sanitation systems.
- Unfortunately, the Indian cities experience lack of this service or lack of well management of it.
- This has resulted into
- gross pollution of surface and groundwater
- widespread disease through untreated disposal of pathogen-laden sludge
- high costs of combating water-borne diseases to individual households
- Thus, a sound faecal sludge management system is of utmost importance in densely populated areas, where most residents are often not connected to conventional sewer networks.
The sanitation problems
- The sludge is most often collected by unorganized private service providers who use vacuum pumps or other types of pumps loaded onto trucks/vehicles that can enter high-density areas.
- The collected and untreated material is usually dumped in the nearest water body or open area, sometimes even in farmer fields. This is hazardous to safe and healthy living.
- These providers areneither incentivised nor regulated to take the sludge to a safe location for disposal.
- It has to be noted that responsibility of providing effective faecal sludge management lies with local governments, water authorities, water utilities, in partnership with formal or informal private service providers.
What to do?
- For efficacious citywide sludge management, faecal sludge should be collected on a scheduled route instead of on-demand /call-for-service basis. This will create de-sludging to be a sustainable business for service providers.
- For alternatives to conventional treatment systems, non-networked and innovative treatment systems and technologies should be used by cities. These include
- Constructed wetlands
- Anaerobic digestion and waste stabilization ponds
- Co-treatment in sewage treatment plants
- These solutions together result in effective faecal sludge management treatment that is practicable both from an economic and operations stand point.
Role of stakeholders
- Faecal sludge management is not only an engineering or infrastructure solution, but a city system which requires strong collaboration among all stakeholders, especially government and citizens.
- There is a strong push by the national government to provide technical assistance to states and cities to design and implement effective faecal sludge management systems for their citizens.
- This will also equally requireactive cooperation of citizens else private service providers, city planners and administration will not be able to give effective and sustainable faecal sludge management.
- The citizens have to ensure that there is regular de-sludging of their septic tanks, ensuring that no untreated sludge leaks into their immediate environment. They should also regularly pay for the cleaning services provided by government.
- Similarly, the service providers should ensure quality services to citizens by not dumping untreated waste into the environment. They have to ensure high maintenance of their vehicles, ensuring that service personnel are adequately protected from contamination and that there are no leakages during desludging operations.
- Municipalities need to create facilities for
- safe treatment and disposal
- set up the right incentives and disincentives for adhering to safe disposal
- create the right market structures to encourage private sector playersto expand and sustain operations for both de-sludging and treatment.
There is an urgent need for stakeholders to take the action to tackle the sanitation problems of the cities. Lack of sanitation costs around 6.4% of GDP because of death and disease. India is losing approximately 1000 children everyday to poor sanitation. Thus, effective faecal sludge management is a critical step in saving these lives.
Connecting the dots:
- Critically analyse the sanitation management scenario in urban cities in India.
- What is faecal sludge and its management? What are the problems arising by it and how to tackle it?
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