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
Tuberculosis and India’s fight against
Tuberculosis (TB) has been a deadly disease for India and the world. The number of lives lost for TB and its increasing spread in spite remarkable success on other disease fronts raises concerns.
At the end of 50 years of tuberculosis control activities, the disease remains a major health challenge in India.
As per new estimates, the number of new cases every year has risen to 2.8 million and mortality is put at 4,80,000 each year.
These figures may go up when the national TB prevalence survey is undertaken in 2017-18.
Against this backdrop, the Ministry of Health and Family Welfare, in its National Strategic Plan for Tuberculosis Elimination (2017-2025), has set a highly ambitious goal of “achieving a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB by 2025.”
How did it come about?
Though the Revised National Tuberculosis Control Programme (RNTCP) has treated 10 million patients, the rate of decline has been slow.
Providing universal access to early diagnosis and treatment and improving case detection were the main goals of the national strategic plan 2012-17.
But RNTCP failed on both counts, as the Joint Monitoring Mission report of 2015 pointed out.
Going by the current rate of decline, India is far from reaching the 2030 Sustainable Development Goals — reducing the number of deaths by 90% and TB incidence by 80% compared with 2015.
Yet, the latest report for TB elimination calls for reducing TB incidence from 217 per 1,00,000 in 2015 to 142 by 2020 and 44 by 2025 and reduce mortality from 32 to 15 by 2020 and 3 per 1,00,000 by 2025.
Why does it matter?
Radical approaches are needed to come anywhere close to reaching these ambitious targets.
Most importantly, the TB control programme plans to do away with the strategy of waiting for patients to walk in to get tested and instead engage in detecting more cases, both drug-sensitive and drug-resistant.
The emphasis will be on using highly sensitive diagnostic tests, undertaking universal testing for drug-resistant TB, reaching out to TB patients seeking care from private doctors and targeting people belonging to high-risk populations.
The other priority is to provide anti-TB treatment — irrespective of where patients seek care from, public or private — and ensure that they complete the treatment.
For the first time, the TB control programme talks of having in place patient-friendly systems to provide treatment and social support.
It seeks to make the daily regimen universal; currently, the thrice weekly regimen is followed by RNTCP, and the daily regimen has been introduced only in five States.
There will be a rapid scale-up of short-course regimens for drug-resistant TB and drug sensitivity testing-guided treatment.
In 2013, India “achieved complete geographical coverage” for MDR-TB (multi-drug-resistant tuberculosis) diagnosis and treatment; 93,000 people with MDR-TB had been diagnosed and put on treatment till 2015.
Though Bedaquiline, the drug for people who do not respond to any anti-TB medicine, is provided in six sites in the country, the number of beneficiaries is very small.
The report envisages a countrywide scale-up of Bedaquiline and Delamanid.
In a marked departure, the report underscores the need to prevent the emergence of TB in susceptible populations.
One such segment is those in contact with a recently diagnosed pulmonary TB.
Incidentally, active-case finding is already a part of the RNTCP programme but rarely implemented.
It wants to increase active case finding to 100% by 2020. Since RNTCP expenditure has increased by 27% since 2012 and is inadequately funded, the Ministry proposes to increase funding to ?16,500 crore.
Acknowledging that the business-as-usual approach will not get the Health Ministry anywhere close to the goals, it has earmarked critical components that will be addressed on priority.
These include –
sending customised SMSes to improve drug compliance
incentivising private doctors to notify cases
providing free medicines to patients approaching the private sector,
facilitating nutritional support to TB patients, including financial support,
rewarding States performing well in controlling TB,
using management information systems to monitor all aspects of TB control.
“The ultimate impact of this national strategic plan will be transformational improvements in the end TB efforts of India,” the report says. It plans to take a “detect-treat-prevent-build approach” in its war against TB.
Connecting the dots:
TB is a growing concern in India which can potentially threaten the health chart of India. Critically discuss the new National Strategic plan especially w.r.t. rising prevalence of MDR and XDR TB.
SCIENCE AND TECHNOLOGY
TOPIC:General Studies 3
Science and Technology- developments and their applications and effects in everyday life
Indigenization of technology and developing new technology.
Awareness in the fields of IT
Increasing the adaptability of Digital world
Digital India is seeing a growth in acceptance with increasing telecom and internet penetration.
A Google report published last year, estimated that the Indian digital payments industry would grow to $500 billion by 2020 and would account for 15% of India’s GDP.
It also said that more than 50% of the internet users in the country would embrace digital payments by 2020.
The demonetisation move by the government has transformed the entire digital payments scenario almost overnight. And the most visible beneficiaries have been mobile wallet companies whose user numbers have soared.
But, there was a drop in active wallet users—after the November-December rise—in January by 50%. The base of using different means of digital payments has widened but there is unmistakable drop in digital payments vis-a-vis the time when people had to.
With the incoming of cash, people will resort to more convenient use of it rather than using multiple stages to use digital mains.
Low penetration of PoS terminals across India is a problem. There are over 14 million retail outlets in India but barely 1.5 million PoS machines (required to swipe credit or debit cards). In their absence, people tend to withdraw cash.
The people are still unable to use the smartphones efficiently to make the mobile payments easily. This is because the smartphone penetration is not enough for people to take advantage of its advanced services.
The security of data is foremost concern of using digital medium across all the sections of society-rich or poor, urban or rural. The fear of a security breach leading to money being siphoned off is highly prevailing, especially among new users. Random reports of security date breach heighten concerns regarding usage of digital medium.
Lack of adaptability by many vendors is a challenge in having more access to digital systems. This is largely because most are yet not aware of such alternate medium and many are lagging behind in understanding and adopting the technology.
Digital India is one of the 10 major thrust areas in Budget 2017-18. Thus there will be a boost to cleaning up the system, have transformational impact, energise private investment through low cost credit and benefit the common man.
Indian banks will be introducing one million PoS terminals by end of March 2017.
Also, another two million Aadhaar-linked PoS terminals may be commissioned by September 2017.
Sale of smartphones needs to be increased so as to increase its outreach as a multiple facilitator- bank/computer/library etc.
However, it is easier said than done as India is an extremely price-sensitive market.
Hence, more focus should be in innovating and creating low cost technology that enables digital transactions with ease.
The smartphones and other digital medium have various options which protects user data. However, users generally lack reassurance that all these are fully secure.
Hence, the digital payment entities have to significantly enhance security features, whereby hacking such systems becomes nearly impossible.
This is possible via multiple layers of protection such as stringent encryption, use of biometrics and multiple software levels that drive near-total secure transactions.
Many new customers are entering the digital world. For them as well as existing users, digital transaction experiment should be made hassle-free.
The entry barriers should be minimised, beginning by keeping the charges minimal.
There will be Aadhar Pay wherein it will be useful for people who do not have debit and credit cards, and net banking facility.
The cash and digital payments are going to have a tough competition for usability.
The experience of using a digital payment system should also be simple, safe and convenient to use. Today, multiple digital payment options are used by customers- credit cards, debit cards, mobile wallets, UPI etc. and the system should work seamlessly.
The government has an important role to play in furthering its vision of ‘Digital India’. There should be a ‘Digital India year’ or ‘Digital India Decade’ dedicated to the vision of digitising common man’s life. There already exist 9 pillars of Digital India which need to be promoted vigorously. Enormous amount of money—over $200 billion centre and states combined— is spent in delivering benefits to the country. If this money is used through digital means, there are positive chances of the social infrastructure becoming more effective and becoming available to all people of India. Digital transformation is a crucial pillar for efforts to transform, energise and clean India.
Connecting the dots:
What are the challenges faced in increasing digital penetration post demonetisation. What are possible solutions for the same? Enumerate