Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources
Issues relating to poverty and hunger
Important aspects of governance, transparency and accountability, e-governance- applications, models, successes, limitations, and potential; citizens charters, transparency & accountability and institutional and other measures
Solving the issue of high NMR in India
India has not performed well when it comes to neo-natal mortality rate(NMR). It is measured as death of a newborn within 28 days per 1,000 live births.
According to World Bank statistics, we moved from 33 in 2010 to 28 in 2015. As a benchmark, the UN Sustainable Development Goal (SDG) for NMR is 12 by 2030. If India continues on this slow trajectory, we will achieve the SDG only by 2040.
Examples shows the problem is not unsolvable:
Sri Lanka, has an NMR of 5.4.
Closer home, Kerala is already at 6 and Tamil Nadu at 14.
Achieving the target- Way forward:
Achieving the SDG target of 12 for NMR by 2030, or even faster, will require five key interventions—all related to the basic management of public health.
Need for 2-3 emergency C-section points in every district:
Usually there exists only one-two operational C-section points in most districts. This implies longer travel times for women in labour, creating distress and overburdening facilities—which in turn cannot provide adequate care, thereby endangering the newborn.
While research indicates that the C-section rate in India is now beyond the optimal range (greater than 10–15%), the situation in public institutions is quite the opposite. In Uttar Pradesh and Bihar, the C-section rates in public institutions remain at 4.7% and 2.6%, respectively.
To achieve two-three fully operational C-section points on priority, a functional trio of specialists (paediatrician, gynaecologist and anaesthetist) and specialized equipment are needed. 10–20% of facilities have a complete trio but still do not perform procedures due to behavioural and accountability issues. This needs to be addressed.
Quality special newborn care units (SNCUs):
Conditions like asphyxia, prematurity or sepsis require specialized care.
Two-three SNCUs should be fully functional per district. This means that three-four beds per 1,000 deliveries need to have critical equipment, including radiant warmers and phototherapy machines.
Additionally, the critical nature of the newborns warrants round-the-clock care—a minimum of four nurses.
Addressing key clinical skill gaps:
Basic clinical skills can prevent a majority of neonatal deaths. Unfortunately, many clinical staff lack these basic skills, or don’t practice them.
For example, simple process of placing a pre-term child against the mother’s chest keeps the baby warm and facilitates weight gain through breastfeeding. However, this practice (kangaroo mother care) is still not widely practised.
Similarly, clinical staff are shy about practices like neonatal resuscitation that can tackle asphyxia.
Several tools, including a “safe birth” checklist, are available. Development agencies (for example Unicef) conduct specialized training programmes for clinical staff. States should mandate such training and the practice of these basic protocols.
Improving care of pregnant women:
While many complications are detected during labour, many can be identified during pregnancy through tests, like those for blood pressure and haemoglobin.
Coverage of antenatal visits by front-line workers is alarmingly low: 51% according to the National Family Health Survey, 2015-16.
Additionally, the quality of nurse and pregnant women interactions is often poor.
Simple diagnostic procedures are not conducted, resulting in dismal rates of high-risk pregnancy identification.
Availability of basic diagnostic equipment, an expansion of front-line worker capacity (using methods like supportive supervision) and their increased accountability towards coverage and quality of antenatal visits are key.
Data tracking and accountability:
Currently, management information systems are only able to track around 20-40% of actual deaths. This is because staff are rarely held accountable for the data. Complex and multiple registers are also to blame.
Field data collection processes need to be simplified. Wherever possible, technology like mobile apps should be used.
Systemized data-driven reviews of key NMR-related measures, including still-birth rates, are necessary. Data tracking would enable success.
It can be concluded that it is not cutting-edge science that will save lives. Simple fixes, many of them administrative and managerial, don’t get addressed. In order to make the foundations of our health system robust we first need to implement the simple solutions.
Connecting the dots:
India has not performed well when it comes to neo-natal mortality rate(NMR). If India continues on the same trajectory, we will achieve the SDG related to NMR only by 2040. Discuss the measures if taken would help to solve the issue.
Our health system lacks robustness because simple fixes, many of them administrative and managerial, don’t get addressed. Discuss.
TOPIC: General Studies 3:
Conservation, environmental pollution and degradation, environmental impact assessment
Air pollution in Delhi: GRAP
Delhi has declared a public emergency, on account of poor air quality. The city registered “severe” on the Air Quality Index (AQI). “Everyone may experience serious health effects”, notes the AQI website.
What is AQI?
An air quality index (AQI) is a number used by government agencies to communicate to the public how polluted the air currently is or how polluted it is forecast to become. As the AQI increases, an increasingly large percentage of the population is likely to experience increasingly severe adverse health effects.
There are six AQI categories:
Associated Health Impacts
May cause minor breathing discomfort to sensitive people.
Moderately polluted (101–200)
May cause breathing discomfort to people with lung disease such as asthma, and discomfort to people with heart disease, children and older adults.
May cause breathing discomfort to people on prolonged exposure, and discomfort to people with heart disease
Very Poor (301–400)
May cause respiratory illness to the people on prolonged exposure. Effect may be more pronounced in people with lung and heart diseases.
May cause respiratory impact even on healthy people, and serious health impacts on people with lung/heart disease. The health impacts may be experienced even during light physical activity.
Air pollution causes cancer, lung disease and heart attacks. It is a public health risk that lowers the quality of life and productivity.
What must be also taken into account is that sustained poor quality of the air one has to breathe is a sharply negative factor, for drawing in investment. Investor would not want to set up shop in a place where people are guaranteed to turn sickly and only the desperate would take up jobs.
Badly maintained vehicles on badly planned and congested roads, irresponsible burning of trash by citizens and construction dust account for a large part of the problem.
In Delhi, the burning of crop stubble in distant Punjab fields is a source of Particulate Matter 2.5, as the wind drives the smoke into the capital region.
Unstable power grids in and around Delhi force people to depend on diesel generators for extended hours of electricity supply.
The crop stubble burning in neighbouring states have compounded to the problem with experts suggesting that if wind speed did not pick up in next few days, the city could witness a situation similar to last year when AQI crossed dangerous 500 level.
What is EPCA?
Environment Pollution Control Authority (EPCA) is a SC-mandated body that has over a dozen members. It was notified in 1998 by the Union Environment Ministry under the Environment Protection Act.
What is graded response action plan (GRAP)?
The plan was prepared by the Supreme Court-mandated Environment Pollution Control Authority (EPCA), which held meetings with stakeholders from all states over several months. A graded response lays down stratified actions that are required to be taken as and when the concentration of pollutants reaches a certain level.
This plan will be putting into action a number of anti-pollution measures and there will be specific actions for each category — moderate to poor, very poor, severe and emergency.
The measures include stoppage in the running of diesel sets, a three-fourfold increase in the parking rates, enhanced bus and metro services, and newspapers, TV and radio stations alerts on a daily basis with advice to people with respiratory and cardiac problems.
Also, air in moderate-to-poor category will involve periodical mechanised sweeping of roads, deployment of traffic police for smooth flow of traffic at identified choke areas and strict enforcement of pollution norms at brick kilns and industrial complexes.
Recommendations of EPCA:
It has asked the Delhi government to put more emergency measures in place.
It has suggested that parking fees be quadrupled.
It also asked Delhi Metro to lower fares during non-peak hours for at least 10 days and introduce more coaches.
Serious problem pertains to the passive attitude of the Delhi government. In the past two years, it has waited for pollution to assume emergency proportions before reacting, and then done nothing more than respond to courts or court-mandated bodies like the EPCA.
The Delhi government implemented the odd-even policy last year only after the Delhi High Court asked it to submit a time-bound plan. Despite the problems it created for people, there was enough support for the policy which demanded the Delhi government conduct a comprehensive analysis of its successes and failures. But it has, reportedly, developed cold feet over the odd-even policy.
The EPCA’s proposals will require at least 16 authorities to work together. The EPCA and the Delhi government have not devised a coordination mechanism between these bodies.
Power plants must use beneficiated coal and deploy catalytic converters to reduce and trap particulate matter.
Citizens must be educated as to the dangers of pollution and learn to cooperate, whether on fire crackers or burning trash.
The GARP needs to be taken seriously. Proactive rather than reactive measures are the need of the hour.
Connecting the dots:
What do you mean by Graded response action plan(GRAP)? Discuss the effectiveness of such plans in solving the issue of air pollution in cities like Delhi.