Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Issues relating to development and management of Social Sector/Services relating to Health
Anti Microbial Resistance
Introduction
India is severely affected by anti microbial resistance and this has increased the burden of diseases. It is important for the government to initiate several measures from creating awareness to policies that shall be instrumental to address the same.
Chennai Declaration:
“The Chennai Declaration” named after the city where the meeting took place, is the consensus evolved out of the meeting and co-authored by representatives of various medical societies.
The document is based on realistic goals and objectives, with a deep understanding of the background Indian scenario.
Over the last decade or two, the Indian health-care infrastructure underwent significant changes. While possessing many world-class corporate hospitals and institutes, the facilities available in many villages and remote areas are still vastly inadequate.
Medication including antibiotics may be purchased over the counter and/or are prescribed by practitioners from alternative medical branches and healers.
Formulating and implementing an antimicrobialstewardship program in one of the largest countries, with an enormously heterogenic and diverse health-care system, is indeed a huge challenge. Strict control on over?the counter sale (OTC) as well as in hospital antibiotic usage should be the first steps of the policy.
Whether such a policy is implementable on the Indian subcontinent is an issue that warrants serious debate.
The lack of (qualified) doctors in many remote places possibly makes the complete ban of OTC antibiotics throughout the country obsolete.
Consequently, a targeted strategy of absolute control in densely populated areas, where qualified doctors will be available, and a more liberal approach in remote places, with monitoring of a selected list of oral antibiotics, should be more feasible.
Issue:
One of the most critical concerns facing the global health fraternity today is the escalating burden of antimicrobial resistance (AMR).
AMR develops as result of microorganisms such as bacteria, viruses, fungi and parasites becoming immune to antimicrobial drugs such as antibiotics. These microorganisms are commonly known as superbugs.
Over the past decades, antimicrobial agents have been instrumental in alleviating communicable diseases across the world.
While antibiotic resistance is a global hazard to public health, India, the largest consumer of antibiotics in the world, is notoriously seen as the epicentre of this threat.
Increasing infections:
Last year, India saw a 70-year-old woman from the US died after contracting a superbug during a two-year residence in the country.
Doctors in the US say the patient was infected with a multidrug-resistant organism known as carbapenem-resistant Enterobacteriaceae (CRE) which is immune to all available antibiotics.
In the recent past, India has witnessed many large outbreaks of emerging infections and most of them were of zoonotic origin (diseases transmitted from animals to humans).
While exact figures are hard to come by, WHO’s Global Burden of Disease report of 2004 suggests a 15-times greater burden of infectious diseases per person in India than in the UK.
According to the calculations based on World Bank data and the Global Burden of Disease report of 1990, the crude infectious disease mortality rate in India today is 416.75 per 100,000 persons, which is twice the rate prevailing in the US.
The US Center for Disease Control and Prevention estimates that in the US, more than two million people fall sick every year due to antibiotic-resistant infections, resulting in at least 23,000 deaths.
In India, the threat is much more pressing. According to the Indian Network for Surveillance of Antimicrobial Resistance (INSAR), there is widespread existence of superbugs throughout the country including a startling 41 per cent of methicillin-resistant Staphylococcus aureus (MRSA).
Multi-resistant Entero-bacteriaceae has also become rampant.
On the one hand, infectious diseases are on the rise; on the other, AMR is posing a serious impediment in their cure.
Hospital-acquired infection in vulnerable patients with resistant strains is another major threat.
Resistance to antimicrobial drugs also means that the success of treatments for medical procedures such as chemotherapy and organ transplantation and post-surgical recovery come under immense risk.
All these effects of AMR have substantial repercussions on the socio-economic set up.
Possible Solutions:
A mix of poor public health systems and hospital infections, high rates of infectious diseases, inexpensive antibiotics and rising incomes are all coming together to increase the prevalence of resistant pathogens.
Some important factors responsible for the rising antibiotic resistance in India are –
Indiscriminate use of antimicrobial drugs,
Over-the-counter availability of antibiotics,
Laxity of regulatory bodies in approval of antibiotics,
Lack of public awareness about antibiotic resistance,
Injudicious use in veterinary practices,
Overburdened health infrastructure
Inequity in healthcare.
The dire issue of AMR needs to be addressed immediately.
The first step towards optimising the use of antimicrobials to halt the spread of infections caused by multidrug-resistant organisms is antibiotic stewardship.
This involves coordinated intervention designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the most appropriate antimicrobial drug regimen, dose, duration of therapy, and route of administration.
Capacity building and sensitisation of all the stakeholders is an integral pre-requisite of this programme.
The multidisciplinary team members comprise an infectious diseases physician, a clinical pharmacist, a microbiologist, an infection control team, a hospital epidemiologist, an information system specialist, quality improvement staff, laboratory staff and nurses.
If ever a post antibiotics era becomes inevitable, Bacteriophage Therapy or simply phage therapy holds promise as an alternative treatment option.
Bacteriophages are viruses that infect and kill bacteria.
The revitalisation of phage therapy has received increased global attention since the appearance of multidrug-resistant bacteria.
The most striking advantage of bacteriophage therapy is the ability to tailor treatment accurately to kill the pathogenic bacteria — provided the diagnostic procedures are highly accurate
Conclusion:
Efforts should be concerted and holistic in nature. In the absence of involving stake holders at levels the real issue will not be solved. Further it is important to take required steps at the earliest, else it will hurt the health profile of the nation as such.
Connecting the dots:
Elaborate on the criticality of antimicrobial resistance in India. How does it affect the socio economic set up of India?
NATIONAL /SECURITY
TOPIC:
General Studies 3
Role of external state and non-state actors in creating challenges to internal security.
Security challenges and their management in border areas; linkages of organized crime with terrorism
General Studies 2
Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
The Joint doctrine of the Indian armed forces
A brief look at border security stats in 2016
As per a government report, terror incidents came down by around 25% after the surgical strikes carried out by Indian Army in PoK in September.
There was also a drastic reduction in the number of stone-pelting incidents in Jammu and Kashmir after the surgical strikes.
On infiltration side, 371 attempts of infiltration were made in 2016 out of which 118 militants were able to infiltrate, while 217 had to return. 35 militants were killed and three were arrested during their infiltration bids.
A parliamentary panel on home affairs however has said that after the 1971-Pakistan war, this is the first time the borders have become so vulnerable as a significant spurt in ceasefire violations in 2016 has been recorded.
India is currently facing a challenging situation at its borders with cross border infiltrations, security breaches and terrorist attacks, especially from its western fronts. A military doctrine serves as a cornerstone document for application of military power in a “synergised manner leading to enhanced efficiency, optimum utilisation of resources and financial savings”.
In news: India’s latest military doctrine was released after 10 years with the first one being released in 2006. The highlight of the doctrine has been inclusion of surgical strike
Surgical strikes were not intending to put an end on terrorism but it did reverse a discourse which began in 1998 post Indian and Pakistani nuclear tests that India was out of conventional options to tackle its continued cross-border terrorism.
The latest military doctrine has embedded ‘surgical strikes’ as a part of sub-conventional operations. It means that now onwards it is among a range of options at the military’s disposal to respond to terrorist attacks.
The scope of surgical strike has been left open as there is no mention of their employment being within the country or beyond its borders.
This ambiguity is intended to send the message to the troublesome neighbouring countries.
In the last two years, the Army had carried out surgical strikes across the border with Myanmar and Line of Control (LoC) Pakistan, targeting terrorist camps.
Some of the other objectives are:
Acknowledging that a conventional war by two nuclear powers is not an immediate possibility due to “political and international compulsions”.It mentions that the possibility of sub-conventional escalating to a conventional level would be dependent on multiple influences, principally: politically-determined conflict claims; strategic conjuncture; operational circumstance; international pressures and military readiness.
It notes the need for training of ‘‘Special Operations Division’’ for execution of precision tasks.
It reiterates the basic tenets of the Indian nuclear doctrine, no-first use (NFU) and minimum credible deterrence, contrary to recent calls to revise the NFU and speculation in the West that India would resort to a first strike.
It adds that conflict will be determined or prevented through a process of credible deterrence, coercive diplomacy and conclusively by punitive destruction, disruption and constraint in a nuclear environment across the Spectrum of Conflict.
It also declares about the guiding philosophy for evolution of force application and war fighting strategies which shall be undertaking the ‘Integrated Theatre Battle’ with an operationally adaptable force, to ensure decisive victory in a network centric environment, in varied geographical domains.
The broader objective states that Special Forces units will be “tasked to develop area specialisation in their intended operational theatres” to achieve an optimum effect.
Another important announcement under the “National Military Objectives” is: “Enable required degree of self-sufficiency in defence equipment and technology through indigenization to achieve desired degree of technological independence by 2035.”Though a grand announcement was made during ‘Make In India’ initiative to make defence industry self-sufficient, it has been observed that most of the projects are given to foreign companies, thereby defeating the purpose of the initiative.
Conclusion
These objectives open up a variety of capability addition and process optimisation for the Indian military to be able to enforce it. It also mention about the collaboration in past decade in the Indian armed forces, especially integration in the field of operations, training, management, and perspective planning.
However, though the document makes a bold announcement of its objectives, it will remain toothless unless necessary elements are not in place. This document pertains to national security and in no circumstances should be treated as par with other documents of policy formulations or become a political tool for sloganeering.
To achieve these broad objectives, it requires seamless synergy between the three services which has been demanded since a long time now. The decisions on appointment of a Chief of Defence Staff (CDS), formation of cyber, space and Special Forces commands and carving out inter-service theatre commands have to be now taken over in urgency.
Also, more funds and talent should be accorded to military R&D organisations such as DRDO to facilitate the growing indigenisation of military.
Connecting the dots:
The armed forces of India have released a joint military doctrine recently. Critically analyse the importance of such doctrine and possible steps to be taken for its successful implementation.
