National Health Policy, 2017 approved by Cabinet Focus on Preventive and Promotive Health Care and Universal access to good quality health care services

National Health Policy, 2017 approved by Cabinet Focus on Preventive and Promotive Health Care and Universal access to good quality health care services

The Union Cabinet chaired by the Prime Minister Shri Narendra Modi in its meeting on 15.3.2017, has approved the National Health Policy, 2017 (NHP, 2017).  The Policy seeks to reach everyone in a comprehensive integrated way to move towards wellness.  It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.

This Policy looks at problems and solutions holistically with private sector as strategic partners. It seeks to promote quality of care, focus is on emerging diseases and investment in promotive and preventive healthcare. The policy is patient centric and quality driven. It addresses health security and make in India for drugs and devices.

The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence.

In order to provide access and financial protection at secondary and tertiary care levels, the policy proposes free drugs, free diagnostics and free emergency care services in all public hospitals.

The policy envisages strategic purchase of secondary and tertiary care services as a short term measure to supplement and fill critical gaps in the health system.

The Policy recommends prioritizing the role of the Government in shaping health systems in all its dimensions. The roadmap of this new policy is predicated on public spending and provisioning of a public healthcare system that is comprehensive, integrated and accessible to all.

The NHP, 2017 advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals.  It envisages private sector collaboration for strategic purchasing, capacity building, skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services, and disaster management. The policy also advocates financial and non-incentives for encouraging the private sector participation.

The policy proposes raising public health expenditure to 2.5% of the GDP in a time bound manner. Policy envisages providing larger package of assured comprehensive primary health care through the Health and Wellness Centers'. This policy denotes important change from very selective to comprehensive primary health care package which includes geriatric health care, palliative care and rehabilitative care services. The policy advocates allocating major proportion (upto two-thirds or more) of resources to primary care followed by secondary and tertiary care. The policy aspires to provide at the district level most of the secondary care which is currently provided at a medical college hospital.

The policy assigns specific quantitative targets aimed at reduction of disease prevalence/incidence, for health status and programme impact, health system performance and system strengthening. It seeks to strengthen the health, surveillance system and establish registries for diseases of public health importance, by 2020. It also seeks to align other policies for medical devices and equipment with public health goals.

The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions- investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health. The policy emphasizes reorienting and strengthening the Public Health Institutions across the country, so as to provide universal access to free drugs, diagnostics and other essential healthcare.

The broad principles of the policy is centered on Professionalism, Integrity and Ethics, Equity, Affordability, Universality, Patient Centered & Quality of Care, Accountability and pluralism.

It seeks to ensure improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and strategic purchasing in healthcare deficit areas from accredited non-­governmental healthcare providers, achieve significant reduction in out of pocket expenditure due to healthcare costs, reinforce trust in public healthcare system and influence operation and growth of private healthcare industry as well as medical technologies in alignment with public health goals.

The policy affirms commitment to pre-emptive care (aimed at pre-empting the occurrence of diseases) to achieve optimum levels of child and adolescent health. The policy envisages school health programmes as a major focus area as also health and hygiene being made a part of the school curriculum.

In order to leverage the pluralistic health care legacy, the policy recommends mainstreaming the different health systems. Towards mainstreaming the potential of AYUSH the policy envisages better access to AYUSH remedies through co-location in public facilities. Yoga would also be introduced much more widely in school and work places as part of promotion of good health.

The policy supports voluntary service in rural and under-served areas on pro-bono basis by recognized healthcare professionals under a 'giving back to society’ initiative.

The policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and proposes establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health across the continuum of care.

The policy advocates a progressively incremental assurance based approach.

Background:

The National Health Policy, 2017 adopted an elaborate procedure for its formulation involving stakeholder consultations. Accordingly, the Government of India formulated the Draft National Health Policy and placed it in public domain on 30^th December, 2014. Thereafter following detailed consultations with the stakeholders and State Governments, based on the suggestions received, the Draft National Health Policy was further fine-tuned. It received the endorsement of the Central Council for Health & Family Welfare, the apex policy making body, in its Twelfth Conference held on 27^th February, 2016.

The last health policy was formulated in 2002. The socio economic and epidemiological changes since then necessitated the formulation of a New National Health Policy to address the current and emerging challenges.

National Health Mission

National Health Mission

The National Health Mission (NHM) aims for attainment of universal access to equitable, affordable and quality health care services, accountable and responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health.

Under NHM, support to States/UTs  is provided for five key programmatic  components:

(i)     Health Systems Strengthening including infrastructure, human resource, drugs & equipment, ambulances, MMUs, ASHAs etc under National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).

(ii)   Reproductive, Maternal, Newborn, Child and Adolescent Health Services (RMNCH + A)

(iii) Communicable Disease Control Programmes

(iv) Non-Communicable Diseases Control Programme interventions upto District Hospital level

(v)   Infrastructure Maintenance- to support salary of ANMs and LHVs etc.

The objectives of NHM are summarised as under:

                    i.            Reduction in child and maternal mortality

                  ii.            Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.

                iii.            Access to integrated comprehensive primary health care.

                iv.            Population stabilisation, gender and demographic balance.

                  v.            Revitalize local health traditions & mainstream AYUSH.

                vi.            Universal access to public services for food and nutrition, sanitation and hygiene and universal access to public health care services with emphasis on services addressing women’s and children’s health and universal immunisation.

              vii.            Promotion of healthy life styles.

The NHM has been successful in accelerating the decline of Maternal Mortality Ratio (MMR), Under 5 Mortality Rate (U5MR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR). It has also achieved many of the disease control targets.

The key targets and achievements of NHM are given below:

Targets as per NHM Framework for Implementation

S.no.	Targets (2012-17)	Achievements
1	Reduce IMR to 25/1000 live births	IMR has reduced to 37 in 2015 (SRS).
2	Reduce MMR to 100/1,00,000 live births	MMR has reduced to 167 in 2011-13 (SRS).
3	Reduce TFR to 2.1	TFR has reduced to 2.3 in 2014 (SRS).
4	Reduce annual prevalence and mortality from Tuberculosis by half	Tuberculosis Prevalence and mortality reduced to half as compared to 1990 level. Incidence reduced from 300 / lakh in 1990 to 217/ lakh in 2015 Mortality reduced from 76/ lakh in 1990 to 32/ lakh in 2015 Data Source : WHO Global TB report 2016
5	Reduce prevalence rate of Leprosy to <1/10000 population in all districts.	Prevalence rate of Leprosy reduced to Less than 1/10000 population in 551 Districts as on 31st March 2016.
6	Annual Malaria Incidence to be <1/1000	Annual Malaria Incidence is 0.67 in 2016.(Prov)
7	Less than 1 per cent microfilaria prevalence in all districts	Out of 256 LF endemic districts, 222 districts have reported Mf rate less than 1% as per reports of 2016.
8	Kala-Azar Elimination by 2015, <1 case per 10000 population in all blocks	Out of 628 endemic blocks 492 (78%) have already achieved elimination till 2016.

The economics of maternity leave

Maternity benefits alone will not be enough to bridge India’s gaping gender gap in the workforce

Last week, Parliament more than doubled the extent of paid maternity leave from 12 weeks to 26 weeks, placing India in the league of wealthy Western countries that have some of the most generous benefits for new mothers. In fact, once the amendment to the Maternity Benefit Act, 1961, comes into effect, only Canada and Norway will be ahead of India, with 50 and 44 weeks of paid leave, respectively. This development deserves a cautious welcome.

On the one hand, the many benefits of maternity leave, particularly for the new mother and child, are well documented: data from around the globe shows that access to maternity leave reduces the risk of infant mortality, and improves breastfeeding rates and duration which has a positive bearing on the child’s physical and mental health. Studies also show that adequate maternity leave (of at least 12 weeks) helps prevent postpartum depression and stress in new mothers. On the economic front, there is ample evidence to suggest maternity leave does not hurt businesses and is actually good for the economy—women workers who have access to maternity leave are more likely to return to the workforce, allowing their firms to not just retain but also attract the best talent. Moreover, the cost incurred by employers in the process (reimbursements for temporary replacements or overtime expenses) is considered to be negligible.

On the other hand, however, there have also been instances wherein pro-women, family-oriented policies have backfired. For example, after Chile made it mandatory for companies of a certain size to provide free childcare (India is doing something similar by making it compulsory for companies with either 30 women employees or more than 50 employees to provide access to a crèche) it was found that companies responded by reducing women’s salaries by nine to 20%. Similarly, when Spain introduced a new law in 1999 allowing all workers with children under 7 to work reduced hours without being fired, it was only women who took the benefit—and soon companies were found to be hiring and promoting fewer women while women of childbearing age were 45% more likely to be fired, according to a study by the IE Business School in Madrid. One way to offset this problem is to offer fathers paternity leave, as well as have the option of parental leave wherein both parents can share an extended leave period—as is already the norm in many developed countries.

Still, it is worth noting that even in the advanced economies of Scandinavia which boast of gender parity in the workforce, it has been found that while expanded parental leave increased women’s participation, much of the increase was in part-time work, as Chinhui Juhn and Kristin McCue note in Specialization Then And Now: Marriage, Children, And The Gender Earnings Gap Across Cohorts. Their results were corroborated in a Cornell study across 22 countries which found that while generous maternity leave ensured that women returned to the labour force, they were more likely to have unstable contract jobs. In fact, Juhn and McCue observe, women in these countries were less likely to be in management and professional occupations than women in the US who only get 12 weeks of unpaid leave—a rarity in the developed world.

So how will this play out in the Indian context? A survey by the Associated Chambers of Commerce and Industry of India last year found that 25% of urban Indian women quit their jobs after having their first child. Extended maternity leave might help change this pattern, but the question to be asked is: will this be enough to bridge India’s appalling gender gap in the workforce? Or could it actually make things worse?

In 2012, which is the most recent data available, only 27% of Indian women worked compared to 55% in OECD countries and 63% in East Asia. This deficit shaves off an estimated 2.5 percentage points from the country’s gross domestic product every year. Worse still, India is one of the few countries where women’s participation in the workforce has actually fallen—the International Labour Organization reported last year that female participation declined from 34.1% in 1999-00 to 27.2% in 2011-12. There is also a stark rural-urban divide: In 1972-73, women comprised 31.8% of all rural workers; in 2011-12, that figure had dropped to 24.8%. For urban workers, the number has increased only marginally, from 13.4% to 14.7% in that same time period.

What explains this poor participation number—that too in spite of high economic growth and rising school enrolment numbers for women? According to the ILO report, a complex interaction of social and economic factors is at play here. For one, an adequate number of jobs which could easily absorb women workers especially in the rural areas, was not created. Second, even if there were jobs available, women didn’t always take them up because household incomes were rising anyway and they had no incentive to step out. Add to this the long list of barriers that women face in accessing employment opportunities, such as the risk of exploitation particularly in the informal sector, the lack of wage parity, concerns regarding safety and security, etc., and the paltry numbers begin to make sense.

It also becomes clear that India’s problem is not just about ensuring women return to the workforce after childbirth but in bringing women into the workforce in the first place. Resolving this will require more than just maternity leave—let us keep that in mind as we celebrate our newly acquired progressive credentials.

Do you think maternity leave will improve women’s participation in the labour force?

Ozone and Environment

Ozone and Environment

What is Ozone?

Ozone is a form of oxygen. But unlike oxygen, ozone is a poisonous gas. Each ozone molecule is made of three oxygen atoms, so its chemical formula is 0₃. Ozone is formed when ultraviolet radiation causes oxygen molecules (0₂) in the upper layers of the atmosphere to split apart. If a freed oxygen atom (O) bumps into an oxygen molecule (0₂), the three oxygen atoms re-form as ozone (0₃ ).

Good and bad ozone

In the stratosphere (the layer that is about 15 - 50 kms above the earth's surface), where ozone exists naturally, it prevents the sun's ultraviolet rays from reaching the earth and thereby protects life.

In the atmospheric layer closest to the earth's surface, due to pollution by vehicles, nitrogen oxides and Hydrocarbons levels increase. In the presence of sunlight, these chemicals form ozone.  This ozone can cause health problems like coughing, throat irritation, aggravation of asthma, bronchitis etc. It can also damage crops. While ozone in the stratosphere benefits life on Earth by blocking ultraviolet radiation from the Sun, ozone in the lower atmosphere can trigger health problems.

What is ozone depletion?

Chlorofluorocarbons (CFCs) are the primary Ozone depleting chemicals. They are used as refrigerants in refrigerators, air conditioners etc. They contain Chlorine.

Ozone depletion process

• Step 1 : The CFCs generated as a result of human activities reach the ozone layer in the atmosphere
• Step  2 : The UV radiation from the sun breaks the CFCs and releases Chlorine
• Step 3 : The Chlorine atoms breaks the ozone molecule and thereby ozone depletion.

How ozone depletion affects us?

When the ozone layer gets depleted, the UV radiation of the sun striking the earth gets increased. This can cause genetic damage, skin cancer (melanoma and non-melanoma), premature aging of skin, cataracts and other eye damage and can also lead to immune system suppression. It can also have adverse effects on marine environment.

Preventive Measures

• Choose a cleaner commute — car pool, use public transportation, bike or walk when possible.
• Combine errands to reduce "cold starts" of your car and avoid extended idling.
• Use environmentally safe paints and cleaning products whenever possible.
• Some products that you use at your home or office are made with smog-forming chemicals that can evaporate into the air when you use them. Follow manufacturers' recommendations for use and properly seal cleaners, paints, and other chemicals to prevent evaporation into the air.
• Replace CFC’s with HCFCs.

India ranks first among the world’s milk producing nations

Demand of milk in the country is expected to reach upto 150
million tonnes by the end of year 2016-17 and upto 210
million tonnes by 2021-22. The dairy sector has grown
substantially over the years. As a result of prudent policy
intervention, India ranks first among the world’s milk
producing nations, achieving an annual output of 145 million
tonnes (Provisional) during the year 2014-15 as compared
to 137.68 million tonnes during 2013-14 recording a growth
of 5.32 per cent. The anticipated milk production in the
country for the year 2015-16 is about 148 million tonnes.
This represents a sustained growth in the availability of
milk and milk products for growing population.
Dairying has become an important secondary source of
income for millions of rural families and has assumed the
most important role in providing employment and income
generating opportunities particularly for women and
marginal farmers. The per capita availability of milk was at
a level of 302 grams per day during the year 2013-14,
which was more than the world average of 294 grams per
day. Most of the milk in the country is produced by small,
marginal farmers and landless labours. About 15.46 million
farmers have been brought under the ambit of 1,62,186
village level dairy corporative societies upto March 2014.
The cooperative milk unions procured an average of 39.2
million kg of milk per day during the year 2014-15 as
compared to 34.2 million kg in the previous year

Land–use classification in India

Land–use classification in India

1. Forest: Includes all lands classed as forests under any legal enactment dealing with forests or administered as forests.
2. Area under Non-agricultural Uses: Includes all lands occupied by buildings, roads and railways or under water, e.g. river, and canals and other lands used for non-agriculture purpose.
3. Barren and un-cultivable land: Includes all barren and un-cultivable land like mountains, desert etc.
4. Permanent pastures and other grazing lands: Includes all grazing lands where they are permanent pastures and meadows or not. Village common grazing land is included under this head.
5. Land under miscellaneous tree crops and groves etc: This includes all cultivable land, which is not included in ‘Net Area Sown’ but is put to some agricultural uses. Lands under Casuarina trees, thatching grasses, bamboo bushes, and other groves for fuel, etc which are not included under ‘Orchards’ are classified under this category.
6. Culturable Wasteland: This includes lands available for cultivation. Such lands may be either fallow or covered with shrubs or jungles, which are not put to any use. Land once cultivated but not cultivated for five years in succession should be include in this category at the end of the five years.
7. Fallow lands other than current fallows: This includes all lands, which were taken up for cultivation but are temporarily out of cultivation for a period of not less than one year and not more than five years.
8. Current Fallows: This represents cropped area, which are kept fallow during the current year. For example, if any seeding area is not cropped in the same year again, it may be treated as current fallows.
9. Net Area Sown: This represents the total area sown with crops and orchards. Area sown more than once in the same year is counted only once.

Agriculture land/Cultivable land/Culturable land = 5+6+7+8+9

Cultivated Land= 8+9

Reporting area of land utilization= 1 to 9

Digital India

Digital India is a programme to transform India into digital empowered society and knowledge economy. The Digital India is transformational in nature and would ensure that Government services are available to citizens electronically. It would also bring in public accountability through mandated delivery of government’s services electronically, a Unique ID and e-Pramaan based on authentic and standard based interoperable and integrated government applications and data basis. The programme will be implemented in phases from the current year till 2018.

Vision Areas

The vision is centred on three key areas

1. Digital infrastructure as Utility to Every Citizen
2. Governance and services on demand
3. Digital empowerment of citizens

Digital Infrastructure as Utility to Every Citizen

• Availability of high speed internet as a core utility for delivery of services to citizens.
• Cradle to grave digital identity that is unique, lifelong, online and authenticable to every citizen.
• Mobile phone and Bank account enabling citizen participation in digital and financial space.
• Easy access to a Common Service Centre.
• Shareable private space on a public Cloud.
• Safe and secure Cyber-space.

Governance and Services on Demand

• Seamlessly integrated across departments or jurisdictions.
• Services availability in real time from online and mobile platforms.
• All citizen entitlements to be available on the Cloud to ensure easy access.
• Government services digitally transformed for improving Ease of Doing Business.
• Making financial transactions above a threshold, electronic and cashless.
• Leveraging GIS for decision support systems and development.

Digital Empowerment of Citizens:

• Universal digital literacy.
• All digital resources universally accessible.
• All Government documents/ certificates to be available on the Cloud.
• Availability of digital resources / services in Indian languages.
• Collaborative digital platforms for participative governance.
• Portability of all entitlements for individuals through the Cloud.

Scope of Digital India

The overall scope of this programme is

1. To prepare India for a knowledge future.
2. On being transformative that is to realize IT (Indian Talent) + IT (Information Technology) = IT (India Tomorrow).
3. Making technology central to enabling change.
4. On being an Umbrella Programme – covering many departments.
• The programme weaves together a large number of ideas and thoughts into a single, comprehensive vision, so that each of them is seen as part of a larger goal. Each individual element stands on its own, but is also part of the larger picture.
• The weaving together makes the Mission transformative in totality.
5. The Digital India Programme will pull together many existing schemes which would be restructured and re-focused and implemented in a synchronized manner. The common branding of the programmes as Digital India, highlights their transformative impact.

Nine pillars of Digital India

Digital India aims to provide the much needed thrust to the nine pillars of growth areas, namely

1. Broadband Highways
2. Universal Access to Mobile Connectivity
3. Public Internet Access Programme
4. e-Governance: Reforming Government through Technology
5. e-Kranti - Electronic Delivery of Services
6. Information for All
7. Electronics Manufacturing
8. IT for Jobs
9. Early Harvest Programmes