Avoid Indiscriminate Use of #Urea

Constant decline in soil fertility status, mainly due to nutrient removal by intensive cropping systems in amounts far-exceeding their replenishment through fertilizers and manures during past few decades, is considered one of the serious second-generation problems of Green Revolution.  Farmers often use nitrogenous fertilizers (mostly urea) or nitrogenous and complex fertilizers (mostly urea and DAP), ignoring the application of potash and other deficient nutrients. 

On the other hand, multi-nutrient deficiencies have already emerged and expanded in most of the soils. Soil analysis under different projects revealed widespread deficiency of at least six nutrients viz., Nitrogen (N), Phosphorus (P), Potash (K), Sulphur (S), Zinc (Zn) and Boron (B) in different parts of the country.  Some diagnostic surveys carried out in rice-wheat growing areas of north-western India revealed that farmers often apply greater than recommended rates of N to sustain the yield levels that were attained earlier with even less fertilizer use. 

Urea, being most common N fertilizer, is indiscriminately used irrespective of scientific prescriptions.  Excessive use of urea leads to several adverse implications on soil, crop quality and overall ecosystem.  Some major disadvantages of excessive/indiscriminate use of urea are listed as under:

It enhances mining of soil nutrients that are not applied or applied inadequately, thus leading to deterioration of soil fertility.   Such soils may require more fertilizers over time to produce optimum yields. 

Nitrogen applied in excess of crop demand is lost through volatilization, denitrification and leaching.

Excessive use of N (urea) encourages climate change (when lost through denitrification) and groundwater pollution (when lost through leaching).  Increase in nitrate content of groundwater in some intensively-cropped areas has been reported, which is obviously due to leaching of nitrates beyond crop root zone.  Increase in nitrate content of groundwater is potentially harmful, as it is used for drinking purposes in most of the rural areas.

Fertilizer N (urea) application beyond recommended rates enhances crop succulence, thus making the plants prone to disease and pest infestation, and to lodging.

Unbalanced use of urea decreases N use efficiency, thus leads to increase in cost of production and lowering of net profits.

For increasing use efficiency of N and other nutrients, profitability and environmental safety, fertilizer N (urea) application needs to be rationalized.  A few guidelines for rational use of N fertilizers are indicated below:

Fertilizer N (urea) application should be invariably balanced not only with P and K but also with deficient secondary and micronutrients.

Soil test-based fertilizer prescriptions have to be adopted.  Farmers should insist for S and micronutrient testing, as NPK alone (without S and micronutrients) is no longer balanced fertilizer prescription.

Neem oil coated urea should be preferred over pilled urea, especially for basal dressing. 

Losses of N are usually less when urea is top-dressed before irrigation.

Modified N scheduling using leaf color chart (LCC) gives better N use efficiency in crops.  LCC-based real-time N application needs to be promoted in the crops (like rice and wheat) for which LCC thresholds are available.

Conjoint use of organic manures and fertilizers may help curtailing the application of fertilizers including that of urea.

Inclusion of legumes may curtail fertilizer N (urea) requirement by 25-50%. Depending on cropping system and availability of irrigation, legumes could be introduced as catch crop, green manures, forage crop, break crop or as short duration grain crop.

#InsuranceReform – A Game Changer

Insurance industry in India is a $250 billion industry, equivalent to four-fifth of the country’s foreign exchange reserves. But its growth has been hampered because of the unusual delay in the passage of Insurance amendment bill, which 10 years after it was conceived was passed by Parliament recently.

Life insurance has potential to grow at 12 per cent annually and general insurance by 22 per cent in the next ten years as insurance penetration is one of the lowest in the world. But what was standing in the way was infusion of fresh capital, particularly foreign, which was possible only if the foreign direct investment cap is raised. The Insurance amendment bill has precisely done that by raising the FDI cap to 49 per cent from the present 26 per cent.

The last few years have been challenging for the industry with declining growth in life insurance premiums and significant challenges in non-life profitability. This was driven by a combination of macro-economic factors and structural challenges inherent in the insurance industry. Confederation of Indian Industry is of the view that this can be reversed by concerted action by industry players. The Insurance amendment bill also brings in regulatory reforms.

A CII report prepared in partnership with global consultancy firm McKinsey says the Insurance industry in India is at an inflexion point in its development. With Government’s reformative drive and resolve, the industry can jointly achieve the vision of building a customer centric and value-creating industry over the next decade. The inclusive growth will enable India to become a global top 10 insurance market with a total Gross Written Premium size of $250 billion.

India had very poor penetration of life insurance cover accounting for less than one per cent of population. With the opening up of the sector to private players and foreign direct investment up to 26 per cent in the late 1990s, the life insurance cover has more than trebled to 3.7 per cent of the population by 2012. With FDI cap being raised up to 49 per cent now, the life insurance cover will nearly double to 6 per cent of population in the next five years and to more than 10 per cent by 2025. It is also not true to say that state-owned Life Insurance Corporation of India’s growth has been stunted with the opening up. In fact opening up has helped LIC as new technologies and methods have come into the sector now and competition had made the state owned organization more aggressive. LIC’s annual premium on life insurance has increased from Rs 19,000 crore at the turn of the century to 3.64 lakh crore by 2012

To achieve the targets set for next five years, India needs nearly Rs 50,000 crore of additional capital in the sector, of which nearly half would have to come by way of foreign investment.

The Life Insurance industry has around 380 million policies in force and pays claims for around 12 per cent of the total deaths in the country. It has a critical role given the limited social security avenues available and has also played a crucial role in inculcating the savings habit among a large mass of the population which has limited access to other forms of savings, the CII study says.

Over the last five decades, the industry has developed significantly on dimensions related to access, efficiency and structure. However, much of the gains of the first 10 years of insurance sector liberalisation have been wiped out in the past 4 years as the industry has been impacted significantly by macro-economic, regulatory and internal structural challenges. The industry is at the crossroads today, with a real risk of losing its relevance if the status quo continues. The insurance reform bill has therefore come at an appropriate time.

Take for instance health insurance cover. The amount of money individuals spent on medical treatment totaled to around Rs 3 lakh crore annually in India, of which only Rs 20,000 crore is through insurance cover. The rest Rs 2.8 lakh crore is spent on medical treatment particularly by the poor and lower middle class through their hard-earned savings or borrowing at high cost or by selling family silver. The general insurance cover, of which health and motor vehicle insurance formed part of it accounted for only 0.7 per cent of the population. It is expected to double to nearly 2 percent in the next five years. With life and general insurance cover doubling in the next five to 10 years more than 700 million lives can be covered providing much needed social safety net hitherto not available to vast majority of the population. With Jan-Dhan Yojana, which has a mandatory accident insurance cover, can help in insurance penetration. Crop insurance is yet another area where there is a lot of potential.

The General Insurance industry has witnessed a strong performance with 18 per cent growth between 2005 and 2014 and is now a $13 billion industry breaking into the top 20 industry globally. It currently provides cover of more than $ 17,000 billion.

But home insurance penetration is less than 1 per cent; there is significant under-insurance in segments such as two-wheelers and personal health; corporate (property and indemnity), SME and rural risk coverage are substantially lower than global benchmarks. These are areas in which there could be significant growth in the next 5-10 years.

The government sponsored Rashtriya Swasthya Bima Yojana (RSBY) provides coverage to the population below the poverty line. The health insurance cover provided to poor in Tamil Nadu has worked wonders. It has not only helped poor get treatment but also helped government earn money through insurance claim. The Tamil Nadu government’s popular health card scheme that provided insurance up to 2 lakh per family or individual has helped General Hospital in Chennai alone earn Rs 18 crore last year by way insurance claim for treatment of poor people covered under the scheme. This scheme could win-win for both government and poor people. 

The government has recently announced that it would promote universal health coverage. There are several learnings from other markets as well. In Brazil 40 per cent of the spending on health is through health insurance unlike in India where it is just 6-7 per cent. Health insurance has potential to penetrate to more than 75 per cent of 1.2 billion population in the country.

The Insurance Amendment Bill, passed by parliament also safeguards Indian ownership and control and provided Insurance regulator, Insurance Regulatory and Development Authority of India (IRDA) flexibility to discharge its functions more effectively and efficiently. The Bill amends the Insurance Act, 1938, the General Insurance Business (Nationalization) Act, 1972 and the Insurance Regulatory and Development Authority (IRDA) Act, 1999.

The amended law, which replaces an ordinance enacted in December 2014, also enables foreign reinsurers to set up branches in India including top global re-insurance company Llyods.

It is not India alone opening up its insurance sector. Many countries allow foreign direct investment in the insurance sector as domestic companies do not have the wherewithal or resourced to meet insurance requirement of the entire population. Also reinsurance is critical for sharing the risk cover involving billions of dollars in the event of natural calamities and large accidents.  In US, UK, Japan, France and Germany, FDI up to 100 per cent is allowed in the sector. Even in China up to 50 per cent FDI is allowed. In case of Indonesia it is 80 per cent and Malaysia, it is 51 per cent. Even after the opening up only up to 49 per cent FDI is allowed in India.

Apart from deepening penetration, the opening up of insurance and pension sector helps Indian government and companies to access long-term funding for infrastructure projects, which require investment up to $1 trillion in the next five years.  Only pension and insurance funds can provide long-term capital of 10-30 years duration as only they have access to such long term deposits. Unfortunately in India commercial banks fund infrastructure projects because access to long-term capital is now limited. Banks by nature get deposits short-to-medium term and hence lend short-to-medium term. Now by lending long term, banks in India have asset-liability mis-match. Access to pension and insurance funds will make it easier for long term funding of infra projects. Foreign insurance players operating in India will now provide access to pension and insurance funds of their parent companies. The US and Canadian pension and insurance funds are waiting to invest their huge capital in countries like India this insurance reform will pave the way.

#‎ukpcs2012mainstestseries‬

Amnesty International human rights award 2015

Amnesty International has given its top 2015 human rights award to both Chinese dissident artist Ai Weiwei, a fierce critic of Beijing, who has been banned from leaving China after an 81-day detention in 2011, and U.S. folksinger Joan Baez.

The Ambassador of Conscience Award recognises "those who have shown exceptional leadership in the fight for human rights, through their life and work", Amnesty said in a statement on Tuesday.

Previous winners include Pakistani teenager Malala Yousafzai, Nelson Mandela and Myanmar's opposition leader Aung San Suu Kyi.

"Through his work Ai Weiwei reminds us that the right of every individual to express their self must be protected, not just for the sake of society, but also for art and humanity," said Salil Shetty, Amnesty's Secretary-General, in the statement.

Mr. Shetty said of Mr. Baez: "With her mesmerising voice and unwavering commitment to peaceful protest and human rights for all, Joan Baez has been a formidable force for good over more than five decades".

The joint award will be presented at a ceremony in Berlin on May 21, the statement said.

But it is almost certain that Mr. Ai, 57, will not be able to collect it as he remains under close surveillance and is unable to leave China.

In 2011, Mr. Ai was detained without any charge and held mainly in solitary confinement, sparking an international outcry. A court later upheld a $2.4 million fine against Ai for tax evasion.

The world-renowned artist maintains the charges were trumped up in retaliation for his criticism of the government.

Lee Kuan Yew passed away

First Prime Minister (PM) of Singapore Lee Kuan Yew passed away on 23 March 2015. He was 91.

Mr. Lee is described as the ‘founding father’ and ‘architect’ of modern Singapore. He is also considered as pioneer for transforming the island country from a small port city into a wealthy global hub after its independence from United Kingdom and separation from Malaysia.

About Lee Kuan Yew

• He was born in Singapore on 16 September 1923 as a British subject.
• Lee Kuan Yew had studied law at Cambridge University and had graduated with double First Class Honours.
• In 1954, Mr. Lee co-founded the People’s Action Party (PAP) and was its first Secretary-General. He had led the party to eight victories from 1959 to 1990. 
• He was elected as First Prime Minister of Singapore in 1959. Since then he had served as PM of country for 31 years and had stepped down in 1990. He also had overseen the separation of Singapore from Malaysia in 1965.

Section 66 A of IT Act unconstitutional and untenable: Supreme Court

The Supreme Court (SC) on 24 March 2015 struck down the Section 66A of the Information and Technology Act 2000 calling it unconstitutional and untenable.

SC in its ruling held that Section 66A interferes with freedom of speech and expression envisaged under Article 19 of Constitution of India and also hit the root of two cardinal pillars of democracy liberty and freedom of expression.

This verdict was given by SC bench comprising of Justices J. Chelameswar and R.F. Nariman on bunch of petitions filed in the wake of misuse of the penal provision by government authorities.

Supreme Court held that

• Section 66 A is unconstitutional because it failed two major tests, the clear and present danger test and the tendency to create public disorder test.
• Language used in this section is vague and nebulous does not properly define words like offensive or even persistent.

SC also rejected the assurance given by NDA government during the hearing defending certain procedures of the law so it cannot be question and abused.

However in this ruling SC did not strike down two other provisions in sections 69A and 79 of the IT Act and mentioned that they can remain enforced with certain restrictions.

Background

• The first petition in this regard was filed in 2012 by a law student Shreya Singhal who had challenged the Section after two young women were arrested for posting comments Facebook in Thane district.
• In the comments they had criticized shutdown in Mumbai following Shiv Sena leader Bal Thackray’s death.

About Section 66A of IT Act 2000

• It gives power to government authorities to issue directions to block public access of any information through any computer resource.
• It also allows authorities to arrest a person for posting allegedly offensive content on websites and imprisonment for a term which may extend to three years and with fine

RNTCP is the Largest and Fastest Growing Public Health Program in the World Today

Tuberculosis continues to be major public health problem throughout the world, more so in developing countries and India in particular. India has the largest number of cases of TB and around one-fourth of the world TB cases are in India. Every year there are approximately two million (2.2 million) new cases of TB (incidence) occur in the country.  To tackle this problem, Govt. of India introduced and launched the Revised National TB control Programme or RNTCP in 1992-93 replacing the earlier NTP, and this is now the largest and fastest growing public Health Program not only in India but also in the world today.  

RNTPC

The goals of RNTCP are to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India. The objectives are to achieve and maintain a case detection of at least 70% of new sputum positive TB patients and to achieve and maintain a cure rate of at least 85% in newly detected smear positive cases. Further, the program has made its national strategic plan (2012-17) with new goals to decrease mortality and morbidity due to TB and stop transmission of infection until TB ceases to be a major public health problem in India in line with the Millennium Development Goals and Stop-TB partnership targets. The new objectives are to achieve 90% notification rate for all forms to TB cases, to achieve 90% success rate for all new and 85% for re-treatment cases, to significantly improve the successful outcomes of treatment of Drug Resistant TB Cases, to achieve decreased morbidity & mortality of HIV associated TB and to improve outcomes of TB care in the private sector.

DOTS

The basic strategy is DOTS (Directly Observed treatment – short course) through which treatment completion is ensured. Diagnosis and treatment is provided free of cost to all individuals. The program operates through 3644 Tuberculosis Units (TUs) and 13,306 designated microscopy centres (DMCs) throughout the country. So far under the programme, and  since implementation  > 60 million TB suspects have been examined,  > 17 million patients have been  placed on treatment and  > 3 million  lives have been saved. India’s TB control programme is on track as far as reduction in disease burden is concerned. There is 42% reduction in TB mortality rate by 2012 as compared to 1990 level. Similarly there is 51% reduction in TB prevalence rate by 2012 as compared to 1990 level.

ACSM

 The program has a well-defined ACSM (Advocacy, communication, and social mobilization) strategy based on Communication needs, Target Groups and Communication tools/Media options to reach target groups. Roles and responsibilities are defined at the central, state and district level. The ACSM strategy is modified for addressing newer initiatives like MDR- TB and TB HIV co-infection and is supported under the project Axshaya wherein 374 districts in 23 states are involved.

TB-HIV

Other strategies of RNTCP include TB-HIV management in collaboration with NACO. It is a well-known fact that TB is more common in HIV cases and is one of the most common causes of infection and mortality. TB patients are regularly tested for HIV and vice versa. Patient with this dual infection receive co-trimoxazole chemoprophylaxis. Both anti-TB drugs as well as antiretroviral drug therapy are given to patients with both infections and disease.    CB-NAAT (Cartridge-based nucleic acid amplification) test is done in priority basis to detect TB   in Presumptive TB cases among People living with HIV / AIDS in all CB-NAAT sites. Pilot projects are operating in 30 sites in five high burden states (Tamilnadu, Karnataka, Telengana, Andhra Pradesh and Maharashtra).

Paediatric TB

Paediatric tuberculosis is also covered by the program which is unique in the world. About 6-7% of all TB cases occur in children as per the program reports.  Revised Paediatric TB Guidelines have been released, wherein a  newer diagnostic algorithm was developed with newer six weight bands are available according to the weight of the child, there is provision for flexibility in extending intensive and continuation phase for selected conditions, also increased dose for INH chemoprophylaxis is given to these cases. Drug resistant TB in children has some inherent problems like difficult to diagnose, getting an appropriate sample for testing, and clinical diagnosis predominates without laboratory confirmation. Treatment in these situations is challenging. Paediatric formulations of treating these MDR-TB cases in children are not available in the market. Administering drugs by crushing & breaking to meet body weight requirements affects bio-availability. Monitoring progress on treatment is also difficult. Malnutrition, co-morbidity, adverse drug reactions adds on to the challenge of treatment adherence. Also there are other issues like availability of expertise to manage paediatric MDR TB is limited. Some of the initiatives taken are the establishment of CB NAAT labs at Delhi, Chennai, Kolkata and Hyderabad, identification of key hospitals and private clinics catering to pediatric populations and establish referral network for pediatric, identification of Engaging more number of pediatricians for referrals and sensitization meeting for identified key personnel.

Urban TB Control

Although RNTCP is being implemented in every part of country either through the State government or through the local self- government wherever there is a separate health system in corporations, focus is given for urban TB control. Exclusive resources for urban areas included in RNTCP in terms of TB health visitors for every 1 lakh aggregate urban population, additional funding norms in ACSM in urban areas, Urban / pubic private mix Coordinators, NGO/Private Practitioner (PP) schemes are specially oriented with urban areas. These provisions are made because there are inadequate diagnostics, insufficient treatment facilities, enormous, unregulated, distinctly divided private sector, intense transmission due to congregate settings/poor Airborne Infection control (AIC) measures and poor TB risk perception and inadequate efforts for advocacy and social mobilization. Through themission mode Slum TB Control, there are provisions for identification of high risk wards, line listing of all health care providers segregated by AYUSH and others, house to house survey for active case finding and training of all health care providers in Standards for TB care in India.

Drug-resistant TB (DR-TB)

India is world’s highest MDR-TB burden country with 64,000 cases emerging annually in notified Pulmonary TB cases. To get an exact picture national drug resistance survey underway since July 2014. Diagnosis and treatment of MDR TB and XDR TB (Extensively drug resistant TB) are difficult, costly, takes minimum of 2 years of treatment and the drugs have a lot of side effects. The program manages these cases through PMDT (Programmatic management of Drug resistant TB).  The program (earlier known as DOTS-PLUS) was started in July 2007 and is now available throughout the country. Under this all investigations and treatment are provided free. At present the country has 58 Culture and Drug Susceptibility Testing (DST) Laboratories.  There are 122 DR-TB Centers mainly in Medical Colleges and other larger hospitals. There are 50 Linked DR-TB Centers and 89 CB-NAAT (X’pert) Sites to give quick diagnosis within 2 hours. So far over 15, 000 cases of MDR TB are undergoing treatment or are being treated.  Newer initiatives in this area include formation of Expert Committee on Regulation of newer anti-TB drug e.g. bedaquiline study, counselling project to enhance treatment adherence among DR-TB patients and piloting of DST Guided Treatment in selected districts. 

Others

The cases are now registered through Nikshay, a case Based Web Based recording and reporting system. TB now is a notifiable disease under Government notification and the Govt. of India has banned the use of serology in the diagnosis of TB. The program is trying to bring all private sectors through case notification, persuading the private sector to follow standardized treatment guidelines.

Medical college faculty, who are academicians are seldom directly involved in the implementation of national public health programmes. More than a decade ago for the first time in the global history of tuberculosis (TB) control, medical colleges of India are involved in the Revised National TB Control Programme (RNTCP) of Government of India (GOI). Till the time involvement of medical colleges in the RNTCP was conceived, the interaction between the academicians in the medical colleges and the Programme managers was sparse and on many occasions discordant. The young doctors in training seldom got an opportunity to practice what was preached to them. As a result, the facilities available under the RNTCP were seldom utilized to the full extent possible. Keeping in mind the needs of the country, a future “5-Star” doctor who would take up the responsibilities as a care provider, decision maker, communicator, community leader, and a manager was visualized and such a future doctor would not only serve the patients and the community but would also gain their respect.

A substantial proportion of patients with TB are managed at medical colleges across the country. From the TB control point of view, medical colleges, in both the government and private sectors are recognized to occupy a key position with a unique potential for involvement with the RNTCP. To widen access and improving the quality of TB services, involvement of medical colleges and their hospitals is of paramount importance. Being tertiary care medical centres, large numbers of patients seek care from the medical colleges. In addition, the role of medical college faculty in TB control as key opinion leaders and role models for practicing physicians and as teachers imparting knowledge, skills and shaping the attitude of medical students cannot be underestimated. There is a pressing need for all medical colleges to advocate and practice DOTS strategy which provides the best opportunity for cure of TB patients. In addition, medical colleges have the diagnostic facilities for extra-pulmonary TB (EPTB), human immunodeficiency virus (HIV)-TB co-infection, multidrug-resistant TB and extensively drug-resistant TB (M/XDR-TB). Recognizing the potential of involving medical colleges in TB control a decade ago, the RNTCP of GOI, for the first time in the world conceived and implemented the unique experiment of involving the academicians who constitute the faculty in the public health programme for TB control. A mechanism of National, Zonal and State level Task Forces was conceived for the involvement of medical colleges, wherein the sole responsibility of participation of medical colleges in DOTS strategy lies with the faculty of medical colleges, which perhaps made them more responsive.

The involvement of medical colleges in TB control envisaged and successfully implemented by the RNTCP for more than a decade in India is an extraordinary effort. The Task Force mechanism has entrusted the responsibility to medical colleges to ensure their effective contribution to the efforts of GOI in TB control. The successful amalgamation of the public health approach and the expertise of academicians has immensely benefited the RNTCP and TB control in India and facilitated the emergence of the “future doctor” from among the medical students.

# March 24^th is World Tuberculosis Day