Health Sector In India

IMMUNIZATION

Purpose

To control vaccine preventable diseases with special focus on reducing IMR as infants are most vulnerable to fatal vaccine preventable diseases

Challenges of Immunization

1. Voluntary Exclusion
   1. Injection Fear
   2. Religious and cultural impediments: Low rates of vaccination among Muslim communities have led to significant outbreak of diphtheria in Kerala and Andhra Pradesh.
   3. Accessibility issue
2. Inefficient cold storage mechanisms
3. Lack of human resource expertise to administer injections
4. Duplication in coverage data

Addressing Challenges

• Generating Awareness: The citizens need to be made aware of the benefits of immunization to overcome the cultural, behavioural and religious hurdles that currently hinder its efficient expedition. Communities need to start appreciating immunization as their fundamental health right rather than as government agenda thrust upon them
• Use of Technology in Vaccine Delivery: India needs to replace antiquated logistics and temperature monitoring systems with available modern technologies for efficient vaccine delivery. The e-VIN (Electronic Vaccine Intelligence Network) is an indigenous technology that digitizes vaccine stock and monitors the temperature of cold chain through smart phone applications.
• Participation of CSOs and private organizations for increased effectiveness of delivery systems
  • Bill and Melinda Gates Foundation has signed an MoU with the U.P government to provide technical, managerial and design assistance in intensifying its vaccination programmes for Japanese Encephalitis and Cerebral Fever
• Stepping up Research & Development: Newer technologies and vaccines that lower dosage, number of dosages, reduce wastage and enhance vaccines are required to stimulate best response particularly in small children
• Addressing HR deficiency: Robust training, management and knowledge sharing structures are required for effective implementation of immunization programme.

India’s fight against Polio

India declared itself polio free in 2014 and WHO recognized the same in 2015

Features of India’s Polio campaign

• Mass awareness generation targeted at mother and children through schools and media
• Effective participation of international organizations- UNICEF, WHO
• Specific targeting for migrant population
• Continuous research and development enabling usage OPV and IPV (Inactivated Polio Vaccine – Inactivated with formalin) where lesser doses are required although gut immunity is not addressed in IPV

Current Scenario

Import Threat of Polio: Although India and South-east Asia are currently free of polio, Afghanistan and Pakistan still have cases which may be exported to India. Hence India continues with its OPV campaigns across the country immunizing the new born

From the vaccine itself: Polio can spread through the excreta of children who have been administered the OPV by the way of vaccine derived poliovirus (VDPV). VDPV can cause outbreaks among unimmunized population.

Way Forward

Replace OPV with IPV: IPV does not cause VDPV but protects children equally well from polio

Mission Indradhanush – Ministry of Health and Family Welfare

A nationwide immunization programme aimed at universal immunization of children for vaccine-preventable diseases including Diphtheria, TB, Polio, Measles, Rubella, Rotavirus, Japanese Encephalitis, Hepatitis B, Tetanus, Whooping Cough, Pneumonia through intensive efforts and special immunization drives

Target of the Scheme: Universal Immunization by 2020

Benefits of the Mission

• Enhance immunity of children to fatal diseases thus enabling reduction in IMR and child mortality rates
• Particularly beneficial to children in vulnerable sections of society in families which are exposed to frailties of diseases due to lack of sanitation and hygiene
• Impetus to neo natal and maternal health care services
• Disease free childhood enables better holistic development of children
• Enables job creation and subsequent empowerment for ASHA workers and auxiliary nurse and midwifes (ANMs) engaged in mobilization, tracking, monitoring and administering immunization respectively
• Generates greater awareness among parents especially among mothers regarding benefits of immunization and preventive healthcare
• Takes into account migrant children and ensures they are also immunized

DRINKING WATER

Introduction:

                NITI Aayog in its Composite Water Management Index Report sites that India is facing its worst water crisis in its history and asserts that the demand of water will outstrip supply come 2030 if adequate steps are not taken. Such is the urgency water conservation requires in our country.

Why India is water-stressed?

• High population and Demand: Large quantities of water are required to meet domestic as well as industrial demands. The problem is even more visible in urban areas where there is a high population density causing greater burden on scarce water resources making it difficult for civic bodies to supply requisite amounts equitably
• Non-Scientific and Water Inefficient Irrigation Practices: In many parts of the country, irrigation is performed using flood irrigation technique which is a highly water inefficient and low productive method. Further leakage across irrigation canals also lead to water loss. Hence there is a need to promote and provide micro-irrigation facilities to yield dual benefits of increased productivity and water efficient irrigation under PMKSY
• Ground Water Depletion: The surface run off in many regions is not captured in aquifers leading to drainage loss while tube well irrigation has heightened the pressure on ground water resources. Mining has also led to contamination of ground water which necessitates ground water acquirement from greater depth.
  • According to Composite Water Management Index Report of NITI Aayog, 21 cities will run out of ground water by 2020
• Water Pollution: Wetland encroachments and discharge of industrial effluents have led to contamination of fresh water resources rendering it unfit for human consumption and domestic usages.
• Culture of Wastage: Efficient usage of water has been not practiced adequately in families, institutions and other regions imbibing a culture of water wastage. This behavioural issue needs to be addressed through novel methods like water pricing which would put a price on water and promote its judicious and efficient use.
• Climatic Variations: Indian agriculture and water supply remains dependent on the monsoon bounty which may or may not produce requisite amount of rainfall

National Water Policy, 2012

• Judicious Usage of water: Shift from flood irrigation techniques to micro irrigation techniques promoting efficient usage of water and increased productivity
• Incentivizing Conservation: Water Pricing to be introduced to promote judicious use of water, ensure its equitable distribution for drinking, irrigation, industrial and other purposes and enhance accountability of unscrupulous waste of water resources
• Institutional Mechanism: Establish National Water Board as implementing agency
• Bridge Water Divide: Efficient sanitation practices with special focus to bridge supply gap in rural and urban areas to provide adequate water supply for sanitation facilities and improve sewerage facilities in rural areas the importance of which is elevated in background of the objective of achieving ODF rural areas as a part of SBA(Gramin)
• Private Sector Participation: Address the issue of demand supply mismatch in populous urban areas through system strengthening and strategic engagement leveraging support of private entities through blue bonds enabling financing of municipal water infrastructure facilities. In water-rich east and northeast regions, special focus needs to be given on infrastructure facilities in the interest of food security
• Recovery of Water: Direct use of rainfall, desalination and avoidance of inadvertent evapotranspiration are additional strategies for augmenting utilizable water resources
• Community Level Participation: Mapping aquifers using community-level participation to improve groundwater quality and quantum. Enhance capability and resilience of communities to deal with climate vagaries which are likely to increase the variability of water resources
• Inter-Linking of Rivers: Calls on states for considering inter linking of river basins after adequate environmental, social and economic assessment

National Rural Drinking Water Programme – Swachch Bharat Abhiyan (Gramin)

Aim: Ensure availability and accessibility of water of minimal quality standards at all times to every rural person for the purpose of cooking, drinking and other domestic needs

Components

• Coverage through the piped water supply, hand pumps
• Sustainability through source diversification and stabilization
• Assured Quality
• DDP areas
• Natural Calamity
• Establishment of Support System

Features of the Programme

• Piped Water Supply: Emphasis on provision of piped water supply in rural habitations in targeted areas of Assam, U.P, Bihar and Jharkhand to reduce drudgery and time taken for transportation of water
• Sustainable functioning of rural water supply systems through adoption of O&M methods for better working and to control leakages
• Desert Development Programmes: Special focus on arid regions through desert development programmes targeted at 21 districts across 5 states
• Community Level Participation: Devolution of responsibility and O&M affairs to Panchayati Raj institutions enabling community level participation
• Promoting irrigation efficiency: To avoid over exploitation of ground water resources which can be a good source for drinking water

Fund Allocation

                Recently the Union government has restructured the NRDWP to improve flexibility, result orientation and competition between states. The States will now on be allotted funds for the second instalment based on their performance so far. Hence states are expected to ramp up their efforts in order to avail for central assistance.

Water Pricing

Water pricing seeks to peg usage of quantum of water resources at differential prices increasing accountability on the consumer thus enabling reduced wastage in lieu of financial disincentive. It aims to promote judicious and efficient usage of water to enable equitable distribution of water for domestic, industrial, agricultural and all other purposes.

Benefits of Water Pricing

• Helps to overcome the behavioural issue of wastage of water by providing financial incentives for promoting efficient usage of water resources
• Increases accountability on the consumer thus reduces consumption levels relieving pressure on ground water resources
• Incentivizes farmers to shift from flood irrigation techniques to micro irrigation techniques enabling efficient usage of water
• Incentivize farmers to shift from water-intensive crops to dry crops helping to correct the vagaries of the current faulty MSP policy and address the issue of skewed production of wheat and rice which makes India a virtual exporter of water
• Incentivizes consumers to turn to alternative forms of water supply like rainwater harvesting reducing financial and resource burden on civic bodies at the same time encouraging community-level participation
• Helps to address the asymmetrical distribution of water resources between rural and urban areas by discouraging unscrupulous consumption in urban households and industries

Challenges

• Water pricing requires adequate safeguards to vulnerable sections of the population who may have less purchasing power compared to other sections.
• Special considerations need to be maintained for entitlement of marginal and small scale farmers especially in water-deficient regions of the country
• Arriving at a consensus on the price considering the vast geographical and regional disparities in water availability and distribution
• Shifting to water policy regime requires correction of faulty public procurement policy which promote skewed production of water-intensive crops
• Financial burden on citizens for access to a basic necessity
• Government does not have control on water resources like it does in case of other natural resources
• Constitutional barrier of Article 21 ensuring right to water for all individuals as a part of right to life

Implementation Ideas

• Targeted focus on irrigation as it accounts for 78% of water usage in India
• Surface water usage needs to be monitored through net metering and appropriately priced
• Ground water consumption is priced through proxies – monetary equivalent of diesel or electricity used to draw ground water
• Separation of electric feeders for agricultural and non-agricultural purposes already a focus under DDUGJY

Read Also RTI Act and  judiciary

Ground Water Bill, 2017

• The legitimacy of uncontrolled groundwater leverage for landowners has led to the current situation of depleted ground water resources
• The new bill specifies the need for decentralised control to give regulatory control to local users and the necessity to protect at the aquifer level
• Recognizes the fundamental right to water and places in protection principles
• The bill would help to improve sharing of resources that is beneficial to the larger majority than to a resource rich few