Government Scheme

LaQshya & its Significance | UPSC – IAS

“LaQshya” (Labour room Quality improvement Initiative) programme of the Ministry of Health and Family Welfare which is Intended to Improve the Quality of care in labour Rooms & Maternity Operation Theatres in

• Government Medical College Hospitals,
• District Hospitals,
• Sub-district Hospitals and
• other high caseload health facilities.
• Designated FRUs and high case load CHCs with over 100 deliveries/month ( 60 in hills and desert areas)

Under the laQshya initiative, States are urged to undertake concerted efforts in a campaign mode to ensure that respectful and high quality maternal care is provided to each woman during delivery and immediate Postpartum. It would essentially entail undertaking several actions simultaneously at different levels –

• National,
• States, Districts and
• Health Facilities.

It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 40% newborn deaths take place on the day of the delivery.

It aims to give qualitative care to the pregnant mother in the Labour Room to minimize the risks associated with childbirth.

Objectives of LaQshya | UPSC – IAS

• To reduce maternal and newborn mortality & morbidity due to hemorrhage, retained placenta, preterm, obstructed labour, newborn sepsis, etc.
• To improve Quality of care during the delivery and immediate postpartum care, stabilization of complications and ensure timely referrals, and enable an effective two-way follow-up system.
• To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facilities.

Quality certification of labour rooms Under LaQshya Initiative | UPSC – IAS

The achievement of quality benchmarks should be used for branding of the QoC at the health facility. This will give
sense of pride to the staff as well as provide confidence to the community that they are getting quality care at public hospitals. The departments may be provided badges (LaQshya Medal) based on the quality score, achieved in the state level assessment.

• Platinum Badge : Achieving more than 90% Score.
• Gold Badge : Achieving More than 80% Score.
• Silver Badge : Achieving more than 70% Score.

These badges should be worn by the care providers as well as prominently displayed at relevant places in the hospitals.

Goal of LaQshya | UPSC – IAS

• Reduce preventable maternal and newborn mortality,
• Morbidity and stillbirths associated with the care around delivery in Labour room and
• Maternity Operation Theatres and ensure respectful maternity care.

Strategies of LaQshya | UPSC – IAS

• Reorganizing/aligning Labour room & Maternity Operation Theatre layout and workflow as per ‘Labour Room Standardization Guidelines’ and ‘Maternal & Newborn Health Toolkit’ issued by the Ministry of Health & Family Welfare, Government of India.
• Ensuring that at least all government medical college hospitals and high caseload district hospitals have dedicated obstetric HDUs as per GoI MOHFW Guidelines, for managing complicated pregnancies that require life-saving critical care.
• Ensuring strict adherence to clinical protocols for management and stabilization of the complications before referral to higher centres.

E-Samiksha Portal | UPSC – IAS

E-SamikSha is a real time, on-line system for monitoring of follow-up action on the decisions taken during the presentations made by different Ministries/Departments to the Prime Minister

• E-Samiksha is an online monitoring and compliance mechanism developed by Cabinet secretariat with technical help from National Informatics Centre.
• It is used for tracking the progress on projects & policy initiatives and follow up actions of various ministries by cabinet secretary and Prime Minister on a real-time basis.
• Central government departments have been asked to work out specific targets to be achieved by 2022 which will be monitored by PM under e-Samiksha platform.

Significance of E-Samiksha Portal | UPSC – IAS

• With the usage of eSamikSha, system implementers have been able to bridge/Improve/Speed-up monitoring and compliance of a large number of action points, proposals, targets, issues etc.
• Reduction in service delivery time and clearing the pendency through single window interface.
• As most of the activities are online, system implementers have been able to do away with physical movements, which in turn results in saving of enormous amount of paper, travel cost and energy.
• E-SamikSha system has bolstered the ICT culture within the Government, paving way for file-less functioning.

Project Dhoop by Food Safety and Standards Authority | UPSC – IAS

It is a nationwide campaign launched by FSSAI along with NCERT, New Delhi Municipal Council and North MCD Schools to spread awareness about consumption of Vitamin D through natural sun light and consuming fortified food among school going children.

Vitamin D and its importance for the body

• Vitamin D is essential for the development of human bones. It facilitates absorption of calcium and phosphorus by intestines and their retention in the body and deposition in bones and teeth.
• When skin is exposed to sun, the cholesterol in the skin converts the cholesterol to Vitamin D via additional conversions in the liver and kidneys.
• The deficiency of Vitamin D can cause Rickets in children and Osteomalacia in adults, whereas acute deficiency could lead to brain, cardiovascular and kidney damage.
• Source of Vitamin D – Fish liver oil, egg yolk, milk, liver etc.

Eat Right India movement FSSAI | UPSC – IAS | Pib

The Food Safety and Standards Authority of India (FSSAI) recently organised the Swasth Bharat Yatra, a key element of the ‘Eat Right India Movement’.

What is Eat Right India movement ?

• It is multi-sectoral effort with primary focus on daily intake – of salt, sugar, fat, phasing-out trans-fats from diets and promoting healthier food options.
• It is built on two broad pillars of Eat Healthy and Eat Safe.

It brings together three ongoing initiatives of FSSAI that target citizens:

• The Safe and Nutritious Food (SNF) Initiative, focused on social and behavioral change around food safety and nutrition at home, school, workplace and on-the-go.
• The Eat Healthy Campaign focused on daily intake – of salt, sugar, fat, phasing-out trans-fats.
• Food fortification, focused on promoting five staple foods- wheat flour, rice, oil, milk and salt, with key vitamins and minerals added to improve their nutritional content.

It has seven broad areas of action | UPSC – IAS | Pib

• To increase demand for healthier food by influencing each other as role models, caregivers and peers,
• Set standards in schools, promote healthy eating habits and use food as a pedagogical tool,
• Have appropriate consumer friendly nutrition labelling and restriction on marketing to children through a suitable regulation,
• Have higher taxation for unhealthy food through differential GST rates,
• Ensure availability of healthier food options and guide consumers through appropriate menu labelling,
• Redesign choices available at points of sale with increased availability and prominent display of healthier options,
• Encourage food processing industry to formulate their food products by reducing unhealthy ingredients.

Under the movement, “Aaj se thoda kam campaign” was launched to encourage citizens to adopt healthy food habits through social media and mass media.

Leprosy in India Today | NLEP | UPSC – IAS | The Hindu

National leprosy Eradication Programme

Initial reports of Leprosy Case Detection Campaign of the National Leprosy Eradication Programme (NLEP) indicated an all-time high of nearly 50,000 new leprosy cases in Bihar.

Today’s scenario 2019

• India was officially declared to have eliminated leprosy in 2005 when new cases fell to less than 1 per 10,000, yet India still accounts for the largest number of leprosy affected people in the world (58 per cent).
• Indian research contributed to the development of Multi-Drug Therapy or MDT, now recommended by WHO, which led to the shortening of treatment and higher cure rates.
• In recent years, along with other countries, India has repealed legislation that discriminates against persons affected by leprosy.
  • In 2016, it repealed the draconian colonial-era Lepers Act and in January 2019 Lok Sabha passed a bill seeking to remove leprosy as a ground for divorce

What is Leprosy? | UPSC – IAS 

• Leprosy is a chronic infectious disease caused by Mycobacterium leprae and is highly contagious.
• The bacteria has a long incubation period. Once a person is infected, it can take 6-10 years or even 20 years for the first symptoms to surface.
• The disease mainly affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract and the eyes.
• It is curable and treatment provided in the early stages averts disability. Mycobacterium Indicus Pranii (MIP)
• It is an indigenous vaccine for leprosy developed by National Institute of Immunology.
• It is now being introduced into the National Leprosy Elimination Programme (NLEP).
• It will boost the immune system against the bacterial disease.

Challenges in eradicating leprosy | UPSC – IAS | The Hindu

• Antimicrobial resistance in leprosy: Global data shows that a total of 8% of the Mycobacterium leprae bacterial strains studied showed gene mutations conferring resistance towards drugs such as rifampicin, dapsone and ofloxacin.
• Non-adherence to drugs: Due to various reasons a significant number of patients become irregular and default from MDT.
• Issues with 2005 declaration of Leprosy elimination:
  • It led to the diversion of focus as both funding as well as resources declined and the frontline workers stopped making household visits to identify undetected cases, shifting instead to voluntary patient registration.
  • The dermatologists didn’t send patients for treatment, as the strong rhetoric of elimination made them believe leprosy is a disease of the past.
  • Neither funders nor young researchers are attracted to an officially eliminated disease, even if it is still ubiquitous.
• Stigma about leprosy: Fear of stigma, and the resulting discrimination, discourages individuals and their families from seeking the help they need.
• Lack of funding: Financial crunch in leprosy research and awareness campaigns leads to a shortfall in human reserves and trained medical professionals who can diagnose the disease correctly in its nascent stage.

Measures taken to eradicate Leprosy|UPSC – IAS | The Hindu

International Efforts

• Multidrug therapy, made available by WHO free of charge to all patients worldwide since 1995, provides a simple yet highly effective cure for all types of leprosy.
• In 2016, WHO launched The Global Leprosy Strategy 2016–2020: accelerating towards a leprosy-free world which aims to reinvigorate leprosy control efforts and avert disabilities, especially among children affected by the disease in endemic countries.

Government of India Initiatives (Govt Schemes for leprosy) | UPSC – IAS

• National Health Mission aims to reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts.
• Ayushman Bharat’s 1,50,000 Health and Wellness Centres across the country plan to screen all Indians for leprosy.
• Sparsh Leprosy Awareness Campaign aims at communicating the importance of early detection and treatment of leprosy.
• New preventive approaches like chemoprophylaxis and immunoprophylaxis are being considered to prevent transmission.
• 30th of January (Martyrdom Day of Mahatma Gandhi) was celebrated all over India as Anti Leprosy Day to spread public awareness about the disease.
• A Leprosy Case Detection Campaign was launched in 2016, involving house-to-house screening and referral of patients for diagnosis.
• 12th Five year plan had set out to achieve elimination of leprosy at the district level by 2017.

India’s National Leprosy Eradication Programme | UPSC – IAS

It is a centrally sponsored Health Scheme of the Ministry of Health and Family Welfare which aims to eradicate leprosy from India.

Strategies for Leprosy Elimination

• Decentralized integrated leprosy services through General Health Care system.
• Early detection & complete treatment of new leprosy cases.
• Carrying out house hold contact survey in detection of Multibacillary (MB) & child cases.
• Early diagnosis & prompt MDT, through routine and special efforts
• Involvement of Accredited Social Health Activists (ASHAs) in the detection & complete treatment of Leprosy cases for leprosy work
• Strengthening of Disability Prevention & Medical Rehabilitation (DPMR) services.
• Information, Education & Communication (IEC) activities in the community to improve self-reporting to Primary Health Centre (PHC) and reduction of stigma.
• Intensive monitoring and supervision at Primary Health Centre/Community Health Centre.

A Way forward | UPSC – IAS | PCS 

• Avoid shallow declarations: India remains a long way away from elimination at the state or district levels, let alone eradication. It is necessary to learn lessons and avoid creating an environment of complacency.
• Speedy implementation of the Health and Wellness Centres (HWC) initiative in the true spirit of comprehensive primary healthcare approach.
• Enhancing training of health-care providers: in communication and behaviour change skills, and by improving the patients’ access to quality care and friendly services.
• Adherence to MDT: can be improved by multiple initiatives that target the views and actions of patients, health-care workers, and society.
• Removal of stigma: Leprosy program managers should design positive health messages and use innovative media to appeal to and reach target groups to motivate leprosy patients to seek early treatment and the community to accept leprosy patients.
• Creating Livelihood Opportunities: Those who have been cured at an early stage and can work, should be given opportunities to learn skills and trades that would enable them to work.

Rashtriya Arogya Nidhi (ran) Scheme – India | UPSC – IAS | Pib

After withdrawing the National Policy for Treatment of Rare Diseases (NPTRD), the Minister of Health and Family Welfare has approved a proposal for adding a sub-component under the umbrella scheme of Rashtriya Arogya Nidhi (RAN) for provision of one-time financial assistance to those below threshold poverty line for specified rare diseases which require one-time treatment

About Rashtriya Arogya Nidhi | UPSC – IAS | Pib

• The RAN was set up to provide financial assistance to patients, living below poverty line and who are suffering from major life threatening diseases, to receive medical treatment at any of the super speciality Hospitals/Institutes or other Government hospitals.
• The financial assistance to such patients is released in the form of ‘one-time grant’, which is released to the Medical Superintendent of the Hospital in which the treatment has been/is being received.
• It has been set up as society registered under the Societies Registration Act, 1860.

 

An illustrative list of categories of treatment to be provided from the fund is as follows :

1.Cardiology& Cardiac Surgery:

1. Pacemakers

2. CRT/Biventricular pacemaker

3. Automatic Implantable Cardioverter defibrillator (AICD)

4. Combo devices

5. Diagnostic Cardiac Catheterization including Coronary Angiography

6. Interventional procedure including Angioplasty, Rota-ablation, Balloon Valvuloplasty e.g. PTMC, BPV etc.

7. ASD, VSD and PDA device closure

8. Peripheral Vascular Angioplasty, Carotid Angioplasty, Renal  Angioplasty

9. Coil Embolization and Vascular plugs

10. Stents including Drug Eluting Stents

11. Electrophysiological Studies (EPS) and Radio Frequency (RF) Ablation

12. Heart surgery for Congenital and Acquired conditions including C.A.B.G

13. Vascular Surgery

14. Cardiac Transplantation etc.

2. Cancer :

1. Radiation treatment of all kinds including Radiotherapy and Gamma Knife Surgery.
2. Anti-Cancer Chemotherapy supportive medication and antibiotic, Growth factor,
3. Bone Marrow Transplantation- Allogenic Or Autologous
4. Diagnostic Procedures- Flow cytometry/cytogenetics /IHC Tumour Markers etc.
5. Surgery for cancer patients
6. Catheters, central lines and venous access devices.

3.Urology/Nephrology/Gastroenterology :

1. Dialysis and its consumable (Both haemodialysis as well as Peritoneal)
2. Plasmapheresis in acute renal failure
3. Continuous renal replacement therapy in acute renal failure in ICU sick patient.
4. Vascular access consumables (Shunts, catheters) for Dialysis
5. Renal transplant-cost of renal transplant varies from 2.5 to 4.0 lakh Depending upon type of drug used as per patient need.
6. PCN and PCNL Kits
7. Lithotripsy ( for Stones)
8. Disposables & Stents for endoscopic surgical procedures in Urology & Gastroenterology.
9. Liver Transplantation and Surgery for portal hypertension.

 

4. Orthopedics:

1. Artificial prosthesis for limbs
2. Implants and total hip and knee replacement
3. External fixators
4. AO implants, used in the treatment of bone diseases and fractures
5. Spiral fixation Implant- Pedicle Screws (Traumatic, Paraplegic, Quadriplegic)
6. Implant for Fracture fixation (locking plates & modular)
7. Replacement Hip –Bipolar /fixed
8. Bone Substitutes

5.  Neurosurgery – Neurology :

1. Brain Tumors
2. Head injuries
3. Intracranial aneurysm
4. AVMs
5. Spinal tumors
6. Degenerative /Demyelinating diseases of brain/spinal cord
7. Stroke
8. Epilepsy
9. Movement disorders
10. Neurological infections

6.Endocrinology :

1. Hormonal replacement for lifelong therapy : –   Cases of complicated diabetes which require one time treatment e.g. amputation or renal transplant

–    Hypopituitarism

–    Hypothyroidism

–    GH deficiency

–    Cushing’s Syndrome

–    Adrenal insufficiency

–    Endocrine surgery

1.  Mental Illness :
2. Organic Psychosis acute and chronic
3. Functional psychosis including Schizophrenia, Bio-polar Disorders, delusional disorders and other acute polymorphic psychosis Severe OCD, Somatoform disorders, eating disorders
4. Developmental disorders including autism spectrum disorders and   Severe Behavioural disorders during childhood.

8. Drugs :

 

1. Immunosuppressive drugs
2. Anti D
3. Anti Haemophilic Globulin
4. Erythropoietin
5. Blood & Blood products/Plasma for patients of Burns
6. Liposomal Amphotericin
7. Peg Interferon
8. Ribavirin
9. CMV treatment (IV Ganciclovir, Valganciclovir)
10. Voriconazole
11. Anti-rejection treatment (ATG, OKT 3)
12. Treatment for Post –transplant viral infection
13. Any life supporting drugs.

9.  Investigations:

Ultrasound, Doppler studies, Radio-nucleotide scans, CT Scan, Mammography, Angiography for all organs, M.R.I, E.E.G, E.M.G, Urodynamic studies, Cardiac Imaging- Stress Thallium & PET, Cardiac MRI, Investigation for CMV, BK Virus, TMT, Echocardiography.

Psycho diagnostics, neuropsychological assessments, IQ assessments, blood tests like serum lithium and drug level of carbamazepine, valproate, phenytoin and any other similar medications : CSF studies screening for substances or abuse/toxicology.

10. Others :

 

1. Immunoglobulin for AIDP (GB Syndrome ) and Myasthenia Gravis.
2. Anti viral
3. Anti Fungal
4. Wilson disease : Penicillamine A
5. Botulinum A toxin injection for spasticity
6. Baclofen for spasticity

 

11. Miscellaneous :

Shunts for Hydrocephalus.

Particularly Vulnerable Tribal Groups (PVTGs) | UPSC – IAS

Particularly Vulnerable Tribal Groups (pvtg) –  (earlier it was –  Primitive Tribal Groups) was the category with in Scheduled Tribes created on recommendation of Dhebar commission.

• Presently there are 75 tribal groups categorized by Ministry of Home Affairs as Particularly Vulnerable Tribal Groups (pvtg)
• PVTGs reside in 18 States and UT of A&N Islands.
• The Central government is planning to reimpose Restricted Area Permit (RAP) in the North Sentinel island where an American was killed by members of the Sentinelese tribe.

Issues and News  | UPSC – IAS

Due to security reasons, certain areas have been declared as Protected Area/Restricted Areas where no foreigner can enter or stay without obtaining permit from the competent authorities.

• Under the Foreigners (Restricted) Areas Order, 1963, parts of Sikkim and entire Andaman & Nicobar Islands have been declared as `Restricted’ Areas.
• Under the Foreigners (Protected Areas) Order, 1958, all areas falling between the ‘Inner line’ and the International Border of the State have been declared as ‘Protected Areas’.
• Currently Protected Areas are located in- all of Arunachal Pradesh and Sikkim, parts of Himachal Pradesh, Jammu and Kashmir, Manipur, Mizoram, Nagaland, Rajasthan and Uttarakhand.
• The North Sentinel island is one of 29 islands for which government had relaxed the RAP in order to promote tourism and boost employment opportunities.

Tribes of Andaman & Nicobar | UPSC – IAS 

• There are 6 aboriginal tribes in Andaman & Nicobar islands belonging to two broad groups of Negrito and Mongoloid. Except Nicobarese (Mongoloid), the rest 5 are recognizes as Particularly Vulnerable Tribal Groups (PVTGs) i.e. Sentinelese (Negrito), Great Andamanese (Negrito), Ongs (Negrito), Jarawas (Negrito) and Shom Pens (Mongoloid).
• Sentinelese: They the only remaining tribe in the Andamans to still maintain their isolation from the rest of the world and live like hunter gatherers.
  • o They are connected to the Jarawa on the basis of physical, as well as linguistic similarities.
  • o Both Sentinelese men and women do not wear clothes.
• Great Andamanese: The great Andamanese is a collective term used for 10 different tribes that lived in most of the large islands in the Andaman.
  • They are also known for their brave History where they fought with bows and arrows with the English men who tried to occupy their land (The Battle of Aberdeen).
  • Today most tribes are extinct and their cultural and linguistic identities largely been lost. (e.g. their members now speak mostly Hindi).
• Jarawa: Jarawas continue to be hunting and gathering nomadic tribe and are often hostile to outsiders.
  • Men fish with bows and arrows in the coastal waters while women catch fish with basket.
• Onge: They are hunting and gathering tribe settled at Dugong Creek and South Bay on Little Andaman Island.
• Shompen: The Shompens are primarily hunter-gatherers and also practise a little bit of horticulture and pig rearing.
• Nicobarese: They are largest of tribes and are primarily horticulturalists.

Issues being faced by the Particularly Vulnerable Tribal Groups (pvtg) | UPSC – IAS

These tribes have faced social disintegration among them with cultural erosion in the wake of contacts.

• Diseases: Some expeditions to establish contact with these tribes have led to spread contagious diseases among them.
• Disasters: The islands inhabited by these tribes are often faced with natural disasters such as the Tsunami of 2004. Also, global warming has been putting pressure on these areas.
• Unsustainable and exploitative tourist influx in the region has led to serious problems for these tribes and for the region too. Outsiders coming mainly from Tamil Nadu and West Bengal have outnumbered these tribes.
• Loss of food: Loss of forests, overfishing, etc. has diminished their food sources.

A Way Forward :- | UPSC – IAS

Protect Cultural Heritage:

• Extensive efforts must be made to ensure that their customs, languages, religious practises etc. are not lost as a result of outside influence.
• The ANTRI (Andaman and Nicobar Tribal Research and Training Institute) has been set up with an objective of formulation of policies for tribal integration and protection of PVTGs

Prevent Forced contact:

• It is important that security apparatus is stepped up and the region is properly policed and protected from any outsiders – fishermen, tourists or evangelicals.
• The A&N (Protection of Aboriginal Tribes) Regulation, 1956 provides protection to the aboriginal tribes by declaring their traditional areas as reserves and prohibited entry of all persons except those with authorisation.
• With regard to Sentinelese tribes, the A&N Administration has adopted an ‘eyes-on and hands-off’ policy to ensure that no poachers enter into the island.

Provide Basic Social Services:-

• Health Services, Basic education, etc. must be provided to the tribes that are being assimilated in the mainstream. Specific issues like natural disasters, endemic diseases such as anaemia, etc. must also be attended to.
• The Ministry of Tribal Affairs is implementing the “Development of PVTGs” scheme which covers the 75 identified PVTGs among Scheduled Tribes in various states/UTs.

Promote sustainable Economic activities:

• Development of cottage industries, plantations crops (e.g. coconut), fishing, animal husbandry etc. are some viable economic options given the fact that there is not much scope for agriculture.
• Sustainable tourism activities like adventure sports, deep sea diving, etc can be promoted without putting the tribes at danger from outsider contact.
• Tackling ecological Issues such afforestation, coral bleaching, sewage discharge,etc should also be of high priority.