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This week in health: the healthcare promises in election manifestoes, all about the new surrogacy rules and the role and resistance of ASHAs.

February 27, 2024 02:34 pm | Updated February 28, 2024 08:42 am IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: AFP

(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying thereYou can subscribe here to get the newsletter in your inbox.)

There are no two ways about this thing, election fever is in the air and with advancing summer, the earth has begun to sizzle not just with the heat, but also early election preparedness. In an election year, in the run-up, particularly, it would be criminal to let go of opportunities to insist on future course of actions for political parties, as far a policy goes. In the health sector, all political parties would do well to hone their understanding of health care policy and what the country actually needs at the moment. A more robust fund allocation, for sure, but there are several sectors that former Union Health Secretary Sujatha Rao has brought to our attention, and hopefully, that of the political parties with this article: Electoral season and restructuring the health system. Manifestos are doubtless useful documents as they reflect the thinking and priorities of the political parties, besides enabling people to hold the elected party accountable, she writes, and goes on to examine the manifestos of political parties in the past to see their commitments in the health sector. Given the high stakes and the trend towards current competitive welfarism, the manifestos for 2024 are expected to contain wild promises. The health section in the 2014 and 2019 manifestos of the Bharatiya Janata Party (BJP) and the Indian National Congress showed commonalities and differentials. Both mentioned revamping the primary health system, ensuring universal health care, expanding human resources, increasing use of technology and so on. The differential was with the Congress underscoring health as a public good that citizens are entitled to as a right and the States’ obligation to provide, while the BJP saw health as a commodity, provided through public-private partnerships with market-based pricing moderated by social health insurance. After years of stagnation, the United Progressive Alliance (UPA) and the National Democratic Alliance (NDA), have pushed the needle forward. 

She writes that under the UPA, the National Rural Health Mission, with three times increased funding, aimed to strengthen the delivery capacity in rural India. Five thousand technical personnel and a million community health workers were deployed and the first large-scale pay-for-performance was introduced alongside the first social health insurance programme covering 80% of the population in Andhra Pradesh rapidly expanding to another 13 States. The NDA ensured continuity of policy by scrapping the Medical Council of India (MCI) and establishing the National Medical Commission (NMC), further strengthened the rural health infrastructure with capital investment, expanded social health insurance and established the National Health Authority to undertake strategic purchasing of services from the public and private sector. The NDA also set up an additional 317 medical colleges and doubled medical seats to 1,09,948. While in gross amounts Budgets increased, in terms of proportion to GDP, public spending under the UPA and NPA hovered around an average of 1.2%.

However, what is moot is that the measures, though impressive, were incremental and did not address the serious issues of reforming the very architecture of the health system that had over years become distorted and dysfunctional. Twenty years is a long time. Other countries of similar economic strength achieved significant outcomes within half the time span, she writes. Clearly, the time is upon us, to step up on the gas as far as public health care is concerned. A Health-for-all policy should be more than a pipedream.

In this context, let’s take a look at what Bindu Shajan Perappadan brings to us: Parliamentary panel seeks timely availability of quality medicines, expansion of CGHS network. Providing timely and quality medicines to all, through a state-funded set-up is absolutely key. The Central Government Health Scheme which provides medical care to Central Government employees and pensioners enrolled under the scheme, is central to health delivery in India, given the sheer quantum of people it caters to. The Parliamentary Standing Committee on Health and Welfare in its report recently presented in Parliament called for ensuring the timely availability of medicines, especially antibiotics, and keeping a strict watch on the quality of medicines being disbursed at pharmacies. It also urged a time-bound expansion of the CGHS network, especially in States and Union Territories where facilities available under the scheme are sparse. 

Keeping the gender lens clear, this week’s stories include insights into cervical cancer, the new amendments to the surrogacy rules, and the role of ASHAs in the health care network. 

In a welcome move, the Centre recently amended surrogacy rules, and allowed couples with medical conditions to use donor gametes, setting the score right. The Central government has modified the Surrogacy (Regulation) Rules, 2022 and notified that both gametes need not come from a married couple in case they are certified as suffering from a medical condition that would make. Earlier, the Union Health Ministry had rules that stated that couples undergoing surrogacy must provide both gametes, completely ignoring the medical reason why some couples go in for surrogacy.

As per the latest amendment, the couple can have a child born through surrogacy but must have at least one gamete from the intending couple. For more on this, the nitty-gritty of it all, do read Aaratrika Bhaumik’s explainer here: Why were the surrogacy rules modified?

Saumya Kalia writes on the Accredited Social Health Activists, being overworked, underpaid and on the edge of breakdown. The piece which was written as part of the Dr. Amit Sengupta Fellowship on Health Rights, makes the case for making the ASHAs full-fledged workers, pointing out the unfairness in terming them activists and paying them a pittance, particularly considering the immense load they carry. “The most important thing to say about [an ASHA] is that she’s not being given the status of a health care worker - and everything else leads into or derives from that,” the story notes. Many ASHAs feel satisfied with their job and are willing to learn, but a sense of “bitterness” lingers. Care work empowered them, but it also immiserated them physically and emotionally.

Have you heard of the latest, India-specific model to give accurate gestational age of a foetus? Researchers at the Indian Institute of Technology Madras and the Translational Health Science and Technology Institute, Faridabad have reportedly developed an India-specific artificial intelligence model to precisely determine the gestational age of a foetus in the second and third trimester of pregnancy. Garbhini-GA2 is the first late-trimester gestational age estimation model to be developed and validated using Indian population data. Currently, models used for the Western population are in use which could prove erroneous. Hit the link for more information on this.

And, do read the editorial on cervical cancer, following up on the government’s budget announcement that it would encourage cervical cancer vaccination for adolescent girls. More needs to be done particularly in providing screening and immediate treatment for all girls and women, irrespective of age, education, or economic status.

Jacob Koshy writes about a global study that quantified the rise in blood clots, heart inflammation following COVID-19 vaccination. One of the largest assessments of its kind, spanning 99 million people and investigating reports of adverse reactions following COVID-19 vaccination, found that instances of Guillain Barre Syndrome, myocarditis, pericarditis and cerebral venous sinus thrombosis (CVST) were at least 1.5 times more than expected following inoculation with mRNA and ChadOX1 vaccines. This is in line with previous observations by the World Health Organization and the European Medicines Agency, and was what led to these being classified as ‘rare’ side effects following the vaccination for COVID-19. The Global Covid Vaccine Safety Project, which made the assessment, compiled electronic healthcare data on adverse events related to COVID-19 vaccines from participants across multiple sites, including Argentina, New South Wales and Victoria in Australia, British Columbia and Ontario in Canada, Denmark, Finland, France, New Zealand, and Scotland. The data set did not include patients from India. However, notably, a majority of Indians were administered the ChAdOX1 or Covishield vaccines during the pandemic. 

Just keeping up with our Kyasanur Forest Disease follow-up, Sathish G.T. goes to the field and discovers that with KFD scare, these villages in Koppa taluk wear a deserted look. Since January 1, 30 cases of KFD, a viral infection, have been reported in Chikkamagaluru district. And a majority of them are from Nuggi panchayat limits in Koppa taluk. The panchayat is spread over two villages - Nuggi and Hosur - and a few hamlets. There are around 700 households in the panchayat. The sudden increase in Kyasanur Forest Disease (KFD) cases in Nuggi panchayat in the last few days has left the local people worried. Whenever neighbours or relatives meet, the spreading viral infection dominates their discussion.

In other news, a woman from Siddapura taluk reportedly died of KFD in Shivamogga Karnataka.

In International news, bad news continues to come out of Gaza, as the relentless assault on its territories and people continues. This story is about hunger adding to the terror among Gazans even as truce talks resume in Cairo.  

As there is growing interest in the deployment of AI and smart devices in health care, heed this warning by the FDA against smartwatches and rings that claim to measure blood sugar without needles. The caution applies to any watch or ring, regardless of brand, that claims to measure blood glucose levels in a non-invasive way, the agency said. The FDA said it has not authorised any such device. The agency’s notice doesn’t apply to smartwatch apps linked to sensors, such as continuous glucose monitoring systems that measure blood sugar directly. It would be a mistake to rely on these apps to monitor and control blood sugar levels, in someone with diabetes, because of the inaccuracies the results can throw up. 

There is some good news this week, as C. Aravinda pointed out that the race to global eradication of Guinea worm disease is nearing the finish line.  Nations including South Sudan and Mali, where Guinea worm disease was once more common, have made commendable progress, although the fight continues in Chad and the Central African Republic. There were more than 3.5 million cases of this disease in the 1980s, but according to the World Health Organization’s (WHO) weekly epidemiological report, they dwindled to 14 cases in 2021, 13 in 2022, and just six in 2023. Interestingly the fight against this disease is still rooted in basic public health strategies, rather than fancy research and development.

AI once again enters the picture here, in our tailpiece segment.

Do read Madhumita Murgia’s piece on how AI can play a potentially life-saving role in areas such as medical diagnosis and public welfare. The outputs of AI software today can help human experts make consequential decisions in areas such as medical diagnosis, public welfare, hiring and firing, among others, the author argues. The area of healthcare is one where AI can have truly life-saving potential. She points out how in the area of TB diagnosis itself, the employment of AI will be transformational in reducing the time taken to confirm diagnosis. 

And, of course, there’s all that jazz about a chip in the brain. Yes, if you want to learn more about Neuralink, and what exactly that chip in your brain will do, listen in as Zubeda Hamid quizzes Simantini Ghosh, who is an expert in neuroscience and psychology and who is currently Head of the Department of Psychology at Ashoka University in the In Focus podcast.

From the Health page

Have you a few extra moments, then, do also read:

R. Prasad writes on how 76% of TB patients received payment for nutritional support.

IISc scientists develop synthetic antibody to neutralise deadly snake bite toxin.

Significant risk found even in primary dengue infection, says study.

For a wide ranging coverage of local health issues, across the country, see below: 

Andhra Pradesh

Nellore Sravani writes: A.P. Nurses and Midwives Council signs MoU to train faculty in Basic Cardiopulmonary Life Support.

V. Raghavendra reports: Prime Minister Narendra Modi dedicates AIIMS-Mangalagiri to the nation in Andhra Pradesh.

Chhattisgarh

Shubhomoy Sikdar reports on UAVs being introduced to bridge the gap for healthcare in Chhattisgarh.

New Delhi

AIIMS Delhi introduces steps to make the institute tout and bribe-free.

Karnataka

Shilpa Elizabeth writes: ‘Indira Canteens must consider decentralised kitchens, more nutritious menu’.

Volunteers in Karnataka race to create awareness on rare diseases.

Kerala

C. Maya notes: Kerala reports huge mumps outbreaks, over 6,000 cases reported this year so far.

A.S. Jayanth writes about why adult vaccinations remain unaddressed in Kerala.

Abdul Ghafur explains: Kerala takes a pioneering step to curb antimicrobial resistance.

Dhinesh Kallungal reports: Kerala mulls heat clinics as mercury soars above normal.

35 more family health centres completed in Kerala.

Intense heat: Health department issues alert in Kollam.

Attukal Pongala: Kerala Health Department opens four ‘heat‘ clinics.

Kerala evolves district-level antibiogram.

Kollam district administration to launch comprehensive suicide prevention programme.

Risks of home births in focus following death of woman during delivery.

Harassment of doctor in Kerala: Indian Medical Association complaints to Chief Minister and State Police Chief.

Puducherry

Nurses appointed during pandemic demand regularisation of jobs.

Tamil Nadu

Girl undergoes spine deformity correction surgery in Chennai.

Doctor booked for sexually assaulting woman staff in Tirupattur.

National Centre for Ageing commissioned in Tamil Nadu.

Telangana

Siddharth Kumar Singh says: Hyderabad hospital turns ‘WFH’ into ‘Work From Hospital’.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here

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