Daily Hindu Editorials

👉We must publicise the full information on organ allocations to secure public trust in the donation process👈 Over the last few days a storm has been raised following publication of an article in The Hindu (June 12, 2018) based on a leaked WhatsApp message from the head of the National Organ and Tissue Transplant Organisation (NOTTO) claiming that foreign patients who are waiting for a donor heart transplant are being prioritised over Indian patients by private hospitals in Chennai. This article has angered many. Unfortunately, amidst the din, the basic concepts of organ donation, allocation and transplantation have been completely lost. 👉Tamil Nadu’s advantage A forward thinking bureaucracy, committed non-governmental organisations and a willing political dispensation took up promotion of cadaver organ donation as a must-have in Tamil Nadu around 10 years ago. This was primarily in response to a widely publicised and unrelated kidney donation racket unearthed in the late...

👉There must be an inquiry into how allocations for organ transplants are made in Tamil Nadu👈 Transplantation of human organs is today a mature programme in many States, making it possible for people with kidney, liver, heart and lung failure to extend their lives. Heart and lung transplants are expensive and less widely available, compared with kidney and liver procedures. State governments, which have responsibility for health care provision, are expected to ensure that the organs that are altruistically donated by families of brain-dead people are given to recipients ethically, and as mandated by law. Priority for citizens enrolled in the State and national waiting lists over foreign nationals is laid down in the Transplantation of Human Organs and Tissues Rules. When the law is clear, it is extraordinary that seemingly preferential allotment of hearts and lungs has been made to foreign patients in Tamil Nadu — in 2017, foreigners accounted for 25% of heart transplants and 33% ...

👉A range of policy responses is crucial to tackle the rising incidence of obesity👈 In March, the government announced that it would release an annual “state of nutrition” report, detailing India’s level of stunting, malnutrition and feature best practices for States to scale up nutrition interventions. It is clear that India has a lot to do to tackle nutrition challenges — 26 million children suffer from wasting (a low weight-for-height ratio), more than in any other country. Yet, the country has the second highest number of obese children in the world — 15.3 million in China and 14.4 million in India. While tackling undernutrition through assurance of adequate nutrition (usually interpreted as dietary calories), we need to ensure that it is also about appropriate nutrition (the right balance of nutrients). Our policy response has to move from “food security” to “nutrition security”. 👉New problem India must step up its efforts to fight overweight and obesity just as it...

👉India is on track to curb cigarette use, but chewable tobacco is a health emergency👈 A report from the World Health Organisation on the occasion of World No Tobacco Day (May 31) suggests that India’s efforts to cut the prevalence of cigarette smoking are paying off. Between 2000 and 2015, this fell from 19.4% to 11.5%. By 2025, the report projected, it could drop to 8.5%, putting India well in line to meeting its 2025 target under a WHO global plan to tackle non-communicable diseases. While this is excellent news, it needs to be highlighted that smokeless tobacco is the bigger scourge in the country. The WHO report doesn’t model usage trends in this segment because of the paucity of global data. Other data, however, suggest that India is lagging on this front. Even though there is a 2011 government ban on the sale of food items with tobacco or nicotine in them, the consumption of gutkha, khaini and zarda continues to be rampant. The Global Adult Tobacco Survey in 2016, for examp...

👉The implementation of Ayushman Bharat requires a strong reform agenda👈 The launch of Ayushman Bharat, a national health protection scheme (NHPS), in the last stretch of this government’s tenure comes as no surprise. Social policies in the areas of education, health and the welfare of the disadvantaged or farmers almost always get announced before elections. No political party is an exception to this rule since such ‘feel good’ welfare policies are useful in conferring a sense of legitimacy and caring on the government seeking another term. Despite these political motivations, those working in these neglected sectors welcome such policy announcements as the crisis is acute in these sectors. Health policies have two objectives: to enhance the health of the population and reduce the financial risk for those accessing treatment. Success in the first is measured by a reduction in the disease burden and subsequent increase in people’s longevity. Reduced spending or getting...

👉Age-old practices of infection control are crucial to limit the deadly outbreak👈 The outbreak of the deadly Nipah virus around Kozhikode, Kerala, is a test of India’s capacity to respond to public health emergencies. In 2018, the World Health Organisation listed Nipah as one of the 10 priority pathogens needing urgent research, given its ability to trigger lethal outbreaks and the lack of drugs available against it. As an RNA (ribonucleic acid) virus, Nipah has an exceptional rate of mutation — that is, it can easily adapt to spread more efficiently among humans than it does now. Such an adaptation would result in a truly dangerous microbe. Nipah already kills up to 70% of those it infects, through a mix of symptoms that include encephalitis, a brain inflammation marked by a coma state, disorientation, and long-lasting after-effects, such as convulsions, in those who survive. Thankfully, in most outbreaks in South Asia so far the virus has displayed a “stuttering chain of transm...

👉Building such a database is not easy, does not always offer justice, and is an ethical landmine👈 Despite the spate of violent attacks against women, including rapes, in India, very few of the men implicated have been convicted. While identifying the rapist is the first step to serving justice, his identity does not guarantee due punishment or a stiff sentence for the crime. According to the National Crime Records Bureau, only about a quarter of rape cases ended in conviction in 2016. These rates are low in other countries too. The outrage over these attacks has reinforced the belief that India needs a sex offenders’ database or a DNA database of those accused and charged with rape. India has developed a draft Bill for such a DNA database and the Andhra Pradesh government even announced that it has signed up with a private agency for collecting DNA from all its citizens. 👉Concerns Based on experience in other countries, building such a database is not easy, does not ...

👉 T here is no substitute for hot-cooked meals to address poor child nutrition 👈 The central principle that should guide the Centre in improving maternal and child nutrition is that early childhood is the foundation for the health and well-being of an individual. Tinkering with the existing national programme of providing hot-cooked meals to children three to six years old, and take-home rations for younger children and pregnant and lactating mothers is fraught with danger. Attempts to substitute meals or rations with factory-made nutrients will inject commercialisation into a key mission, and upset the nutritional basis of the scheme. Good sense has prevailed, and the newly-formed inter-ministerial National Council on India’s Nutrition Challenges has chosen to continue the current practice, overruling the Minister for Women and Child Development, Maneka Gandhi, who proposed distribution of packaged nutrients to beneficiaries. Raising nutritional standards for young children has ...

👉 It is important to use different themes on tobacco products to shock users 👈 Contrary to tobacco companies’ claims, there is now empirical evidence that large, graphic pictorial warnings on tobacco products have a telling effect on consumer behaviour. From 38% in 2009-10, the proportion of cigarette smokers in India who thought of quitting due to pictorial warnings increased sharply to nearly 62% in 2016-17. Though not dramatic, the proportion of bidi smokers who wanted to quit also increased from about 30% to 54%, according to the Global Adult Tobacco Survey (GATS), undertaken in 2009-10 and 2016-17, respectively. The increase among adults wanting to quit smokeless tobacco was also significant — 34% to 46% during the two periods. In all probability, the proportion of tobacco users wanting to quit will see an even sharper increase when the next GATS survey is carried out. The reason: the size and graphic nature of the images used as warnings in India. India has come a...

👉Patents for trivial improvements on drugs, though statutorily barred, are routinely granted👈 Over the last few years the Indian Patent Office (IPO) has been focussing on granting patents expeditiously and reducing the backlog of pending applications. Newly recruited examiners have been sending in examination reports rapidly in a race to reduce the examination timeline and increase the grant rate. There needs to be some caution here as the IPO has set an example of having one of the toughest standards in the world to distinguish real innovation from trivial tweaks — a change brought about by the introduction of the anti-evergreening provisions in the Patents Act. India hit the headlines when it incorporated certain anti-evergreening provisions such as Sections 3(d), 3(e) and 3(i) into the Patents Act to restrict patentability of a host of secondary patents — essentially alternative forms of already existing patented drugs aimed at further extending their term of protection....

👉After more than a decade of discussions, there is no solution on what to feed children in anganwadis👈 Many children have died of malnutrition in India and yet Women and Child Development Ministers over the years haven’t decided what food to give children in anganwadis. This is worrying. How many more children must suffer from stunted growth before the Minister in charge of their welfare decides on whether to serve them hot-cooked nutritious meals or packaged/processed fortified mixes? And why does there have to be a choice between the two? Why can’t India incorporate both? Is it really that difficult to keep a close watch on the quality of food served to children between the ages of three and six as well as take-home ration for pregnant and lactating women? Apparently, it is. If you put together the years of the Congress-led United Progressive Alliance government and the Bharatiya Janata Party government, no solution is in sight after more than a decade of discussions. T...

👍YES | VINOD PAUL 💥Building  a robust primary health-care system will save lives and  lead to a healthier India Ayushman Bharat, the new, flagship health initiative of the government, has two dimensions. First, it aims to roll out comprehensive primary health care with Health and Wellness Centres (HWCs) serving as the people-centric nuclei. A nationwide network of 1.5 lakh HWCs will be created by transforming the existing sub-centres and primary health-care centres by 2022. This will constitute the very foundation of New India’s health care system. So far, the country’s primary health care has been focussing on reproductive, maternal health, newborn and child health as well as controlling priority communicable diseases. All this perhaps covers only 15% of our needs. Public health action for preventive/promotive health has also been limited. There is a huge unmet need for primary health care, namely, care for non-communicable diseases (specifically, preven...

💥Seeking full disclosure on how patents are working locally through Form 27 will help promote innovation A new chapter on the access to medication debate in India began when Shamnad Basheer filed a public interest litigation before the Delhi High Court. The petition pointed out the importance of “working requirements” in the Patents Act, 1970; the need to amend Form 27; and the lapses by patentees in furnishing information. The importance of Form 27 on the question of access to health cannot be underestimated. In essence, Form 27 seeks information to ensure that the patented material is adequately supplied in India. If the supply of the patented invention does not cater to the demands, statutorily the reasonable requirement of the public with regard to the patented invention is deemed as not met. This will be a ground to seek compulsory licensing of the product within India. The underlying rationale is to protect public health. 👉Working requirement Patent law grants t...

💥Amendments to the National Medical Council Bill don’t go far enough to address concerns The Union Cabinet this week approved six out of the dozens of changes to the contentious National Medical Commission (NMC) Bill that were suggested by a Parliamentary Standing Committee earlier this month. These changes address some of the loudest criticisms of the Bill. Among them, the final year MBBS exam is now merged with an exit exam for doctors, and a contentious bridge course for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy) practitioners has been axed. Health-care experts had recommended other modifications, which the Cabinet ignored. For example, despite the Cabinet’s amendments, the NMC, the regulatory body that will replace the Medical Council of India, will be heavily controlled by the government. Its members are to be picked by a search committee headed by the Cabinet Secretary, while the Central government is to be the appellate body for those aggrieved by t...

💥The National Health Protection Mission requires a bold, holistic approach The NDA government’s scheme to provide health cover of ₹5 lakh per year to 10 crore poor and vulnerable families through the Ayushman Bharat-National Health Protection Mission has taken a step forward with the Union Cabinet approving the modalities of its implementation. Considering the small window, just over a year, available before the term of the present government ends, urgent action is needed to roll out such an ambitious scheme. For a start, the apex council that will steer the programme and the governing board to operationalise it in partnership with the States need to be set up. The States, which have a statutory responsibility for provision of health care, have to act quickly and form dedicated agencies to run the scheme. Since the NHPM represents the foundation for a universal health coverage system that should eventually cover all Indians, it needs to be given a sound legal basis, ideally thro...

🏥The National Medical Commission Bill seeks to make structural changes in an exploitative health-care system Even as the spotlight shifts to a “maha-panchayat” of doctors under the Indian Medical Association getting ready later this month to challenge the National Medical Commission (NMC) Bill, 2017 (now before a parliamentary standing committee), it is pertinent to look at the Bill’s highlights. Article 47 of the Constitution makes it clear that the state is duty-bound to improve public health, but India continues to face a health crisis, with an absolute shortage of and an inequitable presence of doctors and over-burdened hospitals. Although India has 10 lakh medical doctors, it needs 3,00,000 more in order to meet the World Health Organisation standard of the ideal doctor-population ratio. There is an 81% shortage of specialists in community health centres (CHC), the first point of contact for a patient with a specialist doctor. Those most affected by this are poor and ru...