Social Schemes: Ministry of Health and Family Welfare

World Population Projections 2019

Progress of the World’s Women 2019-20: Families in a Changing World

Study in India

Transgender Persons (Protection of Rights) Bill, 2019

Section 375 of Indian Penal Code

Ministry of Health and Family Welfare

Schemes

1. Pradhan Mantri Swasthya Suraksha Yojana

Objective

• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances in the availability of affordable healthcare facilities in the different parts of the country in general, and augmenting facilities for quality medical education in the under-served States in particular.
• The scheme was approved in March 2006.

Implementation

First Phase

• The first phase in the PMSSY has two components - setting up of six institutions in the line of AIIMS; and upgradation of 13 existing Government medical college institutions.
• It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 crores per institution.
• These States have been identified on the basis of various socio-economic indicators like human development index, literacy rate, population below poverty line and per capital income and health indicators like population to bed ratio, prevalence rate of serious communicable diseases, infant mortality rate etc.
• Each institution will have a 960 bedded hospital (500 beds for the medical college hospital; 300 beds for Speciality/Super Speciality; 100 beds for ICU/Accident trauma; 30 beds for Physical Medicine & Rehabilitation and 30 beds for Ayush) intended to provide healthcare facilities in 42 Speciality/Super-Speciality disciplines.
• Medical College will have 100 UG intake besides facilities for imparting PG/doctoral courses in various disciplines, largely based on Medical Council of India (MCI) norms and also nursing college conforming to Nursing Council norms.
• In addition to this, 13 existing medical institutions spread over 10 States will also be upgraded, with an outlay of Rs. 120 crores (Rs. 100 crores from Central Government and Rs. 20 crores from State Government) for each institution. These institutions are
  • Government Medical College, Jammu, Jammu & Kashmir
  • Government Medical College, Srinagar, Jammu & Kashmir
  • Kolkatta Medical College, Kolkatta, West Bengal
  • Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
  • Institute of Medical Sciences, BHU, Varanasi, Uttar Pardesh
  • Nizam Institute of Medical Sciences, Hyderabad, Telangana
  • Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh
  • Government Medical College, Salem, Tamil Nadu
  • J. Medical College, Ahmedabad, Gujarat
  • Bangalore Medical College, Bengaluru, Karnataka
  • Government Medical College, Thiruvananthapuram, Kerala
  • Rajendra Institute of Medical Sciences (RIMS), Ranchi
  • Grants Medical College & Sir J.J. Group of Hospitals, Mumbai, Maharashtra.

Second Phase

In the second phase of PMSSY, the Government has approved the setting up of two more AIIMS-like institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college institutions namely

• Government Medical College, Amritsar, Punjab
• Government Medical College, Tanda, Himachal Pradesh
• Government Medical College, Madurai, Tamil Nadu
• Government Medical College, Nagpur, Maharashtra
• Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh
• B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak

The estimated cost for each AIIMS-like institution is Rs. 823 crore. For upgradation of medical college institutions, Central Government will contribute Rs. 125 crore each.

Third Phase

In the third phase of PMSSY, it is proposed to upgrade the following existing medical college institutions namely

• Government Medical College, Jhansi, Uttar Pradesh
• Government Medical College, Rewa, Madhya Pradesh
• Government Medical College, Gorakhpur, Uttar Pradesh
• Government Medical College, Dharbanga, Bihar
• Government Medical College, Kozhikode, Kerala
• Vijaynagar Institute of Medical Sciences, Bellary, Karnataka
• Government Medical College, Muzaffarpur, Bihar

The project cost for upgradation of each medical college institution has been estimated at Rs. 150 crores per institution, out of which Central Government will contribute Rs. 125 crores and the remaining Rs. 25 crore will be borne by the respective State Governments.

2. National AIDS and STD Control Programme

• The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/ AIDS in India.
• Over time, the focus has shifted from raising awareness to behaviour change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of People living with HIV (PLHIV).
• The NACP I started in 1992 was implemented with an objective of slowing down the spread of HIV infections so as to reduce morbidity, mortality and impact of AIDS in the country.
• In November 1999, the second National AIDS Control Project (NACP II) was launched to reduce the spread of HIV infection in India, and (ii) to increase India’s capacity to respond to HIV/AIDS on a long-term basis.
• NACP III was launched in July 2007 with the goal of Halting and Reversing the Epidemic over its five-year period.
• NACP IV, launched in 2012, aims to accelerate the process of reversal and further strengthen the epidemic response in India through a cautious and well defined integration process over the next five years.

NACP - IV - Objectives

• Reduce new infections by 50% (2007 Baseline of NACP III)
• Provide comprehensive care and support to all persons living with HIV/AIDS and treatment services for all those who require it.

Key strategies

• Intensifying and consolidating prevention services, with a focus on HIgh Risk Groups (HRGs) and vulnerable population.
• Increasing access and promoting comprehensive care, support and treatment
• Expanding IEC services for (a) general population and (b) high risk groups with a focus on behaviour change and demand generation.
• Building capacities at national, state, district and facility levels
• Strengthening Strategic Information Management System

Key priorities under NACP IV

• Preventing new infections by sustaining the reach of current interventions and effectively addressing emerging epidemics
• Prevention of Parent to Child transmission
• Focusing on IEC strategies for behaviour change in HRG, awareness among general population and demand generation for HIV services
• Providing comprehensive care, support and treatment to eligible PLHIV
• Reducing stigma and discrimination through Greater involvement of PLHA (GIPA)
• De-centralizing rollout of services including technical support
• Ensuring effective use of strategic information at all levels of programme
• Building capacities of NGO and civil society partners especially in states with emerging epidemics
• Integrating HIV services with health systems in a phased manner
• Mainstreaming of HIV/ AIDS activities with all key central/state level Ministries/ departments will be given a high priority and resources of the respective departments will be leveraged. Social protection and insurance mechanisms for PLHIV will be strengthened.

New Initiatives under NACP IV

• Differential strategies for districts based on data triangulation with due weightage to vulnerabilities
• Scale up of programmes to target key vulnerabilities

• Scale up of Opioid Substitution Therapy (OST) for IDUs
• Scale up and strengthening of Migrant Interventions at Source, Transit & Destinations including roll out of Migrant Tracking System for effective outreach
• Establishment and scale up of interventions for Transgenders (TGs) by bringing in community participation and focused strategies to address their vulnerabilities
• Employer-Led Model for addressing vulnerabilities among migrant labour e. Female Condom Programme

• Scale up of Multi-Drug Regimen for Prevention of Parent to Child Transmission (PPTCT) in keeping with international protocols
• Social protection for marginalised populations through mainstreaming and earmarking budgets for HIV among concerned government departments
• Establishment of Metro Blood Banks and Plasma Fractionation Centre
• Launch of Third Line ART and scale up of first and second Line ART
• Demand promotion strategies specially using mid-media, e.g., National Folk Media Campaign & Red Ribbon Express and buses (in convergence with the National Health Mission).

3. National Pharmacovigilance Programme

• The nationwide programme, sponsored and coordinated by the country's central drug regulatory agency – Central Drugs Standard Control Organization (CDSCO) – to establish and manage a data base of Adverse Drug Reactions (ADR) for making informed regulatory decisions regarding marketing authorization of drugs in India for ensuring safety of drugs.
• The National Pharmacovigilance Centre at CDSCO coordinates the programme. The National Centre will operate under the supervision of the National Pharmacovigilance Advisory Committee (NPAC) to recommend procedures and guidelines for regulatory interventions.

Objectives of the Programme:

Broad objectives of the Programme

• To foster the culture of AE notification and reporting
• To establish a viable and broad-based ADR monitoring program in India

Specific objectives of the Programme

• To create an ADR database for the Indian population
• To create awareness of ADR monitoring among people
• To ensure optimum safety of drug products in Indian market
• To create infrastructure for ongoing regulatory review of PSURs
• The National Pharmacovigilance Advisory Committee (NPAC) will oversee the performance of various Zonal, Regional and Peripheral Centres and will perform the functions of "Review Committee" for this program.
  • The NPAC will also recommend possible regulatory measures based on pharmacovigilance data received from various centres.
  • National Pharmacovigilance Programme comprises of twenty-four Peripheral Pharmacovigilance Centers pooling their data at five Regional Pharmacovigilance Centers, which in turn funnel their data to the two Zonal Pharmacovigilance Centers.

4. National Organ Transplant Programme

Background

• The shortage of organs is virtually a universal problem but Asia lags behind much of the rest of the world. India lags far behind other countries even in Asia.  It is not that there aren't enough organs to transplant. Nearly every person who dies naturally, or in an accident, is a potential donor. Even then, innumerable patients cannot find a donor.

Situation of shortage of organs in India

•  There is a wide gap between patients who need transplants and the organs that are available in India.
• An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only.
• An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant.
• Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed.
• Similarly about 50000 persons suffer from Heart failures annually but only about 10 to 15 heart transplants are performed every year in India. 
• In case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.

Issues and Challenges

1. High Burden (Demand  Versus Supply gap)
2. Poor Infrastructure especially in Govt. sector hospitals
3. Lack of Awareness of concept of Brain Stem Death among stakeholders
4. Poor rate of Brain Stem Death Certification by Hospitals
5. Poor Awareness and attitude towards organ donation--- Poor Deceased Organ donation rate
6. Lack of Organized systems for organ procurement from deceased donor
7. Maintenance of Standards in Transplantation, Retrieval and Tissue Banking
8. Prevention and Control of Organ trading
9. High Cost (especially for uninsured and poor patients)
10. Regulation of Non- Govt. Sector

Objectives of National Organ Transplant Programme:

• To organize a system of organ and Tissue procurement & distribution for transplantation.
• To promote deceased organ and Tissue donation.
• To train required manpower.
• To protect vulnerable poor from organ trafficking.
•  To monitor organ and tissue transplant services and bring about policy and programme corrections/ changes whenever needed.

National Organ and Tissue Transplant Organization

• National Network division of NOTTO would function as apex centre for all India activities of coordination and networking for procurement and distribution of organs and tissues and registry of Organs and Tissues Donation and Transplantation in country.
• The following activities would be undertaken to facilitate Organ Transplantation in safest way in shortest possible time and to collect data and develop and publish National registry.

5. AYUSHMAN BHARAT

• Ayushman Bharat is a centrally sponsored programme anchored in the Ministry of Health and Family Welfare (MoHFW).
• It is an umbrella of two major health initiatives, namely Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojna (PMJAY).
• Brief details of these components are as following:

 Ayushman Bharat-Health & Wellness Centres (AB-HWC)

• Delivery of comprehensive primary health care services through Health &Wellness Centres is a critical component of the newly announced Ayushman Bharat scheme. 
• It places people and communities at the center of the health care delivery system, making health services responsive, accessible and equitable.
• Nearly 1.5 lakh Sub-Centres and Primary Health Centres would be transformed as Health & Wellness Centres by 2022 to provide comprehensive and quality primary care close to the community while ensuring the principles of equity, affordability and universality.
• Till date, 4503 HWCs have been operationalized in various states.

Key components of AB-HWC:

• Additional Human Resource - New cadre of health care professional- referred to as the Mid-Level Health Provider- who is a nurse or an Ayurvedic Practitioner trained and accredited for a set of competencies related to primary health care and public health.   Mid-Level Health Provider will lead the team of MPWs and ASHAs at SHC level
• Multiskilling/ Training of existing service providers - upgrading skills to provide expanded package of services
• Efficient logistics system to ensure availability of wide range of drugs and point of care diagnostics.

 

• Robust IT system – to create unique health id and longitudinal health record of all individuals and provision of tele-consultation services
• Provision of services related to indigenous health system and yoga etc for promotion of wellness
• Linkageswith schools to train Health and Wellness Ambassadors to enable creating healthy habits in schools

The package of services envisaged at AB-HWC are:

1. Care in pregnancy and child-birth.
2. Neonatal and infant health care services
3. Childhood and adolescent health care services
4. Family planning, Contraceptive services and other Reproductive Health Care services
5. Management of Communicable diseases including National Health Programmes
6. Management of common communicable diseases and outpatient care for acute simple illness and minor ailments.
7. Screening, Prevention, Control and Management of non-communicable diseases.
8. Care for Common Ophthalmic and ENT problems
9. Basic Oral health care
10. Elderly and palliative health care services
11. Emergency Medical Services
12. Screening and Basic management of Mental health ailments

 Key benefits for community under AB-HWC:

• Expanded package of primary care services –ranging from maternal and child health, communicable diseases to non-communicable diseases (universal screening, prevention, control and management of five common communicable diseases: hypertension, diabetes and three common cancers – those of the oral cavity, breast and cervix,  primary health care for diseases for the eye, oral health, ENT, mental health, provision of palliative care and care for the elderly, and medical emergencies)
• Wide range of free drugs
• Point of care diagnostics at the centres.
• Tele-consultation services with Medical Officers for complications
• Continuum of care ensured through referral linkages and protocols
• Unique health id – longitudinal health record for each individual
• Services related to indigenous health system and yoga for promotion of wellness.

6. Ayushman Bharat–PM Jan Arogya Yojana

• Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).
• It is an umbrella of two major health initiatives, namely Health and wellness Centres and National  Health Protection Scheme.

Health and Wellness Centres

• Under this 1.5 lakh existing sub centres will bring health care system closer to the homes of people in the form of Health and wellness centres.
• These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.

List of Services to be provided at Health & Wellness Centre

• Pregnancy care and maternal health services
• Neonatal and infant health services
• Child health
• Chronic communicable diseases
• Non-communicable diseases
• Management of mental illness
• Dental care
• Eye care
• Geriatric care Emergency medicine

National Health Protection Mission (AB-PMJAY)

Benefits

• AB-PMJAY provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
•  To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
• The benefit cover will also include pre and post-hospitalisation expenses.
• All pre-existing conditions will be covered from day one of the policy.
• A defined transport allowance per hospitalization will also be paid to the beneficiary.
• Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
• The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter.
• As for private hospitals, they will be empanelled online based on defined criteria.
• To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
• The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper less transaction.
• Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.

Medical Termination of Pregnancy

Context

The Lok Sabha has passed the Medical Termination of Pregnancy Bill, to ensure safety and well-being of women.

About

• The Bill amends the Medical Termination of Pregnancy Act, 1971 which provides for the termination of certain pregnancies by registered medical practitioners.
• Definition:The Bill adds the definition of termination of pregnancy to mean a procedure undertaken to terminate a pregnancy by using medical or surgical methods.
• Termination of Pregnancy: Under the Act, a pregnancy may be terminated within 12 weeks, if a registered medical practitioner is of the opinion that:
• Continuation of the pregnancy may risk the life of the mother, or cause grave injury to her health
• There is a substantial risk that the child, if born, would suffer physical or mental abnormalities.
• For termination of a pregnancy between 12 to 20 weeks, two medical practitioners are required to give their opinion.
• The Bill amends this provision to state that a pregnancy may be terminated within 20 weeks, with the opinion of a registered medical practitioner.
• Approval of two registered medical practitioners will be required for termination of pregnancies between 20 to 24 weeks.
• The termination of pregnancies up to 24 weeks will only apply to specific categories of women, as may be prescribed by the central government.
• Further, the central government will notify the norms for the medical practitioner whose opinion is required for termination of the pregnancy.

Constitution of a Medical Board:

• The Bill states that the upper limit of termination of pregnancy will not apply in cases where such termination is necessary due to the diagnosis of substantial foetal abnormalities.
• These abnormalities will be diagnosed by a Medical Board. Under the Bill, every state government is required to constitute a Medical Board. 
• These Medical Boards will consist of the following members: (i) a gynaecologist, (ii) a paediatrician, (iii) a radiologist or sonologist, and (iv) any other number of members, as may be notified by the state government.

Significance of the Bill: 

• The movies in the interest of women’s rights as it will help in expanding access of women to safe and legal abortion services on therapeutic, eugenic, humanitarian or social grounds.
• The bill is a great recognition of women’s reproductive rights as these are essential for women’s equality as they ensure women’s rights of bodily autonomy.

Global Population Summit in Nairobi

Context

• The Nairobi Summit of International Conference on Population and Development (ICPD25) wrapped up in Nairobi with more than 9,500 delegates from 170 countries, adopting 12 resolutions to promote reproductive health for women and girls.

About

• This year marks the 25th anniversary of the ground breaking International Conference on Population and Development (ICPD), which took place in Cairo in 1994.
• World is aiming to achieve the United Nations Sustainable Development Goals by 2030, and universal sexual and reproductive health is central to much of this agenda – ending poverty, security good health and well-being, realizing gender equality and achieving sustainable communities, among many other goals. Urgent and sustained efforts to realize reproductive health and rights are crucial.
• Amid a loud domestic chorus demanding punitive actions to control population, at a global forum India reiterated to guarantee voluntary and informed choices of contraception.
• India also said it would increase its basket of contraceptives and improve the quality of family planning services.
• Some 25 years ago, India had committed to a similar approach to population control at the International Conference on Population and Development (ICPD) in Cairo. The country was among 179 countries that called for the empowerment of women and girls in all spheres.
• The recent move, however, on the back of the Government of Assam announcing a two-child limit for eligibility in government jobs. This has widely been seen as a punitive measure.
• For a country that would surpass China and become the world’s most populous country by 2027, the idea of punitive action to control the population is not new. Despite India’s commitment at an international platform, many states have taken steps to formalise population control through penal provisions.

Measures which can reduce the birth rate

• Minimum age of Marriage: As fertility depends on the age of marriage. So the minimum age of marriage should be raised. In India minimum age for marriage is 21 years for men and 18 years for women has be fixed by law. This law should be firmly implemented and people should also be made aware of this through publicity.
• Raising the Status of Women: There is still discrimination to the women. They are confined to four walls of house. They are still confined to rearing and bearing of children. So women should be given opportunities to develop socially and economically. Free education should be given to them.
• Spread of Education: The spread of education changes the outlook of people. The educated men prefer to delay marriage and adopt small family norms. Educated women are health conscious and avoid frequent pregnancies and thus help in lowering birth rate.
• Adoption: Some parents do not have any child, despite costly medical treatment. It is advisable that they should adopt orphan children. It will be beneficial to orphan children and children couples.
• Change in Social Outlook: Social outlook of the people should undergo a change. Marriage should no longer be considered a social binding. Issueless women should not be looked down upon.
• More employment opportunities: The first and foremost measure is to raise, the employment avenues in rural as well as urban areas. Generally in rural areas there is disguised unemployment. So efforts should be made to migrate unemployed persons from rural side to urban side. This step can check the population growth.
• Development of Agriculture and Industry: If agriculture and industry are properly developed, large number of people will get employment. When their income is increased they would improve their standard of living and adopt small family norms.
• Family Planning: This method implies family by choice and not by chance. By applying preventive measures, people can regulate birth rate. This method is being used extensively; success of this method depends on the availability of cheap contraceptive devices for birth control.

Natural Language Translation

Context

• The U.S. State Department has released the Trafficking in Persons (TIP) report for 2019 by using International Labour Organisation (ILO) data.
• India continued to be placed in Tier-2 on the country trafficking scale.

About

More on News

• Around 25 million adults and children are suffering from labour and sex trafficking all over the world. In 77% of the cases, victims are trafficked within their own countries of residence, rather than across borders.
• The number of victims who were trafficked domestically was high as compared to foreign victims being trafficked in all regions of the world except Western and Central Europe, the Middle East, and certain East Asian countries.
• Victims of sex trafficking were more likely to be trafficked across borders while victims of forced labour were typically exploited within their own countries.
• The report emphasizes on the implementation of the Palermo Protocol. The countries need to build legal frameworks to punish traffickers and provide care for survivors.

Human trafficking

It is the trade of humans for the purpose of forced labour, sexual slavery, or commercial sexual exploitation for the trafficker or others. This may encompass providing a spouse in the context of forced marriage, or the extraction of organs or tissues, including for surrogacy and ova removal.

Categorisation of Countries

• The categorisation of countries is based on efforts to meet minimum standards for the elimination of human trafficking, not on the magnitude of a country’s trafficking problem.
• The report contains country narratives and category designations for all countries, including the U.S.
• This categorisation of countries into three tiersis based on the Trafficking Victims Protection Act (TVPA), U.S. legislation enacted in 2000.The three-tier system includes:

• Tier 1countries are those countries whose governments fully comply with the Trafficking Victims Protection Act (TVPA) minimum standards.
• Tier 2 consists of watch-list countries, whose governments do not fully comply with the TVPA’s minimum standards but are making significant efforts to bring themselves into compliance with those standards and the absolute number of victims of severe forms of trafficking is very significant or is significantly increasing; or there is a failure to provide evidence of increasing efforts to combat severe forms of trafficking in persons from the previous year; or the determination that a country is making significant efforts to bring themselves into compliance with minimum standards was based on commitments by the country to take additional future steps over the next year.
• Tier 3 consists of those countries whose governments do not fully comply with the TVPA’s minimum standards and are not making significant efforts to do so.

India's Position

• India is placed in Tier 2. The Indian government demonstrated overall increasing efforts compared to the previous reporting period.
• The report highlights efforts by the Indian government to crack down on trafficking and convicting traffickers.
• The government took some action following reports of government complicity in forced labour and sex trafficking, although the systemic failure to address forced labour and sex trafficking in government-run and government-funded shelter homes remained a serious problem. The report also highlighted the government’s failures in this regard.
• It recommended India to include amending the definition of trafficking in Section 370 of the Penal Code to “include forced labour trafficking and ensure that force, fraud, or coercion is not required to prove a child sex trafficking offence” and to establish Anti-Human Trafficking Units in all districts with dedicated funding and clear mandates.
• It also recommended India to cease forcible detention of adult trafficking victims in government-run and government-funded shelters and eliminate all recruitment fees charged to workers.