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Jun 05 2023

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Spare the rod and change the law

June 5, 2023

Context: 

The Director General of Health Services (DGHS) ordered reiterating directions that doctors in Central government hospitals prescribe only generic medicines instead of branded drugs.

Objective of the order:

  • The driving force behind these office orders is the hope to provide the patient with the cheapest available generic drug and thus save them the cost of the more expensive branded drugs. 

Why is there reluctance with generic names?

  • Many Indian doctors in both the public and private sector do not trust the quality of all generic medicines in the Indian market. 
  • India has lagged behind countries like the U.S. in creating the appropriate legal and scientific standards that provide guarantees to doctors on the interchangeability of generic medicines with each other and the innovator drug.
  • Many doctors have developed faith in particular brands, not because they receive bribes but because patient feedback has taught them that other brands do not work as effectively.

“Bio-equivalent” position in India:

  • If the dissolution profile of the generic drug is same or similar to that of the innovator drug over a time period, it is declared to be “bio-equivalent” and hence therapeutically interchangeable with the innovator drug.
  • India mandated such bio-equivalence testing only in 2017. Even then, the regulations were vague. A vast majority of drugs in the Indian market have never been tested for bio-equivalence. 
    • Hence, the government cannot provide doctors with a legal guarantee that all generic medicines in the Indian market are, in fact, interchangeable with the innovator drug.

Issues with generic medicines in India:

  • The lack of bio-equivalence testing.
  • The issue of stability testing 
    • The key challenge to manufacturing any drug is to ensure that it remains stable through a stressed supply chain in differing conditions of heat and humidity.
  • Many generic medicines in the Indian market have not been subjected to mandatory stability testing which undermines the trust of government doctors in generic drugs.

Time to focus & action:

  • The DGHS must work towards resolving the genuine concerns being raised by doctors.
  • To ask for regulations which require pharma companies to identify on their packaging whether a drug has been tested for bio-equivalence and stability as required by the law. 
  • Building the confidence of doctors in generic medicine serves public interest better than threatening them with punitive action for failing to comply with directives on mandatory prescription of drugs by their generic names.

News Source: The Hindu

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Citizen Activism that is missing from the Wrestling ring

June 5, 2023

Context: 

Over the past four months, a few nationally acclaimed wrestlers have been protesting against their federation chief, a strongman politician, who they accuse of both misusing his authority and of sexual harassment. 

Citizen Activism:

  • The spurt of ‘citizen activism’ we saw a decade ago in the Nirbhaya protests and the Anna Andolan was nowhere to be seen.
  • This brand of activism was what steadily gained currency post-liberalisation, particularly through the spread of television and social media.

An evolution from the Nehruvian era:

  • The middle classes retreated from active civil society participation from the Nehruvian era onwards, as they assumed control of the power networks within the state-centered political economy. 
  • Meanwhile, civil society came to be hinged around the framework of “segmental loyalties”, which the social-anthropologist, Ernest Gellner, held to be an inescapable fate of the ‘civil’ space in all traditional, heterogeneous societies.
  • While some scholars have taken the preponderance of caste/community-based organizations to claim that the country effectively lacks a modern civil society, others have appreciated the role of these organizations in aiding democratization and exemplifying the “modernity of tradition”. 
  • “In India, religion, caste, ethnicity and language have been effectively mobilized in articulating and representing group identities and interests,” as Sarbeshwar Sahoo wrote in Civil Society and Democratization in India (2013).

A ‘changing Indian sensibility’:

  • In a recent paper, the political scientists, Aseema Sinha and Manisha Priyam, have framed the dominant political discourse as more of a demand-side phenomenon, reflecting the “changing Indian sensibility, especially among India’s professional and middle classes.”.
  • We must remember, the activism of these organizations is also weighed down with inherent limitations. 
  • Hence, the broad political support commanded by them in certain political contexts should not be seen as an automatic function of stable bonds of programmatic solidarity. 

Conclusion:

  • The state of the wrestlers’ protests clarifies the need to look beyond the superficial, celebrity-dependent model of civil society activism. 
  • It is also a reminder that only a democratic process of building durable, programmatic solidarities can become truly capable of transcending the social ceiling of “segmental loyalties”.

News Source: The Hindu

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On Budget 2023: Health in Amrit Kaal

June 5, 2023

Context: 

Recently, in the 2023-24 Union Budget speech, the finance minister announced that the total central government budget for health will roughly be Rs 615 for every citizen.

Concern:

  • This is a 2.7 percent increase from the previous fiscal year and lower than the rate of inflation.
    • In real terms, the central government’s health spending has declined. 

Significance of budgetary spending on health:

  • The small fraction of overall health spending has consequential effects on issues like immunization, newborn and child health and nutrition, maternal health, infectious disease control, health systems and training. 
  • This spending by the government purchases far more health than out-of-pocket or private spending by Indian citizens.

Burden of healthcare in India:

  • Vaccinating a single child against all childhood illnesses costs at least Rs 1,600.
  • A day of hospitalization at a public hospital is estimated at Rs 2,800. At a private hospital, it is Rs 6,800. 
  • Add to these the expenses for supporting women through deliveries, control of infectious disease, primary healthcare, and much more.
  • The system fails the most vulnerable and they are forced to turn to the expensive private sector.The poor, elderly and sick are already at a disadvantage and the burden of health expenditure makes this even worse.

Increasing poor and non-poor gap:

  • A greater proportion of disposable incomes is taken away from a poor household as compared to a non-poor one, further broadening the gap between the two. 
  • According to the WHO, 55 million people fall into poverty or deeper poverty every year due to catastrophic expenditures on health.
  • India’s spending is even lesser than the Lower and Middle-Income Countries. India currently spends 3.2 percent of its GDP on health. 
  • This is much lower than the average health spending share of the GDP — at around 5.2 percent of the Lower and Middle Income Countries (LMIC).

Steps need to be taken:

  • Rationalizing NHM spendings: The National Health Mission allocates less than 3 percent to non-communicable diseases. In comparison, the allocation for communicable diseases is three times more.
  • Balancing Urban and poor health care: Public health and primary health care focus on rural areas. Urban areas have poorly developed infrastructure for primary care even if secondary and tertiary health care services are better. 
  • A third of the country now lives in urban areas and greater resources are needed to improve health here.
  • Focussing on Health research: Health research has been neglected for too long.
  • The bulk of the resources provided to the Indian Council of Medical Research goes towards maintaining a large payroll of scientists and the output is poor.
  • India should follow the example of countries where government-funded health research is conducted at academic institutions, and the government’s role is to make grants and not to carry out the majority of research. 

Conclusion:

  • Health is the most important determinant of what the country can achieve during the next 25 years of Amrit Kaal. 
  • We must find ways to both find more money for health, and also more health for the money to ensure that all citizens achieve their true potential. 

News Source: The Indian Express        

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 Final Result – CIVIL SERVICES EXAMINATION, 2023.   Udaan-Prelims Wallah ( Static ) booklets 2024 released both in english and hindi : Download from Here!     Download UPSC Mains 2023 Question Papers PDF  Free Initiative links -1) Download Prahaar 3.0 for Mains Current Affairs PDF both in English and Hindi 2) Daily Main Answer Writing  , 3) Daily Current Affairs , Editorial Analysis and quiz ,  4) PDF Downloads  UPSC Prelims 2023 Trend Analysis cut-off and answer key
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