Daily Current Affairs

Kerala comes up with Operation AMRITH to tackle AMR (GS Paper 2, Health)

Why in news?

• The Kerala Drug Control Department launched tests in the first week of January 2024 called Operation Amrith (AMRITH - Antimicrobial Resistance Intervention For Total Health) to prevent the overuse of antibiotics in the state.

 

Key Highlights:

• Pharmacies must keep accurate records of antibiotic sales as per this initiative. Additionally, a poster mentioning ‘antibiotics not sold without doctor’s prescription’ should be displayed in the establishment.
• If not complied, strict action would be taken against pharmacies and medical stores that supply antibiotics without doctor’s prescription.
• The public can also participate in this initiative by reporting any pharmacies selling antibiotics without a prescription to the Drug Control Department.

 

Monitoring:

• Operation Amrith is aimed at conducting surprise raids in retail medical shops for detecting OTC sale of antibiotics and also a Toll Free Number is provided for lodging complaints against medical shops, according to the department.
• Once a complaint is received, it will be transferred to the corresponding zonal office for verification and immediate departmental actions will be taken, if violation is detected.

 

Multi-sectoral approach:

• The Kerala government was the first state in India that came up with the state action plan on AMR, KARSAP, in 2018.
• Aligned with India’s National Action Plan on AMR, Kerala’s plan reflected a multi-sectoral approach. Besides human health aspects, it aimed to address animal and environmental dimensions of the AMR problem, which is crucial for effective containment of AMR.
• Delhi-based think tank, Centre for Science and Environment, had actively contributed to the Kerala action plan and has been an implementation partner in the state’s AMR containment efforts.

 

Initiatives:

• After the release of the state action plan on AMR, the Kerala government came up with many initiatives to deal with the issue of AMR in the state.
• This includes the Antibiotic Literate Kerala Campaign, under which the state is taking several initiatives to raise awareness about AMR. In August 2023, Kerala became the first state in India to establish block-level AMR Committees in all 191 blocks.
• With regard to surveillance, the government launched Kerala Antimicrobial Resistance Surveillance Network (KARS-NET) for human use surveillance and developed an integrated AMR surveillance plan in 2018-19 for non-human sector surveillance.
• The Kerala State Pollution Control Board (KSPCB) also inaugurated an AMR laboratory for environmental surveillance of AMR in August 2023.
• Additionally, for proper disposal of unused antibiotics, the Kerala government has come up with the Programme on Removal of Unused Drugs (PROUD), which is a drug take-back programme piloted in 2019 in the district of Thiruvananthapuram.

 

Why focus on AMR?

• The ability of bacteria and other microbes to resist the drugs used to inhibit or kill them is known as AMR. Considered as a ‘silent pandemic’, this phenomenon was associated with being responsible for about five million deaths worldwide in 2019, with 1.3 million deaths being directly attributed to it.
• In 2017, the World Bank estimated that the global increase in healthcare costs are expected to reach up to $1.2 trillion per year by 2050 in a high AMR impact scenario.
• In a similar situation, the world will lose 3.8 per cent of its annual gross domestic product by 2050 and there could be up to 10 million deaths annually, with the most deaths happening in Asia and Africa.

 

Status of medical care on India’s trains

(GS Paper 2, Health)

Context:

• Medical care provisions in the Indian Railways need to address emergency medical conditions, and not accident-related emergencies alone. The Railways need to install a system to capture data on the healthcare needs of people travelling on trains and use that to inform policy

Voice for medical emergencies:

• The Balasore train accident in June 2023 raised important concerns about rail safety, but it was largely about accident-related safety. Due to its high passenger throughput, there is another kind of safety the Railways is responsible for but which is often overlooked, medical emergencies.
• In 2017, 1,076 medical emergencies were reported at the Katpadi Junction railway station in Vellore, Tamil Nadu. A quarter of these emergencies were trauma-related, and the remaining ranged from minor ailments like fever to life-threatening conditions like low blood sugar.
• Nearly one in every 10 emergencies reported at the station’s emergency help desk, operated by the Christian Medical College (CMC) Vellore, required urgent, life-saving intervention.
• Non-communicable diseases like diabetes and hypertension are on the rise in India. In the last few years, the number of deaths due to heart attacks has also risen sharply. Is the Indian Railways prepared to handle medical emergencies that result?

 

Provision of emergency care:

• Medical care provisions in the Indian Railways has evolved to address emergency medical conditions, and not accident-related emergencies alone.
• In 1995, a ‘special first aid box’ was provided in long-distance superfast trains, Shatabdi and Rajdhani. This box consisted of 49 items and was to be used by a doctor travelling on the train.
• An improved version of this kit, called the ‘augmented first aid box’, containing 58 items was provided for specific long-distance trains.
• However, these medical provisions also were found to be inadequate, when they failed to save the life of Netrapal Singh, the Chief Legal Assistant of Railways, who succumbed to a heart attack while travelling from Jaipur to Kota in 2004.
• A petition filed in the Rajasthan High Court in 1996, to improve medical care provision in trains and railway stations, gained momentum after Mr. Singh’s demise. In a 2005 judgment, the Court reported that the reason for underutilisation of the medical team in the pilot phase was a lack of awareness of the service.

 

Guidelines of Rajasthan High Court:

• The Court directed Railways authorities to reserve four berths in long-distance trains to provide medical care and to have a medical team in trains travelling more than 500 km.
• The Court also directed the authorities to adequately advertise the presence of this medical facility in all train compartments and on platforms. However, the Railways appealed this order in 2006 in the Supreme Court.
• It had reserved two berths for medical care, but since critically ill patients had to be deboarded for care and the project had a high cost, the Railways stopped doing this as well.

 

Supreme Court directives:

• Finally, in 2017, the Supreme Court directed the Railways to set up a committee consisting of experts from the All India Institute of Medical Sciences (AIIMS), New Delhi, to recommend further measures.
• Based on the Court’s order and the committee’s recommendations, the Railways determined to modify the contents of the first aid boxes and provide them at all railway stations and in all passenger-carrying trains.
• It also mandated first-aid training for railway staff at the time of joining and once every three years. The committee also recommended a review of service utilisation every three years.

 

The current status:

• In 2018, in response to a question in the Lok Sabha, the Minister of State in the Ministry of Railways replied that all recommendations of the AIIMS expert committee had been implemented.
• In 2021, the Railways also launched an integrated helpline number for all queries concerning the railways, including medical assistance.
• In February 2023, Ashwini Vaishnaw, the Union Minister of Railways, said in the Lok Sabha that deputing a doctor at every railway station had been deemed unnecessary. Yet in December, he said all recommendations of the committee had been implemented.
• Even now, a search on X (formerly Twitter) yields many posts of railway passengers complaining about poor medical services on trains.
• The trains are using the 1995 48-item list rather than the updated 88-item list from 2017.

 

The route ahead:

• Recent advancements in point-of-care diagnostics have revolutionised healthcare. The portable ECG devices and rapid diagnostic kits should be added to identify and treat heart attacks early.
• A more immediate step, however, is for the Railways to ensure the updated 88-item list is in place in all trains and that passengers are aware of these services.
• Periodic inspections are necessary to maintain the quality of care as well.
• Finally, the Railways needs to install a system to capture data on the healthcare needs of people travelling on trains and use that to inform policy.

 

Global surgery, why access to essential surgery is important

(GS Paper 2, Health)

Why in news?

• Global surgery is the neglected stepchild in global health. The neglect is more shocking in South Asia which has the largest population globally lacking access to essential surgery.

 

What is global surgery?

• Global surgery focuses on equitable access to emergency and essential surgery. While it predominantly focuses on low- and middle-income countries (LMICs), it also prioritises access disparities and under-served populations in high-income countries (HICs).
• These “surgeries” include essential and emergency surgeries such as surgery, obstetrics, trauma, and anaesthesia (SOTA).
• Despite small differences, there is largely a consensus across multiple international groups on about thirty procedures that fall under the umbrella of emergency and essential surgery.

 

How far back does global surgery go?

• The year 2015, can be considered the “Annus Mirabilis” or the miracle year for global surgery. It proved to be an inflection point in recognising the importance of surgical care on a global scale.
• One key development that played a significant role in this transformation was the Disease Control Priorities Network (DCPN) report on essential surgery sponsored by the World Bank which highlighted that emergency and essential surgical care is cost-effective; scaling up surgical systems is cost-beneficial; and that there is a large disease burden that is surgically avertable.
• The second development was The Lancet Commission on Global Surgery (LCoGS) which brought together experts and stakeholders to examine the status of surgical care access around the world; ideate the indicators for monitoring surgical care preparedness; systemic capacity and impact; and to develop implementable strategies such as the national surgical, obstetrics, and anaesthesia plan (NSOAP).
• This paved the way for the passage of the World Health Organization Declaration on Safe Surgery (WHO Resolution 68.15) which recognised the impossibility of universal health coverage in the absence of required commitment to emergency and essential surgical systems.
• While 2015 set the stage for popular global surgery, it is critical to note that the history of the field as a whole goes back several decades. The exchange of knowledge and bilateral sharing of trainees under surgical missions in humanitarian settings across various parts of the world in the last century can be considered global.
• Given the focus on reducing disparities, people have also rightly argued that surgeons committed to delivering care in rural and remote parts of the world found global surgery several decades before 2015.

 

Lack of access:

• The magnitude of problems of global surgery is substantial, encompassing a range of challenges including inaccessibility, disease burden, and economic burden.
• The LCoGS noted that five billion people or over 70% of the global population lack timely access to safe and affordable surgical care when needed.
• Most severely, 99% and 96% of the people in low- and lower-middle-income countries (LLMICs) respectively, face access gaps compared to 24% in high-income countries (HICs), which points to a glaring global disparity.
• Of the five billion people, over 1.6 billion people lacking access live in South Asia. This translates to over 98% of the South Asian population lacking access to safe and affordable SOTA care.

 

Impacts:

• In 2010, around 17 million deaths were attributed to surgically treatable conditions, surpassing the combined mortality burden of HIV/AIDS, tuberculosis, and malaria; emphasising the need for improved access.
• South Asia contributed to 50.46%, 32.49%, 26.67%, and 33.35% of the surgically avertable burden of neonatal and maternal diseases, congenital anomalies, digestive conditions, and injuries respectively.
• The disease burden also leads to an economic burden. The cumulative projected loss to GDP due to the absence of scale-up of surgical care are estimated to be $20.7 trillion (in purchasing power parity terms) across 128 countries by 2030.
•  The annual loss in societal welfare was about $14.5 trillion for 175 countries. South Asia contributes to about 7% of the global lost welfare.

 

Neglect in national policymaking:

• Regardless of the disease and economic burden, surgery gets neglected in policies and health planning at the international level. The LCoGS noted that surgery contributed to <1% of all indicators mentioned in the World Bank, WHO, UNICEF, and other reports. Neglect is also present in national policymaking.
• An analysis of National Health Strategic Plans from 43 African countries noted that 19% did not mention surgery or surgical conditions at all while 63% mentioned surgery only five times or less. Similarly, an analysis of 70+ years of policymaking in India also noted limited and decreasing attention to surgery.
• The most recent National Health Policy (2017) had only two mentions of the partial phrase — “surg”.
• While The Lancet Commission on Global Cancer Surgery noted that surgery is central to national cancer control plans, India’s new guidelines on non-communicable diseases (2023) that focuses on cancer heavily has sparse mention of surgery.

 

Lack of research:

• A cursory bibliometric analysis reveals that in 2022, there were only 315 ‘global surgery’ titles (1.5%) in the Pubmed database compared to 21,453 ‘global health’ titles. Research is in turn tied to research funding. For instance, the biggest research funder for healthcare in the U.S. is the National Institutes of Health (NIH).
• In 2021, NIH funded 1,500 large research projects (R01 grants) worth $750 million of which only 40 projects worth $22 million were related to surgery and only one was about global surgery. Neglect in policy, financing, and research and all interrelated with one driving another.

 

What’s next?

• Work from LCoGS and DCPN depicted that emergency and essential surgical care is cost-effective and cost-beneficial.
• At least 30 LLMICs now have some subnational data on their surgical care indicators, the largest one being India. Several African countries have drafted and implemented NSOAPs showing strong political and policy commitment since 2015.
• In South Asia, Pakistan has formulated a National Surgical Care Vision, Nepal has initiated an NSOAP, and the Pradhan Mantri Jan Arogya Yojana has provided millions of surgeries at zero or negligible cost to the bottom 40% of Indians. Research and innovation, policy focus, and sustained financing are key to solving global surgery challenges.