📰 It’s complicated, say Delhi’s ‘notionally unwanted girls’
Economic Survey puts their number at 21 million nationwide
•Sonia Malhotra, 42, says she never felt unwanted growing up, but remembers the subtle differences in the way her parents treated their three daughters compared to the two sons.
•“My sisters and I were not allowed to pursue sports or studies to the extent we wanted. Our parents never explicitly talked about their decision, but they stopped having children after my youngest brother was born. They had had one boy, followed by three girls and then a son,” she says.
•While the Economic Survey, tabled in Parliament on January 29, says 21 million girls in India were “unwanted”, families covered by the statistic say the situation is not that easy to explain.
•Coming up with the first such estimate of “notionally unwanted girls”, the survey calculates the difference between the actual sex ratio and the ideal sex ratio for each birth order. “While active sex selection via fetal abortions is widely prevalent, son preference can also manifest itself in a subtler form,” the survey says, leading to fewer resources for girls.
•By looking at the sex ratio of the last child (SRLC), the survey is able to estimate if there is a preference for a male child. If there was no preference, then the number of boys and girls born, irrespective of the birth order, would be around the same.
•Delhi, which ranks second after Haryana in terms of sex ratio at birth (with around 1,191 males per 1,000 females), has an SRLC tilted heavily towards males. For every 1,000 females, there are around 1,750 males when it comes to SRLC.
•Radha (name changed), a mother of four, says the decision to have a third child after two daughters was economic. “My husband and I are daily wage earners and our son is like insurance and social security,” she says.
•For 24-year-old Sameer (name changed), growing up with two sisters 16 and 12 years older than him, the question of whether his parents were waiting to have a boy did come up in his mind.
•“But, now I think that it wasn’t really planned. My middle sister did think that I was given more freedom, but I don’t know whether it was because I was a boy or because I was born to affluent parents. While when my sisters were born, our parents were in their 20s and struggling to establish themselves in life,” he said.
•While many families do not see their daughters are unwanted, the falling child sex ratio in Delhi (from 917 girls for 1,000 boys in 1991 to 866 in 2011) raises grave concerns.
•In a statement to The Hindu, Population Foundation of India said: “The falling child sex ratio is a grim reminder of India’s continuing aversion to the girl child...Delhi has joined Punjab and Haryana in the list of wealthy states where discrimination against the girl child is greater as compared to less affluent states”.
📰 The lowdown on pulse polio
What is it?How did it come about?Why does it matter?What next?
•On January 28, India carried out the first of its two national rounds of the Pulse Polio Campaign for 2018. The second is on March 11. These two campaigns will see a huge mobilisation of resources to give the oral polio vaccine (OPV) to around 17 crore under-five children. Why do Indian policy-makers continue to focus on polio, though the Southeast Asian region, including India, became polio-free in 2014? This is because the threat of resurgence is real and can happen in two ways. As of today, two countries — Pakistan and Afghanistan — still have circulating polio. And the polio virus can cross borders easily through adults who show no symptoms. In 2011, 10 years after becoming polio-free, China’s Xinjiang province saw 21 cases of paralytic polio and two deaths. When the virus from the outbreak was sequenced, it turned out to be from Pakistan. In 2009, India exported polio to Tajikistan, where it caused an outbreak of 587 cases. Today, India’s only defence against the import of polio is watertight immunisation. A small gap in immunisation among newborns can be enough for the imported virus to seep in.
•The second risk of resurgence comes, ironically, from OPV itself. In rare cases, this vaccine, which contains weakened but live polio virus, can cause paralytic polio. Also, because the vaccine-virus is excreted by immunised children, it can move from one person to another. This makes OPV a double-edged sword. On the one hand, a vaccinated person protects unvaccinated people he/she comes in contact with by spreading immunity through faeces. But on the other, such circulation allows the virus to stick around and mutate to a more virulent form, raising the spectre of vaccine-derived poliovirus (VDPV). VDPV, like imported wild polio, can cause outbreaks in under-immunised population. It is for this reason that the eradication of polio worldwide requires OPV to be stopped and replaced with the Inactivated Polio Vaccine (IPV). IPV does not cause VDPV but protects children equally well against polio.
•Indian researchers started experimenting with the strategy of ‘pulse’ immunisation in the 1980s. By then, OPV was a part of India’s Expanded Programme on Immunisation, but polio burden remained high, with 1,000 children becoming paralysed each day. The success of the programme was being thwarted by low coverage of the vaccine, problems with potency and blunted immune response among Indian children. Against this background, a group of researchers, led by Vellore-based virologist T. Jacob John, championed the idea of pulse campaigns. While routine immunisation waits for parents to bring their children to the clinic, something that many parents do not do, pulse campaigns try to give a ‘pulse’ of vaccine to an entire population in one go. Dr. John suggested that routine immunisation worked in developed countries, because parents were motivated to vaccinate their children. But India needed a different strategy.
•An early experiment in Vellore in 1978 showed that pulses delivered to a large cohort of children gave them strong immunity even when the vaccine was not so potent. This was because vaccine pulses rapidly replaced the wild-polio virus circulating in the community with the vaccine-virus. Vellore was the first Indian town to become polio-free through the pulse strategy, and the rest of India adopted the strategy in 1995.
•Out of the three wild-types of poliovirus that cause the disease, the transmission of one, Wild Poliovirus 2 (WPV-2), was interrupted successfully more than a decade ago.
•The two remaining viruses that are circulating in Pakistan and Afghanistan are WPV-1 and WPV-3. Once we stop these two viruses in their tracks, OPV will be phased out and replaced globally with IPV.
📰 The progress India makes will have a significant impact: Yohei Sasakawa
The fight against leprosy is far from over, says the WHO Goodwill Ambassador for Leprosy Elimination
•Yōhei Sasakawa, who is chairman of the Nippon Foundation, and the World Health Organization Goodwill Ambassador for Leprosy Elimination, was in India recently as part of the “The Global Appeal-2018”. The event aims to end the discrimination faced by people affected by leprosy, and their families, worldwide. Mr. Sasakawa, who is also Japan’s Ambassador for the Human Rights of People Affected by Leprosy, spoke to The Hindu about the challenges before India, which accounts for the largest number of cases of leprosy in the world, and his organisation’s partnership in fighting the battle. Excerpts.
Where does the war on leprosy find us in 2018? Where do we stand in terms of winning this battle? Are there cases still coming in? Which are the areas that are the worst affected and why?
•Leprosy is an age-old disease, described in the literature of ancient civilisations. Throughout history, people afflicted have often been ostracised by their communities and families. The first cure for leprosy emerged in the 1940s, but the important breakthrough came in the early 1980s with the introduction of a highly effective treatment, multi-drug therapy (MDT).
•In 1991, the WHO set a target to eliminate leprosy as a public health problem, defining elimination as a prevalence of less than 1 case per 10,000 population. Since 1995, the WHO has provided MDT free of cost to all leprosy patients in the world. Free MDT was initially funded by The Nippon Foundation and since 2000, is being made available by donations through an agreement with Novartis. More than 17 million leprosy patients have been treated with MDT over the past 30 years.
•Although the annual number of new cases has dropped dramatically since the pre-MDT days, there are still some 200,000 new cases reported around the world each year. There were 214,783 new leprosy cases registered globally in 2016, according to official figures from 145 countries in the world. Of these, 11 countries, among them India, Brazil and Indonesia, reported more than 1,000 patients, among them India, Brazil and Indonesia, with India accounting for more than 60% (135,585 cases) of all new cases.
•Elimination of leprosy as a public health problem, at the national level, has been achieved by almost every country and we believe that 2018 could be a milestone year if Brazil too reaches this point. It would mean every country has now reached the elimination threshold of less than 1 case per 10,000 population.
•But this does not mean that the fight against leprosy is over. That’s why this year, our partnership with Disabled Peoples’ International (DPI) and its Global Chair, Javed Abidi, is very significant. So far, 91 Member National Assemblies (MNAs) of DPI from around the world have endorsed the Global Appeal 2018.
What are the major problems that you face in terms of total eradication of leprosy?
•The challenge is two-fold. There is the medical dimension of continuing transmission of leprosy, with some 200,000 new cases being diagnosed each year. There is also the social dimension in which stigma and discrimination impact the lives of people diagnosed with leprosy and even their families. Fear of discrimination can be a reason why people hesitate to seek treatment, which means they could be passing the disease to others and also putting themselves at risk of developing life-long disabilities.
Who are the worst affected?
•Leprosy affects men and women, adults and children. But factors such as gender discrimination can mean that women and girls are impacted disproportionately by the consequences of leprosy. Children accounted for around 9% of new cases in 2016 and there is now a concerted effort to reduce the number of leprosy cases among them to zero by 2020.
Where does India stand in this fight?
•India accounts for the largest number of cases of leprosy in the world. It is now making concerted efforts to detect and treat cases early with special leprosy-case detection campaigns and other activities. There is also momentum to address outdated legislation that discriminates against persons affected by leprosy. The progress India makes in tackling leprosy will have a significant impact on the global situation.
What are the shortcomings here?
•There is yet no prophylactic vaccine available for leprosy, so early detection and treatment with MDT form the cornerstone of efforts against the disease. Ensuring that all cases are diagnosed and treated promptly remains a challenge among hard-to-reach and marginalised populations. Further efforts at educating the public about leprosy are needed so that people don’t fear coming forward to seek treatment. Those who have been treated and cured do not face discrimination in their daily lives.
📰 Fishing in troubled waters is now costly
•When Tamil Nadu Chief Minister Edappadi K. Palaniswami wrote to Prime Minister Narendra Modi last month, voicing concern about Sri Lanka’s recent decision to impose steep fines on any foreign vessel found fishing in the island’s territorial waters, he was simply following his late leader Jayalalithaa’s footsteps.
•In 2015, she wrote at least 21 letters to the Prime MInister, asking New Delhi to put pressure on Sri Lanka to stop arresting Tamil Nadu fishermen. In 2016, until October, she wrote 22 similar letters, according to officials. Whether it was O. Panneerselvam as Chief Minister, or V.K. Sasikala as the interim general secretary of the ruling AIADMK after Jayalalithaa’s passing, the top leadership has been consistent in this matter. However, Sri Lanka appears to be firm in its position. Amending its exiting Fisheries Act, Colombo has decided to impose anything between LKR 6 million (approximately ₹25 lakh) and LKR 175 million, as fine on foreign vessels fishing in its seas.
•‘Fishermen follow fish and fish know no boundaries’ is a common refrain in Tamil Nadu, when it comes to taking a position on the highly-contested Palk Bay fishing conflict. But for all practical purposes, the International Maritime Boundary Line (IMBL) demarcates territory clearly, and most vessels used by Tamil Nadu fishermen — often bottom-trawlers known for their destructive technique that virtually scrapes the sea bed — have GPS systems installed, enabling fishermen to follow their course easily. The issue continues to be a talking point in high-level bilateral meetings, in addition to figuring extensively in the discussions of the Joint Working Group set up by the neighbouring countries to resolve the problem that has been dragging on for a decade.
Proactive measures
•Following years of bilateral deliberation and the consistent resistance put up by Sri Lanka’s northern fishermen, the two governments came up with some proactive measures. On Tamil Nadu’s part, with assistance from the Centre, efforts are on to convert bottom-trawlers into boats suitable for deep-sea fishing. The State hopes to get 500 deep-sea vessels ready for use this year, according to sources in the Tamil Nadu government.
•This, along with Sri Lanka’s ban on bottom-trawling in July 2017, has had some welcome impact. Both the Sri Lankan Navy and the northern fishermen based in Jaffna and Mannar have observed that fewer Indian trawlers are spotted in their waters. However, that their Tamil Nadu counterparts are yet to completely stop trespassing is worrying the northern fishermen.
•According to the Department of Fisheries and Aquatic Resources in Colombo, as many 49 Indian fishermen have been arrested from the beginning of this year, and 10 of their boats confiscated. Though some are sceptical about using strong legislation while responding to what is fundamentally a livelihood issue, others feel that is the only option in the absence of other safeguards for fishermen in the war-affected regions in the north. It is in this context that the northern fishermen welcome the higher fines.
•Experts have put forth a range of other suggestions, including setting up an autonomous international authority to manage the Palk Bay and its depleting marine resources — initiatives that will warrant much thought, time and effort from both ends. As for northern fishermen, they only wish that Tamil Nadu will take a more honest and comprehensive look at the problem, while making a case for the livelihoods of the fisher-folk in the State.
📰 India’s growth depends on northeastern States: Modi at Global Investors' Summit
Prime Minister calls for greater links with ASEAN
•Prime Minister Narendra Modi on Saturday said India’s growth depends on how fast the eight-State northeast grows.
•Addressing potential investors and industry captains at an international event, Advantage Assam, Mr. Modi said the northeast was destined to take the centre stage of the Centre’s Act East Policy, which aims at taking India’s trade and cultural ties with eastern neighbours and the ASEAN bloc to greater heights.
Connectivity is key
•Connectivity is key to developing the region, the reason why the governmenthas adopted the motto of “transformation by transportation” to change the face of the northeast, Mr. Modi said.
•“The mindset that nothing can change in India has changed, and this is showing in the speed of work such as expansion of road and railway network,” the Prime Minister said.
•The Centre has sanctioned ₹47,000 crore for 115 new railway lines and ₹90,000 for rural roads and National Highway projects in the region, he pointed out.
•Mr. Modi also made it clear that the future of the northeast lies in its trade and cultural ties with the ASEAN, a group of countries with whom India has enjoyed thousands of years of relationship.
•“Formal India-ASEAN ties may be 25 years old, but our association has been there for ages. So have been our ties with Bangladesh and Bhutan,” the Prime Minister said.
•The country, he added, is moving towards qualitative change with a slew of measures for the poor and the middle class, as proposed in the Budget.
•“But the Indian growth engine cannot run smoothly if the Northeast, which needs to develop fast, is left behind,” he said.
‘Will help Bhutan too’
•Mr. Modi’s Bhutanese counterpart, Dasho Tshering Tobgay said India’s Act East Policy would be as much of an advantage for Bhutan as it would be for Assam.
•“For Bhutan, India is an elder sibling, not a big brother. And for India, Bhutan is a younger sibling. Our relationship with India begins with Assam, with which we share more than just a boundary,” Mr. Tobgay added.
•But the Bhutanese Prime Minister virtually stole the thunder from host Assam and India, reminding that the Himalayan country offers more ease of doing business and is low on corruption.
•“Bhutan is 85th among all countries in ease of doing business, and we are trying to break into the top 50 soon. Transparency International says we are 27th on the corruption index, and 13th on the global peace index, which indicates we are among the most stable countries,” Mr. Tobgay added.
•He also referred to the International Monetary Fund’s forecast of 11.2% GDP growth for Bhutan in 2018, which is the second fastest in the world.
Cheapest power
•“Besides, we offer the cheapest power in the world at ₹2.23 per unit, and thanks to a free trade agreement, India is our market. So Advantage Assam is Advantage Bhutan,” he said.
•Apart from erratic supply, power in Assam for industrial units cost ₹6.20-7.25 per unit depending on the size.
•A host of Union Ministers, including Suresh Prabhu, and heads of major corporate houses attended Saturday’s inauguration of the two-day programme that the Sarbananda Sonowal-led Assam government is hosting.
📰 Maldives govt. yet to implement SC ruling
Opposition leaders are still in prison, Parliament session deferred; President Yameen says court order was unexpected
•Nearly 48 hours after the Maldives Supreme Court overturned the conviction of nine opposition leaders, including the exiled former President, Mohamed Nasheed, the Male administration is yet to release them, raising domestic and international concern over the delay.
•On Saturday, authorities indefinitely postponed Monday’s Parliament session, citing “security reasons”, and the government dismissed the acting police commissioner from the post, a day after it sacked the police commissioner, following a tweet from the Maldives police saying it would uphold the Supreme Court ruling.
•The Joint Opposition, including the Maldivian Democratic Party (MDP) led by Mr. Nasheed, has expressed concern over President Abdulla Yameen’s “refusal” to abide by the ruling. “We are deeply fearful that the government’s refusal to implement the Supreme Court order could escalate unrest and incite violence across the country,” it said in a statement.
•The government has maintained that it needed to “vet and clarify the order”. “No deadlines are being considered at this point — the focus is on , through consultations, implementing the ruling in the swiftest manner possible within the proper rules of procedure,” Ibrahim Hussain Shihab, the international spokesperson at the President’s office in Male, told The Hindu.
•President Yameen has said he did not expect the ruling. In a report published on Saturday evening, the Male-based Maldivian Independent quoted Mr. Yameen as saying: “I didn’t expect this Supreme Court ruling at all, but as they are the top court and there’s a ruling, the state and all relevant authorities have to do a lot of work to see how to implement it.”
Ready for polls
•Addressing supporters gathered in Male, Mr. Yameen said: “If they [the Opposition] need to see who has support now, if it takes holding elections early I would do that.”
•The administration has neither released the nine persons, nor reinstated the 12 parliamentarians expelled earlier for defecting, despite the order mandating both. If reinstated, the legislators would raise the Opposition number in Parliament to a majority. The developments have sparked greater anxiety among locals critical of the Yameen administration.
•“I hear that my husband has been shifted to another prison and kept in isolation,” Mariyam Nashwa, wife of former Vice-President Ahmed Adeeb, told The Hindu over telephone. Mr. Adeeb was among the nine persons the apex court named for immediate release, pending a fresh trial.
•For months, Ms. Nashwa has been pleading with the authorities to grant medical leave to her husband who was diagnosed with glaucoma. “He has also been advised cancer screening, but even after the ruling, the government is refusing to release him.”
•After the ruling, India, the U.S. and the EU, among others, have urged the government to respect the order and ensure that democracy and rule of law prevail.
•Top UN officials and human rights watchdogs are also putting pressure on Male to comply with the order. The UN Secretary-General even offered to facilitate all-party talks to find a solution to the “political stalemate” in the Maldives.
•“For the rule of law to retain any meaning, this ruling must be implemented and the witch-hunt against the political Opposition and other critics must come to an end,” said Biraj Patnaik, Amnesty International’s South Asia Director.
•Following inaction for two days, countries, including the U.K., have issued travel advisories warning visitors of possible violence in Male, given the mounting frustration among people awaiting government action.
📰 ‘N. Korea is flouting sanctions’
It exported banned commodities, earning $200 million in revenue : UN report
•North Korea is flouting sanctions by exporting coal, iron, steel and other banned commodities, earning nearly $200 million in revenue last year, a UN report said on Friday.
•A UN panel of experts also found evidence of military cooperation by North Korea to develop Syria’s chemical weapons programmes and to provide Myanmar with ballistic missiles.
•North Korea “continued to export almost all the commodities prohibited in the resolutions, generating nearly $200 million in revenue between January and September 2017,” said the report by the experts.
Multiple evasions
•Coal shipments were delivered to China, Malaysia, South Korea, Russia and Vietnam by ships using “a combination of multiple evasion techniques, routes and deceptive tactics,” said the report.
•The Security Council last year adopted a series of resolutions to tighten and expand exports bans aimed at cutting off revenue to North Korea’s military programs.
•Seven ships have been barred from ports worldwide for violating UN sanctions with coal and petroleum transfers, but the experts said much more must be done to confront “these rampant illicit activities.”
•The panel found that North Korea “is already flouting the most recent resolutions by exploiting global oil supply chains, complicit foreign nationals, offshore company registries, and the international banking system.”
📰 Higher MSPs for farmers won’t accelerate inflation: analysts
Non-perishable agri products may see slight price rise till MSPs come into effect
•The announcement of a Minimum Support Price (MSP) of 1.5 times the farmer’s cost will likely not have a strong upward impact on overall inflation but could spur a waning of the sharp slowdown in food price gains seen in 2017, according to officials and economists.
•In the short term, a slight increase in prices of non-perishable farm products is possible as producers hold on to produce till the higher MSPs come into effect around September or October. The increase in MSPs would come into effect when the Kharif crop came into the market, Economic Affairs Secretary Subhash Chandra Garg had told The Hindu, adding he did not expect any impact in the first six months. However, there was the possibility of an induced effect as farmers held stocks in expectation of a higher price, he said.
Price expectations
•Farmers would hold on to crops only if current prices were lower than 1.5 times the cost of production, economists said, adding that the inflationary impact of higher MSPs would be felt only if food prices fall fell below that level. “If prices are currently depressed and we know that in the future it will be 1.5 times the cost, then the prices may start going up right now,” said Ranen Banerjee, partner and leader - Public Finance and Economics at PwC India. “The non-perishable products, and those that can be stored, will be held till that time.”
•Food inflation decelerated in 2017 at both the wholesale and retail levels. The ‘food and beverages’ category of the Consumer Price Index went from a strong growth of 7.2% in May 2016 to a contraction of 0.2% in May 2017. Similarly, the food part of the primary articles segment of the Wholesale Price Index went from a growth of 6.82% to a contraction of 2.13% over the same period. These plummeting prices due to excess supply had hurt farmers, forcing the government to act.
•The nature of MSPs and the fact that government has limited funds to use to buy crops at that price, would contain inflationary expectations, said D.K. Srivastava, Chief Policy Advisor at EY India.
•“MSPs don’t come into effect until market prices dip. And even if they dip, government’s ability to purchase at MSP is based on budget allocation. Currently, only limited purchases are done due to budget and quality considerations. If all the crops were to be bought, then the budgetary allocation would have to be much higher,” he said.
•Mr. Banerjee added that due to this nature of MSPs, that they kick in only when market prices dip, the upward effect on inflation may be limited, but now even the sharp downward trend seen in the middle of 2017 will no longer take place.
•“It is not necessarily going to have a higher inflationary effect,” Mr. Banerjee said. “But yes, there won’t be a sharp downward movement or drop in prices.”
📰 More efficient desalination with crystalline carbon dots
After 9 cycles, 78% of the original efficiency was seen
•Researchers at Indian Institute of Technology (IIT) Guwahati have been able to synthesise highly crystalline carbon dots by doping them with nitrogen, sulphur and phosphorus. The amount of phosphorus defined the extent of crystallinity. Unlike an amorphous material, less light was scattered or reflected from crystalline carbon dots on shining light. Instead, the crystalline material efficiently converted the absorbed light energy into heat energy.
Simulated sunlight
•The team led by Prof. Arun Chattopadhyay from the Department of Chemistry successfully used the crystalline carbon dots for desalinating seawater by exposing the carbon dots to simulated solar conditions. “The doped carbon dots were not only able to convert light into heat energy but were also able to interact with water and transfer the heat energy to water thus raising its temperature,” says Prof. Chattopadhyay.
•Compared with carbon dots that were doped with all the three elements, those doped with only nitrogen and sulphur were amorphous in nature. “When only nitrogen and sulphur are present the polycyclic carbon does not arrange in a particular manner, making it amorphous. But phosphate esters that form when phosphoric acid is added bond the polycyclic fragments. That is what makes it crystalline,” says Dr. Gayatri Natu from the Department of Chemistry, IIT Guwahati and a coauthor of a paper published in Journal of Materials Chemistry A.
•The three- and two-element carbon dots added to water (with concentration up to 250 mg per millilitre) and exposed to simulated sunlight under reduced pressure showed wide variability in their ability to transfer heat energy to water.
•There was 43.5% evaporation of water within 15 minutes in the case of carbon dots doped with three elements and only 38.3% with carbon dots doped with only nitrogen and sulphur. “When we calculated the solar thermal evaporation efficiencies under standard atmospheric pressure, carbon dots doped with three elements had nearly 84% efficiency. It was about 44% with carbon dots doped with only nitrogen and sulphur,” Prof. Chattopadhyay says.
Thorough testing
•The team tested the ability of the doped carbon dots to desalinate seawater samples from Bay of Bengal, Persian Gulf and a sample with average sea water salinity. Maximum desalination was achieved with carbon dots doped with three elements in the Bay of Bengal water sample — 43% evaporation of the initial volume in 15 minutes. Only 35.5% seawater evaporated during the same time in the case of carbon dots with two elements.
•They tested the doped carbon dots’ ability to desalinate seawater even when the salt concentration was in excess. To do this, more seawater was added to the residual seawater after each cycle and the desalination efficiency was tested for nine cycles.
•“The doped carbon dots with nitrogen, sulphur and phosphorus elements retained up to 78% of the original desalination efficiency even at the end of the ninth cycle,” says Ayan Pal from the Department of Chemistry, IIT Guwahati and first author of the paper. “The doped carbon dots can be reused by removing excess salt through dialysis.”
•Recalling how they stumbled upon doped carbon dots for desalination, Prof. Chattopadhyay says: “We have been working with doped carbon dots and investigating their properties. We found that one set of doped carbon dots was highly crystalline. Since we were interested in the production of hydrogen from water using sunlight we tested these crystalline carbon dots. Though it didn’t produce hydrogen gas, it was evaporating water quickly. So we started testing it for desalination.”
•“We are now trying to make doped carbon dots that are super crystalline so that energy is even more efficiently converted into heat. We also trying to make a film or sponge-like device that floats on water and evaporates water by converting sunlight into heat,” Prof. Chattopadhyay says.
📰 Look for proof
•Policymaking, especially in health, is a complex process. Here, research that guides the process of policymaking is one of many contributing factors, the others being political aspects, interests of key stakeholders, feasibility of the policy, alignment with other policies, and consonance with the larger vision of the government. It is vital that India’s health policies are based on the best available evidence-based research.
Capping stent prices
•For example, a lot has been written on how the National Pharmaceutical Pricing Authority’s (NPPA) decision, taken a year ago, to cap prices of advanced medical equipment, was a recipe for a public health crisis. There is now consensus that price regulation in an otherwise free-functioning market would eventually create inefficiencies. However, effects are often diffused and take time to surface.This makes finding evidence of the impact of such policies ex-post necessary, thereby providing guidance to policymakers to tweak and refine their policy goals and strategies.
•In the example above, the policy was envisaged to make angioplasty procedures more accessible. But did this come about? IQVIA and the Advanced Medical Technology Association (AdvaMed), which comprises nearly 300 global medical technology companies, have released a paper to show that the NPPA’s decision, to cap prices of cardiac stents, was actually bereft of economic logic. The study, conducted a year after the price cap policy came into effect, found that benefits to patients with coronary heart disease and the growth in the number of angioplasty procedures did not significantly change in this time. The study also found that the price cap on stents by as much as 85% resulted in 8-18% reduction in the overall angioplasty procedure cost for patients undergoing single vessel procedure (which accounts for almost three quarters of all angioplasty patients) in private hospitals. Patients at government-run hospitals did not benefit significantly because stents were, in any case, available at below the effective price after capping.
•So, public policies need to be carefully designed. The approach by the NPPA in regulating price devices greatly underestimated the value of policy design. The study shows that the NPPA’s planned actions did not result in representing a realistic and viable means of achieving improved access to affordable health care for people. There is now empirical proof that the big drop in prices due to the policy did not significantly alter the growth rate of angioplasties across hospitals of different segments in the country.
Disease burden
•India faces a growing burden of non-communicable diseases, with cardiovascular diseases at the forefront. In this context, our reliance on any provider of safe, innovative and effective medical devices, which includes cardiac stents, cannot be undermined. By 2020, India is projected to have the highest population of youth, and, by 2027, the world’s largest workforce with a billion people aged between 15 and 64 years. We need to ratchet up medical infrastructure and strengthen the health-care ecosystem so that our demographic dividend does not become a demographic disaster.
•We should adopt public policies that have some empirical support and backed by scientific research. If reason and research point to the contrary, then price caps must go. We can consider alternative measures such as trade-margin rationalisation and differential pricing of medical devices, combined with categorisation, on the basis of the clinical status of patients. These long-drawn but concrete ways will increase accessibility to quality health care, boost innovation, and, most importantly, assist the government in achieving the goal of universal health coverage.
•When the NPPA said that it would reconsider its decision to cap prices, it was perhaps hoping to somehow, carefully and logically, ground its decision. There is evidence now. The NPPA must demonstrate that its actions can not only be cost effective and beneficial but also preserve incentives for innovation to make our health-care system robust in the long run.
