EDITORIALS

• Revamp India’s school health services

Context: As schools reopen, there is a need and an opportunity for States to look at a comprehensive package of services.

Highlights:

• Children across India are back to school for in-person classes after an unnecessarily prolonged and arguably unwarranted closure in the wake of the COVID-19 pandemic.
• It is time for concrete policy measures and actions that target schoolchildren.
• On the education front, while there has been some discourse on ‘learning recovery’, there is an urgent need to factor in the health needs of schoolchildren.
• One of the reasons school health services receive inadequate policy attention is because Health-care needs are often equated with medical care needs.
• Though school age children have a relatively low sickness rate (and thus limited medical care needs), they do have a wide range and age-specific health needs that are linked to unhealthy dietary habits, irregular sleep, lack of physical activity, mental, dental and eye problems, sexual behaviour, and the use of tobacco and other substances, addiction, etc.
• Then, the health knowledge acquired, and lifestyle adopted in the school-going age are known to stay in adulthood and lay the foundations of healthy behaviour for the rest of their life.
  • For example, scientific evidence shows that tobacco cessation efforts are far more successful if started in school.

The Evolution

• The first documented record of School Health Services in India goes back to 1909 when the then presidency of Baroda began the medical examination of schoolchildren.
• Later, the Sir Joseph Bhore committee, in its 1946 report, observed that School Health services in India were underdeveloped and practically non–existent.
• In 1953, the secondary education committee of the Government of India recommended comprehensive policy interventions dealing with school health and school
• feeding programmes.
• The result was programmatic interventions, led by a few selected States, that mostly focused on nutrition.
  • However, school health has largely remained a token service.
• In two and half years of the COVID-19 pandemic, there has barely been any serious initiative about school health. In the first week of March 2022, the government of Delhi began 20 school health clinics with the promise of more.
• Though small, this initiative has two messages:
  • It recognises the importance of school health services in the post-pandemic period.
  • The importance of multi-stakeholder partnership for school health services as these are being set up through corporate social responsibility funding from a donor on the one hand and internal collaboration between health and education departments within government on the other.
• On a flip side, by the Delhi government’s own assertion, these clinics are curative focused services.
• They also highlight the main issue: what makes comprehensive school health services has still not been fully understood.

FRESH Approach

• One of the reasons for wrongly designed, and often very rudimentary, school health services — not only in India but also in most low and middle-income countries — is, arguably, limited understanding and clarity on what constitutes well-functioning and effective school health services.
• This situation co-exists in spite of much evidence guided by international literature.
• UNESCO, UNICEF, the World Health Organisation (WHO) and the World Bank have published an inter-agency framework called FRESH — Focusing Resources on Effective School Health. 
• The FRESH framework and tools propose four core areas and three supporting strategies.
  • The core areas suggest that school health services need to focus on school health policies, i.e.
    • Water,
    • Sanitation and the environment, 
    • Skills-based health education and 
    • School-based health and nutrition services. 
  • The supporting strategies include :
    • Effective partnerships between the education and health sectors,
    • Community partnership and student participation.
• Additionally, guidelines by the Centres for Disease Control and Prevention, Atlanta, U.S. advise that school health services should focus on four main areas:
  • acute and emergency care;
  • family engagement;
  • chronic disease management; and 
  • care coordination.
• According to WHO , school health services should be designed based on local need assessment; should have components of health promotion, health education, screening leading to care and/or referral and support as appropriate.
• The objective of school health services has to be the promotion of positive health, prevention of disease, early diagnosis, treatment and follow up, raising health consciousness in children and enabling the provision of a healthy school environment.
• In the last three decades, many countries ( especially in Europe), have successfully implemented these approaches as part of the health-promoting schools (HPS) initiative.

Opportunity in Reopening

• As schools reopen to full capacity, there is a need and an opportunity for a proactive approach for having expanded and strengthened school health services.
  • Every Indian State needs to review the status and then draw up a road map to revamp and strengthen school health services, along with a detailed timeline and dedicated budgetary allocation.
    • The Fifteenth Finance Commission grant for the health sector should and could be leveraged.
  • Build upon the existing school health infrastructure; the renewed focus has to have comprehensive, preventive, promotive and curative services with a functioning referral linkage.
    • Health talks and lifestyle sessions ( by schoolteachers and invited medical and health experts) should be a part of teaching just as physical activity sessions are. 
    • Some of the teaching must look at adolescent sexual health; also, subjects such as menstrual hygiene, etc. should be integrated into regular classroom teaching.
  • School health clinics should be supplemented with online consultation for physical and mental health needs. 
    • This could be an important starting point to destigmatize mental health services.
  • The role and the participation of parents, especially through parent-teacher meetings should be increased.
    • Parents need to be sensitised about how school health services are delivered in other countries; this may work as an important accountability mechanism to strengthen school health. 
    • Innovative approaches that offer limited health services to parents, families and even schoolteachers could increase use, acceptance and demand.
  • The Government’s school health services initiatives do not include private schools most of the time. 
    • Private schools do have some health services, which are nearly always restricted to curative care and taking care of emergencies.
    • Clearly, school health services should be designed to take care of schoolchildren be they in private or government-run schools.
  • Under the Ayushman Bharat programme, a school health initiative was launched in early 2020, but its implementation is sub-optimal.
    • There is a need to review this initiative, increase dedicated financial allocation to bring sufficient human resources and monitor performance based on concrete outcome indicators.
    • Otherwise, it will end up being a ‘missed opportunity’.
  • Children are the future of society, but only if they are healthy and educated.
    • Therefore, elected representatives, professional associations of public health and paediatricians shoulder the responsibility, every citizen should raise the issue and work towards improved school health services being present in every State of India. 
• Such an approach on an issue that needs a thorough approach is akin to ‘tokenism’.
  • India’s children need better handling than this.

Way Forward:

• Every challenge has a silver lining.
• The onus is on health policy makers and programme managers in every Indian State to do everything in the best interests of children.
• The Departments of Education and Health in every Indian State must work together to
• strengthen school health services. 
  • It is an opportunity to bring children, parents, teachers, health and education sector specialists and the Departments of Health and Education on a common platform to ensure better health and quality education for every child in India. 
• A convergence of the National Health Policy, 2017 and National Education Policy, 2020 should result in the provision of comprehensive school health services in every Indian State.

Source: TH

• India-Vietnam ties, from strong to stronger

Context: As New Delhi pursues its ‘Act East Policy’, Hanoi has become a valuable partner in the Indo-Pacific region.

Highlights:

• India and Vietnam are celebrating the 50th anniversary of their diplomatic relations.
• Bolstering friendship between the two countries is a natural outcome of a growing convergence of their strategic and economic interests, and also their common vision for peace, prosperity and their people.
• A strong commitment of political leadership along with the necessary institutional frameworks and cooperation between the two countries is likely to be more robust in the future.
• More importantly, embedding a flexible framework of engagement can contribute positively to regional stability and prosperity.

Shared Concerns:

• India is essentially a maritime nation and the oceans hold the key to India’s future.
  • India’s external trade (over 90% by volume and 70% by value) is by sea. 
  • Very dependent on the seas for its trade and commerce, India has intensified its efforts to engage with maritime neighbours, including Vietnam.
• India’s relations with Vietnam, some of which is based on a set of historical commonalities, predate any conflict between India and China as well as that between China and Vietnam.
• The strategic dimensions of Indo-Vietnamese relations, initiated during the 1980s, began unfolding in the form of structured and institutional arrangements during the 1990s. 
• As India pursues its ‘Act East Policy’, Vietnam has become a valuable partner in India’s political and security engagements in the Indo-Pacific region.
• The two countries are working to address shared strategic concerns (such as energy security and open and secure sea lines of communication), and make policy choices without undue external interference. 
• India’s broadening economic and strategic interests in the region and Vietnam’s desire for strategic autonomy, both countries will benefit from a stronger bilateral relationship.

• India and Vietnam face territorial disputes with and shared apprehensions about their common neighbour, China.
• Vietnam is of great strategic importance because its position enables it to control ‘the South China Sea, a true Mediterranean of the Pacific’.
• The maritime domain, therefore,has become an essential element of India and Vietnam cooperation.

The Driving Forces:

• There are four key motivations behind India’s growing maritime engagement with Vietnam. 
  • India’s aspiration to counter an assertive China by strengthening Vietnam’s military power. 
  • With India’s increasing trade with East and Southeast Asia, India has begun to recognise the importance of its sea lines of communication beyond its geographical proximity; the South China Sea occupies a significant geostrategic and geo-economic position, resulting in India’s renewed interests in the South China Sea.
  • India desires to intensify its presence to track potential developments in the maritime domain that could affect its national interests.
  • The Indian Navy underlines the importance of a forward maritime presence and naval partnership that would be critical to deter potential adversaries. 
• India’s maritime strategic interests in the region are well established, including the fact that almost 55% of India’s trade with the Indo-Pacific region passes through the South China Sea.
• More importantly, India sees an open and stable maritime commons being essential to international trade and prosperity; therefore, it has an interest in protecting the sea lanes.

Image Source: ET

• Salient features of the Indian approach:

• • Renewed interest in the maritime domain
  • Freedom of navigation
  • A peaceful resolution of disputes and
  • A respect for international laws.
• India is willing to take a principled stand on territorial disputes in the hope that it contributes to the stabilisation of the Indo-Pacific. 
• Such positions align closely with Vietnam’s stance on the management of the South China Sea disputes.
• Ever since the formal declaration of a strategic partnership in 2007 and Comprehensive Strategic Partnership in 2016, the scope and scale of the India-Vietnam strategic and defence cooperation, particularly in the maritime domain, is deepening with a clear vision, institutional mechanisms and the necessary political support from both governments.
• The signing of ‘Joint Vision for Defence Cooperation’ and a memorandum of understanding on mutual logistics support in June 2022 has further strengthened mutual defence cooperation. 
• While a U.S.$100 million Defence Line of Credit has been implemented, India has also announced early finalisation of another U.S.$500 million Defence Line of Credit to enhance Vietnam’s defence capability.
• New Delhi has also agreed to expand military training and assist the Vietnam Navy’s strike capabilities.
  • For example, it is providing ‘comprehensive underwater combat operation’ training to Vietnamese sailors at INS Satavahana in Visakhapatnam.
• India’s Defence Minister handed over 12 high-speed boats to Vietnam recently’ a Khukri– class corvette is also expected to be gifted soon.
• Vietnam is also ‘exploring the possibility of acquiring Indian-manufactured surveillance equipment such as unmanned aerial vehicles’.

Using Frameworks

• The two countries are also engaging in wide-ranging practical cooperation in the maritime domain through a maritime security dialogue, naval exercises, ship visits, Coast Guard cooperation, and training and capacity building.
• They have found mutual convergences on cooperation in the Indo-Pacific region and are synergising their efforts to work in bilateral as well as other sub-regional and multilateral frameworks, such as the Indian Ocean Rim Association (IORA), the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC), the Mekong-Ganga Cooperation, ADMM-Plus or the ASEAN Defence Ministers Meeting-Plus.
• The Special Association of Southeast Asian Nations (ASEAN)– India Foreign Ministers’ Meeting in June 2022 has proposed an ASEAN-India Maritime Exercise and informal meeting between India and ASEAN Defence Ministers in November 2022.
• Both countries are also looking at collaboration around the seven pillars of the Indo- Pacific Oceans Initiative (IPOI).
• There are some other potential areas for New Delhi and Hanoi to further deepen collaboration, such as meaningful academic and cultural collaborations, shipbuilding, maritime connectivity, maritime education and research, coastal engineering, the blue economy, marine habitat conservation, and advance collaboration between maritime security agencies.
• The IPOI framework presents immense opportunities for India-Vietnam relations to aid regional progress and peace. 
• The road map agreed upon by the leaders will be helpful in addressing common challenges and decisively navigating towards making an India-Vietnam partnership that helps in stability in the Indo-Pacific.

Source: TH

• Saving mothers

Context: Data on MMR should lead to restructuring health-care systems for women.

Highlights:

• Few things in science or social science are as incontestable as the importance of maternal health to human development. 
• Maternal mortality indicates a woman’s ability to access health care, contraceptive devices, nutrition, and, in a sense, is a mark of the efficiency of a health-care system in responding to demands made of it. 
• A recent study published in the peer-reviewed journal, PLOS Global Public Health, casts a shadow over the progress of health care targeting women in the country, but also, questions the reliability of the country’s own periodic estimates of maternal mortality ratio, or MMR (number of mothers who die from complications in pregnancy for every one lakh live births.) 

• Researchers from the International Institute for Population Sciences triangulated data from routine records of maternal deaths under the Health Management Information System, with Census data and the Sample Registration System (SRS) to provide the MMR for all States and districts of India.
• The analysis suggests that 70% of districts (448 out of 640 districts) in India have reported MMR above 70 deaths, a target under the United Nations’ Sustainable Development Goals (SDG).
  • Many of the districts in southern India and Maharashtra have an MMR of less than 70.
  • At the same time, the north-eastern and central regions have the least number of districts (12 and six districts, respectively) with an MMR less than 70.
  • Significantly, it also demonstrates the presence of huge within-State inequalities, even among the better performers, Karnataka, Tamil Nadu, Kerala, Andhra Pradesh, and Telangana.
  • Similar heterogeneity was observed in other States as well. 
• According to the SRS (2016-18), only Assam (215) has an MMR of more than 200, while in this district-level assessment, the indications are that about 130 districts have reported above 200 MMR.
• It is ironic that as the nation plans to celebrate the 75th anniversary of Independence grandly, so many districts still show a very high MMR, clearly indicative of the inadequacy of responsiveness of health systems.
• There is adequate proof that improvements in access to contraceptives, antenatal care, post-delivery health care, body mass index, and the economic status, besides a concerted reduction of higher-order births, births in higher ages, will help reduce MMR.
• The message during this milestone anniversary year is two pronged: 
  • improve overall care for women, and 
  • keep real time track of such crucial health data. 
• Immediate action is required to meet the SDG goal regarding MMR. 
• Ultimately, it is more than about just the numbers. 
  • There are people, mothers and infants, entire families behind these numbers who will benefit from such an urgent and intense action on reducing eminently preventable deaths.

NEWS:

• China mulling new highway via Aksai Chin

Context: China is planning to build another highway through Aksai Chin, running along the India border and connecting Xinjiang with Tibet.

Highlights:

• The G695 national expressway will be only the second national highway (since the  G219 highway in the 1950s) through the disputed region, where China controls 38,000 sq km of land claimed by India.
• The construction is expected to be completed by 2035.
• The new highway will run even closer to the Line of Actual Control (LAC) than G219 and is likely to broadly run along the course of G219 from Mazha in Xinjiang in the north, through Aksai Chin, heading south along the borders with India, Nepal and Bhutan, and down to Lhunze in southeastern Tibet right across the border from Arunachal Pradesh.
• Its course will bring it close to several disputed areas that have seen recent tensions, from Eastern Ladakh down to near Doklam close to the India-China-Bhutan trijunction.
• Details of the new construction remain unclear, but the highway, when completed, may also go near hotly contested areas such as the Depsang Plains, Galwan Valley and Hot Springs on the LAC.

Image Source: www.scmp.com

• The NEET conundrum and Tamil Nadu’s steadfast opposition

Context: Tamil Nadu is looking for exemption from the National Eligibility cum Entrance Test.

Highlights:

• The mandatory National Eligibility cum Entrance Test (NEET) for admission to undergraduate and postgraduate medical degree courses was introduced across the country based on a Supreme Court ruling in 2016.
• The Tamil Nadu government vociferously opposed the entrance test from the beginning and initially got exemption from NEET-based admissions.
• However, in August 2017, the Supreme Court refused to grant further exemption to the State. 
• The legal fight against NEET still continues.

Why was NEET introduced?

• The Medical Council of India (MCI) (since replaced by the National Medical Commission) had mooted the NEET in 2009 with a stated objective of ensuring inter-se merit in medical admissions and to avoid multiple entrance tests conducted by different agencies, governments and deemed universities.
• Next year the MCI had issued a notification to regulate MBBS and BDS admissions in the country through a common entrance test.
• However, in 2013, by the majority of a 2:1 verdict the Supreme Court had struck down the NEET as unconstitutional and ruled that the MCI had no powers to issue notifications to regulate admissions in medical/dental colleges.
• Three years later in April 2016, a five judge bench headed by Justice Anil. R. Dave (who delivered the dissenting verdict in 2013), in a rare order recalled its 2013 judgement and eventually mandated the conduct of NEET.
• Following requests from certain stakeholders, the Union Government promulgated an ordinance in May 2016 exempting State-run medical colleges from the ambit of the Supreme Court mandate for a year. 
• After which in 2017, the Supreme Court refused to grant exemption from NEET to Tamil Nadu.

Was Tamil Nadu the only State to oppose NEET?

• No. Other states including Gujarat had also opposed the NEET in the initial years for varying reasons.
• Gujarat government submitted in the Supreme Court that it was “torture” to impose NEET on students who had already mentally prepared for the State entrance exams.
• Tamil Nadu reiterated its argument that the State does not have a legacy of entrance exams since 2007. 
• States like Jammu and Kashmir [now U.T of J&K and Ladakh], Andhra Pradesh and Telangana invoked special provisions in the Constitution to contend that only the State and not the Centre had the legislative competence to conduct examinations for MBBS and BDS courses.

Is the opposition to NEET merely political?

• Beyond issues such as the NEET threatening state autonomy, questions have been raised on the pragmatism of the common entrance test score being the sole determinant of merit from Kashmir to Kanyakumari. 
• The NEET overshadows students’ efforts in their higher secondary education and has been known to spawn multi-billion dollar coaching centres.
• As a result, the focus is more on cracking the ‘be-all-end-all’ examination instead of mastering the subjects at the higher secondary level.
• It also compromises the learning of non-core subjects.
• Besides, there have been discrepancies in the conduct of NEET with cases of impersonation being reported.
• Even in the NEET examination conducted recently, the CBI unearthed an impersonation racket and arrested eight persons.
  • Such racketeering challenges the very concept of merit.
• Also, while it has ensured merit-based admissions in state-run institutions where the fees is affordable; in deemed universities and private colleges even now students with poor NEET scores, who have the wherewithal to pay hefty sums as fees, continue to edge out meritorious aspirants belonging to poor, lower and middle class families.

What were the AK Rajan committee findings?

• The Dravida Munnetra Kazhagam government constituted a committee headed by retired High Court judge Justice A. K. Rajan to study the effects of the NEET-based admission process.
• The committee was asked to find whether the entrance test had adversely affected students from the rural and urban poor, those who studied in government schools, those who studied in Tamil medium or any other section of students from Tamil Nadu.
• If so, the panel was mandated, to suggest the steps to be taken to remove the impediments and to protect the rights of the State, for advancing the principles of social justice and also to fulfil the mandate of the Constitution to provide equal and equitable “access to health” to all sections of the people of Tamil Nadu. 
• Justice Rajan in his report recommended: 
  • “The State Government may undertake immediate steps to eliminate NEET from being used in admission to medical programmes at all levels by following the required legal and/or legislative procedures.”
•  The data showed that 99% of students, who got admitted in medical colleges post-NEET, had gone for coaching. 
• Coaching focuses only on preparing students to answer questions asked in the particular exam as opposed to learning a subject.

Image Source: TH

What is the current status?

• While most States have adopted NEET, the Tamil Nadu government remains opposed to it with the backing of all major political parties, with the exception of the BJP and one or two fringe outfits.
• The President refused assent to two Bills adopted by the Tamil Nadu Legislative Assembly unanimously in 2017 seeking exemption from NEET-based admissions for undergraduate and postgraduate degree medical courses.
• In 2021, a fresh Bill to admit students for MBBS/BDS courses only on the basis of their class XII board examination scores was adopted by the Legislative Assembly.
• In February this year, after the Bill was returned by the Governor, for the first time in the history of the state Legislative Assembly, the Bill was readopted by the House and sent back to the Governor. 

3. 3. The sweltering heat wave across Europe

Context: Large swathes of Europe, the U.K. and the U.S. are sweltering under extreme heat wave conditions.

Highlights:

• Devastation due to extreme weather has been particularly acute in western Europe, which has been hit by raging wildfires, drought, and hundreds of heat-related deaths, ringing alarm bells about a looming climate emergency.

Why is the spike in summer temperatures a cause for worry?

• While Europe has witnessed some hot summers in recent years, rarely have temperatures risen so high across so many regions at the same time. 
• Recently in July, the U.K. posted its highest temperature ever recorded crossing 40°C, resulting in the government issuing its first ever red alert for extreme heat.
• Parts of France, Spain and Portugal recorded temperatures between 42 and 46 degrees. Dozens of towns and regions across Europe reeled under what has been described as a “heat apocalypse”, which has caused widespread devastation this year.

• Wildfires caused by a combination of extreme heat and dry weather have destroyed 19,000 hectares of forest in southwestern France, and thousands of people had to be evacuated to temporary shelters. 
• Portugal reported more than 250 blazes over a period of two days, and 650 deaths due to heat-related illnesses in a span of one week.
• Neighbouring Spain lost 14,000 hectares of land to fires, with an estimated 360 deaths caused by extreme heat, mostly of elderly people. 
• Italy, on the other hand, has been reeling under a drought, with the Po river basin, one of Europe’s ‘food bowls’, not having received rains in more than 200 days.
• Across the Atlantic, with temperatures touching 43°C in some regions, around 69 million Americans were reported to be at risk of exposure to dangerous levels of heat and heat-related illnesses.

What is behind the extreme heat waves?

• Scientists are near-unanimous that the heat waves are a result of climate change caused by human activity.
• Global temperatures have already risen by more than 1°C , and studies in the U.K. had shown that a one degree rise in temperature raises the probability of the country witnessing 40°C by ten times.
• The rising global temperature, which this year led to deviations above the normal by as much as 15 degrees in Antarctica, and by more than 3 degrees in the north pole, have also induced changes in old wind patterns.
• These changes turned western Europe into what has been described as a “heat dome”, a low pressure area that began to attract hot air from northern Africa. 
• In the U.S, the record temperatures are being linked to changes in the jet stream, a narrow band of westerly air currents that circulate several kilometres above the earth’s surface.
• While a conventionally strong jet stream would bring cooler air from the northern Atlantic, in recent years the jet stream has weakened and split into two, leading to intense and more frequent heat waves over parts of the American continent.

How will the extreme heat impact Europe and the U.S. over the long term?

• In Europe, the heat wave has renewed calls for determined action on climate mitigation measures.
• But in the U.S., the political leadership, especially in Republican states, many of which, like Texas, also happen to be extreme weather ‘hot spots’ ,are still reluctant to recognise climate change as the cause of the problem, with local politicians asking people to pray rather than acknowledge the role of a fossil-fuels in triggering extreme weather. 
• In terms of adapting to the ongoing heat wave, the U.S. is marginally better placed, with a majority of the households fitted with air-conditioners.
• But only a tiny minority have ACs fitted in their homes in the U.K. and western Europe.
• With the frequency and duration of heat waves rising this summer, Europe’s energy requirements have shot up at just the wrong time, in the midst of rising fuel costs caused by a ban on Russian gas that European politicians imposed in response to the Ukraine invasion.
• In Germany, despite widespread acknowledgement of the urgent need to curb carbon emissions, even Green Party politicians are speaking of replacing Russian gas with domestic coal. 
• The greater frequency, intensity and duration of the heat waves have also been linked to the growing incidence of drought in different parts of Europe.
• With the winters ending sooner, vegetation starts to grow sooner before the snows of winter have replenished the water tables and the rivers.
• This has led to progressive depletion of water tables and increasingly drier soil and shallower rivers. 
• While the reduction in soil moisture has made forest fires more probable, drying rivers, critical for both agriculture and hydro power have affected harvests and energy security.

What next?

• Europe is facing a torrid summer, with heat wave conditions expected to continue into August. 
• While all the affected nations have issued heat alerts and health advisories to its citizens, who are not used to such temperatures, the economies of both Europe and the U.S. remain firmly bonded to fossil-fuel consumption. 
• While Europe has been more vocal about cutting down emissions and has sought to invest heavily in renewables, this shift has been disrupted by the Ukraine war and an impending energy crisis sparked by the self-imposed withdrawal from cheap Russian gas.
• The United Nations Secretary General Antonio Guterres issued a grim warning pointing out that world leaders faced a clear choice, it is either “collective action or collective suicide”.

Sour