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17th June - The Hindu Editorial - Part-1(in Hindi)
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Subhodeep Das
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  1. Holes in the scheme National Health Protection Scheme With about two months to go for launch of NHPS, its model tender document leaves several questions unanswered UBHODEEP


  2. Context National Health Protection Scheme (NHPS) - Arun Jaitley's Budget speech "world's largest health protection plan" and said that it would cover 50 crore individuals from nearly 10 crore poor and vulnerable families. Model Tender Document For The Selection of Implementing Agencies For the NHPS, released by the Union Ministry of Health and Family Welfare on Wednesday, tries to address some of these concerns UBHODEEP


  3. Concerns: Questions were raised - over the capacity of the country's healthcare system to handle a project of such proportions Apprehensions that private hospitals would milk the NHPS by prescribing unnecessary investigations UBHODEEP


  4. Document states Document states that nearly 47 per cent of the packages under the NHPS, including those related to heart ailments and cancer, require re-authorisation. Hospitals empanelled under the scheme cannot perform these procedures until they have an authorisation letter from the NHPS's Implementation Support Agency. Given that the scheme's predecessor, the Rashtriya Swasthya Bima Yojana, was riddled with unethical practices such as unnecessary hospitalisation, needless investigations and billing for superfluous and unrelated treatment packages, Checks on the empanelled hospitals are well in order. S. UBHODEEP


  5. objective- "improving access of identified NHPS's primary families to quality inpatient care and day-care surgeries" Still in question ??? In the absence of protocols for diagnostic tests for beneficiaries of publicly-funded insurance schemes, any authorisation process can only be arbitrary. There is little in the model document that prevents hospitals from shifting the onus ofobtaining the author isation letter on the critically-ill or their families These grey areas - could defeat the NHPS's primary objective UBHODEEP


  6. Need: Several procedures, including emergency consultation for acute colic, nebulisation for an asthma attack, hypoglycaemia in a diabetic and treatment of "dengue without complication", will be covered by the scheme only if the treatment is availed in a government hospital Can indeed be taken care of at a primary health centre (PHC) But given that there is one government doctor for more than 1,000 people, one state-run hospital for more than 90,000 people and a 22 per cent shortage of PHCs in the country according to the Union Ministry of Health and Family Welfarea seemingly uncomplicated procedure such as nebuliser treatment for asthma most often necessitates a visit to a private healthcare provider. UBHODEEP


  7. Without timely treatment, a dengue fever can aggravate to a life-threatening disease. UBHODEEP


  8. The numbers lie Under-reporting of persons involved in manual scavenging reflects state apathy,societal bias Policy must address this UBHODEEP


  9. Context That manual scavenging is banned by law in the country and state agencies are bound to act against its prevalence could be the reason why every official count of those engaged in the activity is low. Recent inter-ministerial task force has estimated 53,000 manual scavengers in 12 states, four times more than an official count from 2017, the real numbers could be much more than that. UBHODEEP


  10. Reason for the relativelv small numbers The methodology used to survey the workers The various exclusions, especially of workers in urban areas, and Rampant under-reporting by state agencies -There is a continued reluctance on the part of state governments to admit that the practice prevails under their watch. For instance, Haryana government has reported zero manual scavengers whereas the survey counted 1,040 In UP, the state government reported 1,056 persons whereas the survey found 28,796. UBHODEEP


  11. Need: The first step towards solving a problem is to admit that it exists. Acceptance of the caste system, its hierarchy of labour and division of labourers has also influenced decision-makers with regard to this dehumanising practice Many local governments and state agencies, unwilling to invest in technology and in the rehabilitation of workers, prefer to hide the prevalence of the practice instead of acting to end it... UBHODEEP


  12. Need opting for technology-driven solutions provision to provide protective and safety gear is more flouted than followed - Imbibe the spirit of Swaccha Bharat abhiyan 2022 New India. Any lasting solution towards ending the practice will need policy-makers to see why and how it continues to be embedded in the caste system. UBHODEEP