The Hindu Editorial Analysis
23 September 2021

1. Diseases and outbreaks are realities and a well-functioning system can help reduce their impact

  • Source: The Hindu -Page 6/Editorial: A disease surveillance system, for the future
  • GS 2: Health

Context: It talks about the importance & Mechanism of a disease surveillance system.

 

History of Disease Surveillance:

    • Started in Britain: In 1854, when a deadly outbreak of cholera affected Soho area of London, John Snow (1813-1858), a British doctor and epidemiologist, used the health statistics and death registration data from the General Registrar Office (GRO) in London, to plot on a map of the area, the distribution of cholera cases and deaths.

    • Data based policy making: based on Snow's data, William Farr (1807-1883) could convince the local authorities in London to remove the handle of the water pump, which he thought was a source of contamination which was spreading Choera. The cholera outbreak was controlled in a few weeks.

    • John Snow is often referred to as the father of modern epidemiology and William Farr as founder of the modern concept of disease surveillance system.

    • In the late 19th century, with the emergence of understanding that germs cause the diseases, and then in the early 20th century, with the discovery of antibiotics and advances in modern medicine, attention from epidemiology somewhat shifted.

    • 2nd half of Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.

    • These efforts received further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.

 

Surveillance in India

    • History: A major cholera outbreak in Delhi in 1988 and the Surat plague outbreak of 1994, nudged the Government of India to launch the National Surveillance Programme for Communicable Diseases in 1997.

    • In 2004(after SARS outbreak), India launched the Integrated Disease Surveillance Project (IDSP). It is a disease surveillance scheme under the Ministry of Health and Family Affairs, assisted by the World Bank.

      • It aimed to strengthen disease surveillance for infectious diseases to detect and respond to outbreaks quickly. The scheme seeks to set up a Central Disease Surveillance Unit and a State Surveillance Unit in each State where data is collected and analysed.

      • It further focused to strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.

      • It was on this foundation of the IDSP (which now has become a full fledged programme) that when COVID-19 pandemic struck, India could rapidly deploy the teams of epidemiologists and public health experts to respond to and guide the response, coordinate the contact tracing and rapidly scale up testing capacity.

    • These have performed variably in Indian States. For example: as per data from the fourth round of sero-survey, Kerala and Maharashtra States could identify one in every six and 12 infections, respectively; while in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected. The estimated excess deaths are also higher in those States which have weak disease surveillance systems and the civil registration and vital statistics (CRVS) systems.

    • An example is Kerala, arguably the best performing disease surveillance system amongst the India:

      • It is picking the maximum COVID-19 cases;

      • It could pick the first case of the Nipah virus in early September 2021.

    • Other States:

      • Cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of UP, began to be overwhelmed.

      • The situation is not very different in States such as MP and Haryana, where viral illnesses, most likely dengue, are causing hospitalisation but not being correctly identified or are being reported as mystery fever.

 

Way forward: A review of the IDSP by joint monitoring mission in 2015, conducted jointly by the Ministry of Health and Family Welfare, the Government of India and World Health Organization India had made a few concrete recommendations to strengthen disease surveillance systems. These included:

    1. Increasing financial resource allocation: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.

    2. Ensuring adequate number of trained human resource:  the workforce in the primary health-care system in both rural and urban areas needs to be retrained in disease surveillance and public health actions. The vacancies of surveillance staff at all levels need to be urgently filled in.

    3. Strengthening laboratories: The laboratory capacity for COVID-19, developed in the last 18 months, needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections. This should be linked to create a system in which samples collected are quickly transported and tested and the reports are available in real time.

    4. Zoonosis, influenza and vaccine-preventable diseases  surveillance:  the emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health.

    5.  The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground. A dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of deaths (MCCD). These are complementary to disease surveillance systems and often where one is weak, the other is also functioning sub-optimally.

    6. Ensure coordinated actions between the State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance. The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

 

Conclusion:

  • The emergence and re-emergence of new and old diseases and an increase in cases of endemic diseases are partly unavoidable. We cannot prevent every single outbreak but with a well-functioning disease surveillance system and with application of principles of epidemiology, we can reduce their impact. Sometimes, the control of a deadly disease could be as easy as the removal of a handle of a water pump. However, which handle it is to be can only be guided by coordinated actions between a disease surveillance system, a civil registration system and experts in medical statistics, and, finally, informed by the application of principles of epidemiology.

Expected Question: The COVID-19 has shown that there are critical gaps in the disease surveillance infrastructure of India. What steps must be taken to bridge these gaps for the future safeguard against such emerging threats. (250 Words)

 

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2. E-governance holds the promise of improving local governance, but only if we pay attention to the basics

  • Source: The Hindu - Page 7/OPED: Make departments smart, first
  • GS 2/GS 4: Governance 

Context: E-governance is expected to replace the existing structures in the coming decades.  We hope to live in ‘smart cities’, where digital systems enable the use of data — generated by people living and working in the city itself — to continuously improve how the city functions.

    • This article is a white paper on digitalization of the Departments: It lays out five-level framework for assessing where a given function, department, or city stands in its journey of e-governance.

 

Electronic governance or e-governance: It is the application of IT for delivering government services, exchange of information, communication transactions, integration of various stand-alone systems between government to citizen (G2C), government-to-business (G2B), government-to-government (G2G), Government-to-employees (G2E) as well as back-office processes and interactions within the entire government framework.

 

Critical elements of a smart City:

    • Generating Smart Data: A smart city requires good data to inform decision-making. The only reliable way to get good data is to design ‘smart systems’ that generate such data by default.

    • Data exchanges at multiple level:  Given the complexity of our cities, and the various entities that are involved in their governance.

    • Making departments smart: A department refers to a specific administrative entity, with the mandate to deliver a defined set of services, and the resources it is assigned for delivering them; a function is any such set of services and the people who deliver them.

    • Digitalization of Data: when doing their work, local government employees have to switch from using pen and paper and records to using digital tools and systems.  The reality in most local government offices in India is that records are kept on paper; if they do get digitised, it is as part of a post-facto data entry exercise. This creates scope for errors and manipulation.

 

Road towards digitalization

    • Incentivisation for digitalization: To ensure digitisation, city leaders must use a combination of expectation-setting and incentives. They can demonstrate the time saved and ease of work gained when digital tools automate away record creation and retrieval.

    • Mission Mode adoption: leaders can set phased targets for adoption of the new tools, and ensure adequate technical support and education for employees during the transition. These changes are reflected in the ‘process’ and ‘human resources’ levers of the framework.

    • Citizen centricity lever: administrators must ensure that e-governance is not reduced to an exercise in performance management alone. The framework incorporates a ‘citizen centricity’ lever to emphasise that urban local bodies are service delivery organisations, and that internal reforms have to reflect in better experience and empowerment for citizens.

 

Benefits of E-Governance:

    • The ease of interaction.

    • The gains in efficiency through both performance management and process reform. For example, In Andhra Pradesh, for instance, ULB employees reported saving an average of 11 hours every week after a digital system was adopted.

    • The potential for data-driven preventive maintenance of infrastructure — hinge upon adoption of the system by local government employees and citizens themselves.

    • Richer datasets that will bring various departments in a city to collaborate with each other — and indeed with non-governmental partners as well — to create a virtuous cycle of co-creation, learning, and efficiency.

    • Emergence of Smart cities: This is how smart cities emerge, not from the top down, but from organic collaboration between departments, employees, and citizens, who are simply looking to do their own jobs more effectively. A smart city is a network of smart functions and departments.

Expected Question: For emergence of smart cities, digitalization of departments is necessary. Comment(150 Words)