Context :

Government to provide kidney dialysis at home under PMNDP.

In other words, the Centre plans to establish peritoneal dialysis services across states to provide door-step dialysis services for kidney patients.

Aim:

With home-based peritoneal dialysis service, the Centre seeks to –

A. Bring down the overall cost of treatment

B. Achieve equity in patient access

C. Bring in consistency of practice

D. Develop a clinically-safe and effective programme

Problems :

Every year about 2.2 Lakh new patients of End Stage Renal Disease (ESRD) get added in India resulting in additional demand for 3.4 Crore dialysis every year.

ESRD continues to be a result of existing and emerging burden of non-communicable disease.

The burden of Non-Communicable Diseases (NCDs) has been alarmingly increasing and was flagged in the special UN convention for Health.


Peritoneal dialysis :

Peritoneal dialysis is a process to remove excess fluid, correct electrolyte problems and remove toxins using the lining of the abdomen, or peritoneum, in patients suffering from renal failure.

There are two main types of dialysis, which are hemodialysis and peritoneal dialysis.

HAEMODIALYSIS:

Hemodialysis (HD, commonly known as blood dialysis): In HD, the blood is filtered through a machine that acts like an artificial kidney and is returned back into the body.

HD needs to be performed in a designated dialysis centre. It is usually needed about 3 times per week, with each episode taking about 3-4 hours.

PERITONEAL DIALYSIS :

Peritoneal dialysis (PD, commonly known as water dialysis): In PD, the blood is cleaned without being removed from the body.

The abdomen sac (lining) acts as a natural filter. A solution (mainly made up of salts and sugars) is injected into the abdomen that encourages filtration such that the waste is transferred from the blood to the solution.

There are 2 types of PD - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD needs to be done 3 to 5 times every day, but does not require a machine. APD uses an automated cycler machine to perform 3 to 5 exchanges during the night while the patient is asleep.

Close medical supervision is not required for most PD cases, thus making it a feasible option for patients who may want to undergo dialysis in the home setting. Each treatment option has its advantages and disadvantages, which vary with the condition of the patient and presence of underlying diseases. It is therefore important for every patient with ESRD to discuss various treatment options in detail with his doctor before starting treatment.

The majority of patients in India receive renal replacement therapy in hemodialysis center. The number of patients on Hemodialysis and the number of hospital based and free standing units is steadily growing.

A dialysis unit delivers patient care, and has specific requirements of treated water, electricity, medical gases and waste disposal. It additionally requires accommodating all the workers involved in patient care, allow emergency procedures, permit adequate hygiene and maintenance of specialized equipment. The design and layout of a unit must take into account all the above features in order to function smoothly and prevent development of complications. Proper planning of a dialysis unit is therefore essential.

About Pradhan Mantri National Dialysis Program

It was rolled out in 2016 as part of the National Health Mission(NHM) for provision of free dialysis services to the poor.

Public Private Partnership for Hemodialysis services

As per the guidelines, the private partner is to provide medical human resource, dialysis machine along with Reverse Osmosis (RO) water plant infrastructure, dialyzer and consumables, while the space, power, and water supply within District Hospitals is to be provided by the State Government.

Financial support

Currently, under NHM 100 % of the service procedure fees for patients from below poverty line (BPL) economic group is covered. However, non BPL patients would have the benefit of accessing the services close to the community at the district hospitals at same rates as paid by the Government for the BPL patient.

While there exist health schemes such as Rashtriya Swasthya Bima Yojana (RSBY) funded by Govt. of India which cover hemodialysis procedure, it is evident that due to high cost and recurring sessions required over the life time, the total cost for providing dialysis cannot be adequately covered. However, for BPL families registered under RSBY, the cost of dialysis care shall be catered through RSBY funding upto its maximum coverage. The additional resources required would be provided to the state under the National Health Mission.

National Air Quality Index’ (AQI):

Was launched in 2014 to disseminate information on air quality

Initiative under Swachh Bharat Mission

The measurement of air quality is based on eight pollutants

AQI has six categories of air quality. These are: Good, Satisfactory, Moderately Polluted, Poor, Very Poor and Severe.

AQI is considered as ‘One Number- One Colour-One Description’ for the common man to judge the air quality within his vicinity.

8 pollutants measured by AQI :

1.Particulate Matter (size less than 10 µm) or (PM10),

2.Particulate Matter (size less than 2.5 µm) or (PM2.5),

3.Nitrogen Dioxide (NO2),

4.Sulphur Dioxide (SO2),

5.Carbon Monoxide (CO),

6.Ozone (O3),

7.Ammonia (NH3), and

8.Lead (Pb)

National Ambient Air Quality Standards (NAAQS):

National Ambient Air Quality Standards are the standards for ambient air quality set by the Central Pollution Control Board (CPCB)

The CPCB has been conferred this power by the Air (Prevention and Control of Pollution) Act, 1981.

Ambient Air Quality Standards contains 12 pollutants (8 pollutants contained in AQI and 4 others given below)

Benzene
Benzo(a)Pyrene (BaP)
Arsenic
Nickel


System of Air Quality and Weather Forecasting and Research (SAFAR) :

Initiative introduced by the Ministry of Earth Sciences (MoES) to measure the air quality of a metropolitan city

Indigenously developed by the Indian Institute of Tropical Meteorology (IITM), Pune and is operationalized by the India Meteorological Department (IMD).

It gives out real-time air quality index on a 24×7 basis with color-coding (along with 72 hours advance forecast).

SAFAR is an integral part of India’s first Air Quality Early Warning System operational in Delhi.

Objective:

increase awareness among the general public regarding the air quality in their city

helps the policy-makers to develop appropriate mitigation measures and systematic actions

Pollutants monitored by SAFAR:

PM2.5

PM10

Ozone

Carbon Monoxide (CO)

Nitrogen Oxides (NOx)

Sulfur Dioxide (SO2)

Benzene

Toluene

Xylene

Mercury

REVIVAL PACKAGE FOR BSNL AND MTNL

Context:

Union Cabinet approves revival plan of Rs.70,000cr BSNL and MTNL.

Revival plan :

1. Allotment of spectrum for 4G services for Rs.20,000cr

2. Debt restructuring by raising of bonds with sovereign guarantee.

3. Reducing employee costs through Voluntary Retirement Scheme.

4. Monetisation of assets.

5. In-principle approval of the merger of BSNL & MTNL.


Crisis :

For some time now, BSNL is trying hard to sustain itself in a competitive market and was willing to accept what the government decides.

The government was in a Catch-22 situation wherein it had to decide between survival of BSNL/MTNL on one side and safeguarding the interests of employees.



Challenges faced by PSUs:

Overstaffing: BSNL has a huge employee base of 1.66 lakh and MTNL 21,679. Private players have just 25,000-30,000 employees across India.

Huge expenses: About 60% of BSNL’s revenues go towards managing employee expenses, while for MTNL it is around 87%.

Increased competition: Triggered after entry of Reliance Jio in September 2016. PSUs failed to keep up with the change. The low data tariffs with free voice calls impacted the industry as a whole and not just PSUs.

The survival of the PSUs was largely dependent on the attitude of its employees, who could not approach a professional attitude with the change in times.

Excessive interference by the Department of Telecommunications.


What can be done?

If the government is agreeable to an upgrade of its management, and to bring in a commercially driven partner who can leverage the massive resources of the PSUs and generate revenues, then the revival package would be worth it.

Both the firms, especially BSNL, have huge assets, be in terms of real estate or optical fibre, which will be very essential for the smooth rollout of next-generation technology 5G.

BSNL has huge infra assets and Right of Ways are an advantage, which can be shared with private players. Their real estate is very valuable with presence in all major city centres with premium real estate.


Way forward :

BSNL is a strategic public asset which has to be promoted .

With the proposed measures, it is expected that BSNL will come out of losses by 2023-24 while MTNL will be back to profits in 2025-26, according to estimates. Both the PSUs have a debt of around Rs 20,000 crore.