1. Strengthening the primary healthcare system will help tackle the burden of non-communicable diseases
Context: Nearly 71% of all deaths worldwide occur due to non-communicable diseases (NCDs) such as hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and cancer.
- Cardiovascular diseases such as stroke, heart attacks and coronary artery disease are the top cause of global deaths. One out of every four deaths occurs due to cardiovascular diseases, especially among younger patients.
- High Mortality Rate: In the Indian subcontinent, there is early onset and rapid progression of such diseases, and a high mortality rate. Premature loss of life due to NCDs in the age group of 30-69 years is also very high among Indians. Half the deaths due to cardiovascular diseases occur in the age group of 40-69 years.
- National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, in 2010: Launched to address this growing burden of NCDs, as a part of the National Health Mission, focusing on strengthening infrastructure, promoting good health, human resource development, early diagnosis, management and referral.
Disruption of NCD services/Impact of COVID on NCDs
- COVID-19: The rapid spread of COVID-19 has severely tested primary healthcare systems, which perform myriad functions, across the world. Maternal healthcare services, immunisation, health surveillance, and the screening and management of NCDs have all been severely disrupted.
- Greater Impact on Low-Income countries: A World Health Organization (WHO) survey conducted in May 2020 among 155 countries found that low-income countries were the most affected by this disruption.
- More than half (53%) of the countries surveyed had partially or completely disrupted services for hypertension treatment,
- 49% for treatment for diabetes and diabetes-related complications,
- 42% for cancer treatment and
- 31% for cardiovascular emergencies.
- NCDs Impacts COVID: The outcomes in COVID-19 patients with pre-existing cardiovascular disease risk factors or with established cardiovascular disease can be worse than others, perhaps due to low cardiorespiratory reserve, worsening of the underlying cardiovascular disease due to systemic effects of the illness, or precipitating novel cardiac complications.
- Drop in Emergency Services: Data from the National Health Mission’s Health Management Information System in India show that emergency services for cerebrovascular diseases dropped by about 14%. Among NCDs, persons with diabetes are at an exceptionally higher risk of severe clinical outcomes of COVID-19.
- Lack of Information: A recent study reported that nearly one in every two Indians living with diabetes is unaware of their condition. They are at higher risk of dying if they contract COVID-19 because of uncontrolled glucose levels in their blood. Findings from an observational study in Delhi show that 47.1% of hospitalised COVID-19 patients had diabetes.
- Diversion of Heath Staff: In most countries, staff working in the area of NCDs were reassigned to support patients with COVID-19, and public screening programmes were postponed.
- Shortage of medicines, diagnostics and technologies were the main reasons for discontinuing services in one-fifth of the surveyed countries. Cancellations of planned treatments, decreased availability of public transport, and lack of staff were the most common reasons for the disruption of NCD services.
- Lockdown induced effects: Lockdowns and reduced physical interactions led to loneliness, especially in the geriatric population. This resulted in mental health disorders such as anxiety and depression. Lockdowns increase exposure to NCD risk factors as people became more likely to increase their consumption of alcohol and tobacco and adopt an unhealthy diet.
Problems:
- Only 42% of low-income countries had included NCD services in their national COVID-19 preparedness and response plans.
- Worryingly, tobacco cessation activities and rehabilitation have not been included in response plans.
Solutions
- Including Tobacco: India’s response plan to address the growing burden of NCDs must include tobacco cessation activities as tobacco consumption has been indisputably linked to hypertension, cardiovascular diseases and stroke.
- Use of Telemedicine: The use of alternative modalities such as online platforms for disseminating information on exercise and mental health management must be made available to the marginalised. Telemedicine can reduce travel expenses, thus lowering patients’ expenditure burden.
- Digital collection of Data: A positive impact of the pandemic has been that two-thirds of the countries are now collecting data on the number of COVID-19 patients who also have a NCD.
- Giving Equal weightage to NCDs: There is an urgent need for national and State health policymakers to draw up a road map which gives equal weight to patients living with NCDs.
- Utilising the existing network of NGOs while respecting local factors will go a long way in tackling the growing burden of NCDs.
- Innovative Campaigns on maintaining a healthy lifestyle: the monotony of broadcasting the same message over and over again must be broken. Effective and participatory leadership with strong vision and communication, is the need of the hour to tackle the silent epidemic transition to NCDs.
- Screening for NCDs at the grassroots level and the delivery of locally relevant and contextual messages for health promotion and primordial prevention of NCDs can be significantly improved by incentivising the already overburdened ASHA workers.
- Access to essential NCD medicines and basic health technologies in all primary healthcare facilities is essential to ensure that those in need receive treatment and counselling.
- A multidisciplinary approach: Strategies must include mitigation efforts to address administration challenges, a strong health workforce, infrastructure, supplies, maintaining the standard of care, and continued access and care for the vulnerable populations.
- Importance of physical activity and mental health due to restrictions on movement should be brought to the forefront. Multiple risk factors which are interrelated, such as raised blood pressure, glucose, lipids, and obesity, are preventable.
Conclusion: Primary healthcare systems must ensure that persons at risk of NCDs receive appropriate screening, counselling and treatment. In India, those with NCDs find that productive years of life are lost and there is high-out-of-pocket expenditure on treatment. Urgent action is needed using the ‘all of society approach’ to achieve the WHO goal of a 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases by 2025. This can be achieved by strengthening the primary health system to prevent, diagnose and provide care for NCDs in the future, especially during health emergencies such as a pandemic.
2. That global mediation has had a positive role in asking for a more pragmatic attitude from the Taliban is wishful thinking
Context: On August 16, US’s desperate bid to evacuate from Afghanistan is a reminder of the fall of Saigon, Vietnam, and the horrifying scenes of American diplomats evacuated by helicopter, leaving behind supporters to languish in re-education camps.
- Joe Biden’s administration had put all the blame on the Afghan Government.
- Surprisingly, when we think of the Taliban, we have in mind a shabby army of 70,000 fervently Islamist foot soldiers confronting and defeating a modern Afghan army of 3,00,000 men. However, the world was surprised by the speed of the Taliban army in reconquering Afghanistan, from Kunduz on August 7-8 through Mazar-i-Sharif and every other provincial capital last week to Kabul on Sunday
Reasons of hasty withdrawal:
- One-sided accord: The predecessor administration of President Donald Trump and U.S. Special Representative for Afghanistan Reconciliation Zalmay Khalilzad signed the disastrous one-sided agreement with the Taliban, the fate of Afghanistan was sealed. It was just a matter of time.
- Strict date of withdrawal: One historical lesson that was not learned was the predictable collapse of the Afghan government. The surrender to the Taliban slowly gained pace in the months following the Doha deal in 2020, but it began to snowball as soon as Mr. Biden announced in April that U.S. forces would withdraw from Afghanistan.
- Poor Planning: This does not mean that the decision to withdraw American soldiers was wrong per se; rather, there was obviously inadequate planning in preparing the operation. As usual, many innocent people were left behind. There was certainly a moral failure in getting out as many of those Afghans who supported the U.S. intervention and military presence in Afghanistan as possible.
- Afghan Government’s inability:
- Corruption: Certainly, one of the reasons for the defeat of the Afghan army has been the poor training and corruption of the Afghan officers.
- High attrition Rate: They were losing nearly 7,000 men every year, an attrition rate difficult to sustain. They had suffered 30,000 casualties since 2015; Civilian casualties are around 3,000/year.
- Recruitments were drying up and desertions were on the rise. Security forces are down by more than 10% from their sanctioned strength.
- Threat to the families of the forces for going against Taliban.
- Fake entries in the Army: The salary of fake entries were being drawn by the commanders and higher officials in the establishment.
- Poor Strategy: the strategy of pushing the Taliban into the mountains and hinterlands, while securing towns and cities by the Afghan army did not work as expected. It took the Taliban only a few weeks to sweep away the Afghan army, which had been financed and trained by the United States for 20 years.
Posing a danger/Human Rights Crisis:
- Medieval Justice system: Once in power in Afghanistan, the Taliban imposed their own violent and authoritarian version of Sharia Law, exemplified by ‘punishments such as public executions of convicted murderers and adulterers, amputations for those found guilty of theft and imposing the all-covering burka for women.
- Impact on Human Freedom: Television, music and cinema were also banned by the Taliban and girls aged 10 and over were forbidden to go to school’. All these previous actions show that the Taliban will rule Afghanistan once again with extreme violence and barbarity.
Challenge for diplomacy
- No Room for compromise now: Some analysts continue to believe that because of the negotiations in Doha, there is room for compromise with the Taliban and that international mediation has played a positive role in asking for a more pragmatic attitude from the Taliban. This is just wishful thinking that ignores the fact that the rule of the Taliban in Afghanistan will be a great danger for all Afghans and the neighbouring countries.
- Risk of other Terrorist Groups rising: terrorist groups such as al Qaeda and the Islamic State will take advantage of the new rise of the Taliban to create their own power bases in Afghanistan.
- Fate of Afghan People: Last but not least, on a human level, the fate of the Afghan people under the new Taliban government is most important. One thing is certain. The sufferings of the Afghans will not end under Taliban rule.
- International affairs: it will certainly take a Herculean effort to maintain decent working relations with the Taliban. However, India, Iran, Russia, and China are hoping for stability and an end to bloodshed in Afghanistan.
Conclusion: The return of the Taliban will not necessarily be welcomed by all these countries despite the fact that they would rejoice at America’s setback. There will also be a fear of Islamic jihadism all over West Asia, including in Turkey and in Saudi Arabia. So, all and for all, the Afghan debacle is not the story of a defeat of democracy in one country but a sign of a fiasco in international politics in general.
