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Patient Safety Rights Charter

Why in News?

Recently, the World Health Organization (WHO) launched the first-ever Charter on Patient Safety at the Global Ministerial Summit on Patient Safety. This Charter outlines the rights of patients concerning safety and aims to guide governments and healthcare institutions in developing the necessary legislation, policies, and guidelines to ensure patient safety.

What are the Key Features of the Patient Safety Rights Charter?

• The Charter articulates essential rights for patients in the realm of healthcare safety.
• It aims to empower governments and stakeholders to amplify patient voices and protect their right to safe healthcare.

The Charter includes ten key rights that focus on minimizing risks and preventing inadvertent harm, such as:

• Timely, effective, and appropriate healthcare.
• Safe healthcare processes and practices.
• Competent and qualified healthcare professionals.
• Safe medical products and their proper use.
• Secure and safe healthcare facilities.
• Respect, dignity, non-discrimination, privacy, and confidentiality.
• Access to information, education, and support for decision-making.
• Access to medical records.
• The right to be heard and to have fair resolutions.
• Engagement of patients and families in care processes.

What is Patient Safety?

Patient safety is concerned with preventing unintended harm that may occur during healthcare delivery, making it a crucial element of global health initiatives.

Factors Contributing to Patient Harm

Common sources of patient harm include:

• Medication errors.
• Surgical mistakes.
• Healthcare-associated infections.
• Sepsis.
• Diagnostic errors.
• Patient falls.
• Patient harm is often the result of:
  (a) Failures within the healthcare system and organization.
  (b) Technological limitations.
  (c) Human factors.
  (d) Patient-specific circumstances.

What is the Need of Patient Safety Charter?

Ensuring Safety of Patients:

• Approximately 10% of patients experience harm during medical procedures, leading to over 3 million deaths annually due to unsafe healthcare, according to the OECD.
• Investments in patient safety can enhance health outcomes, lower costs associated with patient harm, boost system efficiency, and rebuild community trust in healthcare systems.
• Preventing Avoidable Harm:
  (a) The majority of patient harm is preventable, highlighting the importance of involving patients, families, and caregivers in the effort to reduce harm.
  (b) Patient harm often stems from inadequately designed healthcare systems rather than isolated incidents.
• Implementation of the Global Patient Safety Action Plan 2021-2030:
  (a) A 2023 survey among Member States revealed significant gaps in the implementation of the Global Patient Safety Action Plan.
  (b) The findings stressed the necessity for patient representation and addressing disparities based on income in the implementation processes.
  (c) Interim survey results indicate that only 13% of countries have patient representatives on hospital governing boards or similar mechanisms.
• Targeting SDG: Patient safety is a vital global priority and is essential for achieving Sustainable Development Goal 3: "Good Health and Well-being."

WHO launches first ever Patient Safety Rights Charter

Why in news?

The World Health Organization (WHO) unveiled its inaugural Patient Safety Rights Charter during the Global Ministerial Summit on Patient Safety. This charter serves as the first of its kind aimed at establishing patient rights specifically concerning safety and is designed to aid various stakeholders in developing the necessary legislation, policies, and guidelines to enhance patient safety. Improving patient safety through systematic actions is recognized as a global priority, emphasized in the World Health Assembly resolution 72.6, which outlines global actions on patient safety and the Global Patient Safety Action Plan for 2021-2030.

The Charter outlines ten essential patient safety rights that are critical for reducing risks and preventing unnecessary harm.

Sixth Global Ministerial Summit on Patient Safety:

The upcoming Sixth Global Ministerial Summit on Patient Safety is scheduled to take place in Santiago, Chile, hosted by the Government of Chile on April 17-18, 2024. Its slogan is "Bringing and sustaining changes in patient safety policies and practices." The objective is to foster discussions among stakeholders—including ministers, healthcare leaders, and patient advocates—on strategies for enacting and maintaining changes in patient safety policies and practices, as well as to address the challenges and opportunities in implementing the Global Patient Safety Action Plan.

What is meant by Patient Safety Rights?

Patient safety embodies the fundamental principle of healthcare—'Do no harm.' It encompasses the processes, procedures, and cultural practices within healthcare systems aimed at promoting safety and reducing the risks of patient harm. Furthermore, patient safety is indicative of a country's broader commitment to uphold, protect, and fulfill health-related human rights. Ensuring patient safety is paramount for achieving the Sustainable Development Goals.

Significance of the Patient Safety Rights Charter

• The charter is a vital tool for assisting countries in integrating key concepts such as patient and family engagement, equity, dignity, and access to information within their healthcare systems.
• Addressing the right to health: Approximately 1 in 10 patients experience harm while receiving healthcare, with about half of these incidents being preventable. The charter aims to guide healthcare systems in mitigating avoidable errors.

National Patient Safety Implementation Framework 2018-2025

The goal is to enhance patient safety across all healthcare levels and modalities, including prevention, diagnosis, treatment, and follow-up, while improving overall quality of care and advancing towards Universal Health Care.

This framework is applicable at national and sub-national levels and encompasses both public and private sectors.

Objectives include:

• Establishing institutional mechanisms for patient safety.
• Assessing and reporting adverse events.
• Ensuring a competent health workforce.
• Implementing infection prevention and control measures.
• Ensuring safety in clinical and programmatic domains.
• Promoting patient safety research.

The framework aligns with the 'Regional Strategy for Patient Safety in the WHO South-East Asia Region (2016-2025)' endorsed by the 68th Regional Committee of WHO South-East Asia Region.

To avoid preventable harm:

Patient safety may be compromised by avoidable errors, which include:

• Unsafe surgical procedures.
• Medication errors.
• Misdiagnosis or delayed diagnosis.
• Poor injection practices.
• Unsafe blood transfusions.
• Infections such as sepsis and other healthcare-associated infections.

Patient-centered healthcare systems:

The Charter offers healthcare professionals, leaders, and governments the necessary tools to create patient-centered healthcare systems, thereby enhancing patient safety and reducing harm risks.

A safety language for patients:

This charter empowers patients with the language needed to advocate for themselves within healthcare environments, promoting ongoing collaboration between patients, their families, caregivers, communities, and health systems.

Challenges for patient safety in India

• Limited resources: Participants highlighted challenges such as inadequate access to supplies, insufficient staffing, and poor infrastructure, leading to cross-infection risks in general wards.
• Lack of reporting systems for Hospital-Acquired Infections (HAI): There is currently no authority responsible for the collection, analysis, and reporting of HAI data at the national level.
• Fragmented healthcare delivery systems: The absence of a quality assurance system for medications compounds the issue.
• Professional culture: A punitive approach to adverse events exists, alongside a rigid workplace hierarchy that prioritizes the safety of medical professionals over that of patients.
• Patient education: Misunderstandings regarding safety led to the overuse of medications and the use of counterfeit or expired products.
• Inadequate training for support staff: Insufficient training for nurses and other support staff in clinical practices contributes to safety risks.
• Poor sanitation: Inadequate sanitation leads to hospital-acquired infections and the improper disposal of medical waste, contributing to antimicrobial resistance.

The 10 Fundamental Patient Safety Rights:

• Timely, effective, and appropriate care.
• Safe healthcare processes and practices.
• Qualified and competent healthcare workers.
• Safe medical products and their rational use.
• Safe and secure healthcare facilities.
• Dignity, respect, non-discrimination, privacy, and confidentiality.
• Access to information, education, and supported decision-making.
• Access to medical records.
• The right to be heard and fair resolution.
• Engagement of patients and families in care processes.

Tobacco Epidemic in India

Why in news?

Tobacco is recognized globally as a leading preventable cause of disease and death. India ranks second after China in terms of tobacco users, with nearly 260 million people consuming tobacco.

Statistics About Tobacco Consumption in India: No Significant Decrease of Bidi or Cigarette Consumption

• According to the National Family Health Survey (NFHS), there has been no notable reduction in bidi or cigarette consumption in both National Tobacco Control Programme (NTCP) and non-NTCP districts.
• Reasons for this stagnation may include insufficient staff, poor resource allocation, and inadequate monitoring mechanisms.
• Cigarettes and Bidis Have Become More Affordable
  (a) Over the last decade, the prices of cigarettes, bidis, and smokeless tobacco products have decreased.
  (b) The Goods and Services Tax (GST) has contributed to making these products more affordable due to a unified tax system.
• Tobacco Use Higher Among Women: While tobacco use has decreased across most demographics, there has been a 2.1% increase in usage among women from 2015 to 2021.

How is India Fighting Against Tobacco?

• India is a signatory of the WHO Framework Convention on Tobacco Control (FCTC), which aims to combat global tobacco use.
• This convention encourages nations to formulate strategies for reducing both demand and supply of tobacco.

World No Tobacco Day

• Every year on May 31, World No Tobacco Day is observed to raise awareness about the harmful effects of tobacco.

National Legislation

• The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA) 2003 governs various aspects of tobacco, including production, advertising, and distribution.
• The National Tobacco Control Program (NTCP) initiated in 2007 aims to bolster the implementation of COTPA and ensure compliance with FCTC.

Key functions include:

• Public Awareness Campaigns: Utilizing mass media to inform the public about the health risks associated with tobacco.
• Smoking Cessation Initiatives: Offering support through quitlines, counseling, and behavioral strategies.
• Enforcement Mechanisms: Implementing COTPA provisions through designated authorities.
• The Prohibition of Electronic Cigarette Act (PECA), 2019: This legislation bans e-cigarettes in India.
• National Tobacco Quitline Services (NTQLS): A mobile technology initiative launched in 2016 to assist individuals in quitting tobacco.
• Tobacco Taxation: India imposes heavy taxes on tobacco products, with cigarettes taxed at 53% of their retail price, while bidis are taxed at a lower rate of 16%.

What are Hidden Costs of Tobacco Beyond Health Risks?

• Soil Depletion: Tobacco cultivation depletes soil nutrients rapidly, necessitating increased fertilizer use, which further deteriorates soil quality.
• Deforestation
  (a) The production of tobacco leads to deforestation, as significant amounts of wood are required for processing.
  (b) Processing 1 kg of tobacco can consume up to 5.4 kg of wood.
• Waste Generation: Tobacco production and consumption result in substantial waste, amounting to 170,000 tonnes annually in India.
• Economic Burden
  (a) Healthcare costs related to tobacco use are immense, with an estimated loss of Rs. 1.7 lakh crore in 2017-18, surpassing the national health budget of Rs 48,000 crore.
  (b) Over 6 million workers in the tobacco sector are at risk of health issues due to tobacco exposure.
  (c) The cost of waste management for cleaning up tobacco waste is around Rs. 6,367 crore annually in India.

What are Challenges to Effective Tobacco Control in India?

Non-compliant Products

• Items like smokeless tobacco (e.g., gutkha) and smuggled products evade COTPA regulations, complicating control efforts.

Weak Fines

• Current fines for COTPA violations are minimal (e.g., a maximum of Rs. 5,000 for first-time violations), which are outdated and ineffective as deterrents.

Surrogate Advertising

• Tobacco companies often use advertisements for unrelated products (e.g., elaichi) to promote their brands indirectly, making regulation difficult.
• Surrogate advertisements were noted during the ICC Men’s Cricket World Cup 2023 for at least two tobacco brands.

Stalled Amendments

• Proposed amendments to strengthen COTPA in 2015 and 2020 have not been passed by the government, leaving regulatory gaps.
• Limited Enforcement Capacity
• The NTCP struggles with inadequate staff and resources, hindering full implementation of COTPA.

Effective Lobbying in Tobacco Industry

• Despite the ban on e-cigarettes, enforcement is lacking, allowing continued issues.
• The government offers unequal taxation across tobacco products, which keeps some harmful products cheaper.
• Conflict of Interest with Government
• Concerns arise regarding the government's commitment to tobacco control, especially since it holds a 7.8% stake in ITC Ltd., India's largest tobacco firm.

Way Forward

Needs Strong Foundation

• Updating India’s COTPA and NTCP is crucial for effective tobacco control.

Higher Tobacco Taxes

• Taxes on tobacco products, especially bidis and smokeless options, should be increased to meet the WHO recommended target of 75%.

Effective Monitoring

• Regular monitoring is necessary to track tobacco use trends, identify COTPA violations, and evaluate anti-tobacco campaigns' effectiveness.

Supporting Tobacco Farmers

• Public programs should assist tobacco farmers in transitioning to alternative crops, alleviating the economic impact of reduced tobacco cultivation.

Data-Driven Approach

• Timely data collection on tobacco use patterns is vital for understanding changes and devising strategies to counter tobacco industry tactics.

Menstrual Hygiene in Indian Prisons

Why in news?

The topic of menstrual hygiene in Indian prisons has gained attention due to ongoing challenges faced by incarcerated women regarding their menstrual health. Despite advancements in menstrual hygiene management across the country, female prisoners continue to lack access to adequate facilities and products.

Background:

India has witnessed notable advancements in menstrual hygiene management. According to the National Family Health Survey (NFHS) 2019-2020, approximately 80% of young women aged 15-24 utilize safe menstrual products. However, women in Indian prisons are often overlooked, exacerbating their challenges in accessing basic hygiene needs.

• Despite improvements in urban areas, female prisoners face significant neglect.
• Societal biases contribute to the perception that women cannot commit crimes, affecting the provision of their basic needs.

What is the Meaning of Menstrual Hygiene?

Menstrual Health and Hygiene (MHH) is vital for the health and empowerment of women and adolescent girls. Globally, over 300 million women are menstruating on any given day, yet an estimated 500 million lack access to necessary menstrual products and hygiene facilities.

Effective menstrual management requires:

• Access to water, sanitation, and hygiene (WASH) facilities.
• Affordable and suitable menstrual hygiene materials.
• Information on proper practices.
• A supportive environment to manage menstruation without stigma.

Status of Menstrual Hygiene in Indian Prisons:

Currently, there are 23,772 women in Indian prisons, with 77% of them in the reproductive age group, implying that many menstruate regularly.

• Availability and quality of sanitary napkins in prisons are often inadequate and inconsistent.
• Despite recommendations from the 2016 Model Prison Manual, many states have failed to provide sufficient water and sanitation facilities for female inmates.
• Overcrowding and poor living conditions hinder access to essential items like sanitary napkins and hygiene products.
• A study conducted in a Maharashtra prison in 2023 found that inadequate WASH facilities forced women to store water and share limited toilets, leading to increased urinary infections and difficulties in maintaining menstrual hygiene.
• Prisons often depend on NGOs for the donation of sanitary napkins, which can result in inferior quality products.
• In some cases, only one pair of reusable napkins was provided per woman, which is impractical due to limited access to water and detergent.

Measures Taken by the Government:

The Indian government has made efforts to enhance menstrual hygiene access, particularly for young women.

• The Menstrual Hygiene Scheme aims to distribute free or subsidized sanitary napkins.
• Affordable Suraksha Suvidha Napkins are available at Jan Aushadhi Kendras for ₹1 each.
• In 2023, India introduced the National Menstrual Hygiene Policy, recognizing menstruation as a natural process that requires attention.
• The policy emphasizes equitable access to safe and dignified menstrual hygiene management for all, including prisoners, but lacks a specific action plan and does not involve the Ministry of Home Affairs, crucial for addressing prison-related issues.

Way Forward

To ensure that women in prisons have access to adequate menstrual hygiene products and facilities, the Indian government must take decisive steps.

• Immediate action is required to enforce the inconsistent implementation of the 2016 Model Prison Manual across states.
• Addressing menstrual hygiene in prisons should be viewed through a public health lens, as part of combating 'period poverty.'
• Collaboration between public health authorities and prison administrators is essential to develop a comprehensive strategy for providing necessary menstrual hygiene products and facilities.
• Research is needed to better understand the current state of menstrual hygiene in prisons.

World Bank Report on Global Water Crisis

Why in News ?

The World Bank's new report "Water for Shared Prosperity," released at the 10th World Water Forum in Bali, Indonesia, highlights the alarming global water crisis and its implications for human and economic development worldwide.

Key Highlights of the Report

Alarming Water Scarcity Statistics:

• 2.2 billion people lack access to safely managed drinking water services.
• 3.5 billion people lack access to safely managed sanitation services.
• Eight out of ten individuals without basic services live in rural areas.

Regional Disparities in Access to Water:

• China and India, home to 36% of the global population, possess only 11% of the world's freshwater.
• North America, with just 5% of the population, has 52% of the freshwater resources.
• Africa's Democratic Republic of the Congo has over half of the continent's water resources, while areas like the Sahel and South Asia face severe water stress.
• Low-income countries have seen a decline in access to safe drinking water, with an additional 197 million people affected since 2000.
• Marginalized groups suffer disproportionately based on gender, location, ethnicity, and other social identities.

Impact of Climate Change:

• Climate change increases water-related risks, particularly in developing nations facing prolonged droughts and floods.
• Over 800 million individuals are at high risk of drought, with double that number living in flood-prone areas.
• By 2100, meteorological drought is projected to affect 15% more global land area, potentially impacting up to 50% considering temperature effects.
• Regions like Central Europe, Asia, and the Horn of Africa will be significantly affected.

Human Capital and Economic Growth:

• Access to water and sanitation is vital for educational achievement and human capital development.
• In low-income countries, 56% of jobs are in water-intensive sectors, which are vulnerable to water availability.
• In Sub-Saharan Africa, 62% of employment is in water-dependent jobs, with low rainfall negatively affecting GDP growth.

Social Cohesion and Conflict:

• Effective water management promotes community trust and cooperation, while mismanagement can lead to conflict.
• Proper management fosters inclusivity and reduces tensions, contributing to peace.

Recommended Interventions for Sustainable Water Management:

• Enhancing resilience to hydro-climatic risks for vulnerable populations is essential.
• Improving the development, management, and allocation of water resources is necessary.
• Delivering equitable and inclusive water services is crucial for poverty reduction and shared prosperity.

Extent of Water Scarcity in India

India’s Water Crisis:

• According to the "Composite Water Management Index" by NITI Aayog, nearly 600 million people face high to extreme water stress.
• 8 million children under 14 in urban areas are at risk due to inadequate water supply.
• India ranks 120 out of 122 countries in water quality, with approximately 70% of water being contaminated.

Disproportionate Water Resources:

• India has only 4% of the world's freshwater resources, despite being home to 18% of the global population.
• This imbalance puts immense pressure on available water resources.

Strained Water Availability

Declining Groundwater Levels:

• There are 20.52 million wells in India, but groundwater extraction exceeds the rate of replenishment.
• Many areas are reported to have critical or over-exploited groundwater levels.

Drying Rivers and Reservoirs:

• Seasonal shifts and unsustainable usage are causing rivers and reservoirs to dry up before the monsoon.
• This disrupts water access, especially in summer.

Threat to Agriculture and Food Security:

• High water consumption in agriculture threatens food security and productivity.
• A demand-supply gap of up to 570 billion cubic meters is anticipated by 2030 for agriculture alone.
• Water scarcity could lead to a predicted 50% decline in agricultural productivity by 2050.
• Water scarcity might cost India up to 6% of its GDP by 2050 if not addressed.

Impact of Climate Change on Water Scarcity:

• Monsoon patterns are becoming increasingly erratic, with a 10% decline in average rainfall since the 1950s.
• Rising temperatures lead to higher evaporation rates, significantly affecting surface water availability.
• Glacial melt in the Himalayas disrupts water flow patterns, despite initial increases in water supply.

Water Crisis in Southern India:

• Southern states like Karnataka and Tamil Nadu face severe water crises, with reservoirs at critically low levels.
• El Niño events exacerbate drought conditions, leading to prolonged dry spells and delayed monsoon rains.

Way Forward

Micro-Irrigation Techniques:

• Implementing drip irrigation and sprinkler systems can significantly reduce water consumption in agriculture.

Rainwater Harvesting:

• Storing rainwater can provide sustainable water sources for communities and households.

Desalination:

• Utilizing seawater treatment can offer reliable water sources in coastal regions, though energy consumption is a concern.

Nature-Based Solutions:

• Investing in the restoration of wetlands and natural water bodies can enhance water purification and groundwater replenishment.

Water ATMs:

• Developing "Water ATMs" that dispense treated water through prepaid systems can improve access in underserved areas.

Climate-Smart Agriculture:

• Adopting resilient agricultural practices, such as drought-resistant crops, can mitigate water scarcity impacts.

Public Awareness Campaigns:

• Educating the public on water conservation and responsible usage is crucial for sustainable water management.

Early Cancer Detection in India and CRC Tumour Breakthroughs

Why in News?

Recently, a NITI Aayog (National Institution for Transforming India) report highlighted critical gaps in cancer detection in India, posing public health risks. Meanwhile, researchers in the United States discovered a distinct subtype of Fusobacterium nucleatum in colorectal cancer (CRC) tumours, potentially improving early detection and targeted treatment.

Key Highlights of the NITI Aayog Report on Early Cancer Detection in India

• The report identified a significant deficiency in cancer screening at the Ayushman Bharat Health and Wellness Centres (HWCs), which were intended to provide annual screenings for oral, breast, and cervical cancers for individuals aged 30 and above.
• Less than 10% of the HWCs visited had successfully completed even one round of screening for non-communicable diseases, including cancer.
• While breast cancer screening was being conducted through self-examination, the cervical cancer screening process had not yet been implemented, and oral cancer screenings were only done when symptoms were visible.
• The report revealed that the infrastructure and the availability of essential devices, medications, and diagnostic tests at the HWCs were inadequate according to operational guidelines.
• Reasons for the shortcomings in cancer screening were linked to low awareness levels and insufficient capabilities among HWC staff.
• It was noted that the necessary intensive training and careful monitoring of Auxiliary Nurses and Midwives (ANMs) on the three screening techniques had not been adequately conducted.
• HWC staff displayed limited or no understanding of the need for annual screenings for hypertension and diabetes.

India's Initiatives Related to Cancer:

• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
• National Cancer Grid
• National Cancer Awareness Day
• HPV Vaccine
• Ayushman Bharat - Health & Wellness Centres (AB-HWCs)

Key Highlights of the Study Regarding Colorectal Cancer:

• Researchers successfully isolated Fusobacterium nucleatum bacteria from 130 human CRC tumours and analyzed their genetic structure.
• They discovered that the subspecies Fusobacterium nucleatum animalis (Fna) was notably linked to CRC tumours.
• Fna is divided into two distinct evolutionary lineages or clades, referred to as Fna C1 and Fna C2.
• The Fna C2 clade showed a strong association with CRC tumours and had additional genetic traits that enhance its connection to cancer.
• Fna C2 bacteria are longer and thinner compared to Fna C1, which may help them avoid the immune response and colonize host tissues.
• Genetically, Fna C2 possesses genes that enable it to metabolize compounds such as ethanolamine and 1,2-propanediol found in the human gut.
• Fna C2 demonstrates the ability to survive in more acidic environments, allowing it to travel from the mouth to the gut, which contradicts earlier beliefs that Fusobacterium only reaches the gut through bloodstream infections.
• The findings may pave the way for the development of early diagnostic tests for CRC.
• Targeted treatments could be derived from the characteristics of Fna C2.
• However, selectively targeting Fna C2 without affecting other gut bacteria remains a significant challenge.

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