PMSSY

• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances in the availability of affordable healthcare facilities in the different parts of the country in general, and augmenting facilities for quality medical education in the under-served States in particular. The scheme was approved in March 2006. 
• The first phase in the PMSSY has two components Setting up of six institutions in the line of AIIMS Upgradation of 13 existing Government medical college institutions. It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 crores per institution. These States have been identified on the basis of various socio-economic indicators like human development index, literacy rate, population below poverty line and per capital income and health indicators like population to bed ratio, prevalence rate of serious communicable diseases, infant mortality rate etc. Each institution will have a 960 bedded hospital (500 beds for the medical college hospital; 300 beds for Speciality/Super Speciality; 100 beds for ICU/Accident trauma; 30 beds for Physical Medicine & Rehabilitation and 30 beds for Ayush) intended to provide healthcare facilities in 42 Speciality/Super-Speciality disciplines. Medical College will have 100 UG intake besides facilities for imparting PG/doctoral courses in various disciplines, largely based on Medical Council of India (MCI) norms and also nursing college conforming to Nursing Council norms. In addition to this, 13 existing medical institutions spread over 10 States will also be upgraded, with an outlay of Rs. 120 crores (Rs. 100 crores from Central Government and Rs. 20 crores from State Government) for each institution. These institutions are 

                     # Government Medical College, Jammu, Jammu & Kashmir 

                     # Government Medical College, Srinagar, Jammu & Kashmir

                     # Kolkatta Medical College, Kolkatta, West Bengal 

                     # Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow UP

                     # Institute of Medical Sciences, BHU, Varanasi, Uttar Pardesh 

                     # Nizam Institute of Medical Sciences, Hyderabad, Andhra Pradesh

                     # Sri Venkateshwara Institute of Medical Sciences, Tirupati, AP

                     # Government Medical College, Salem, Tamil Nadu 

                     # B.J. Medical College, Ahmedabad, Gujarat 

                     # Bangalore Medical College, Bangalore, Karnataka 

                     # Government Medical College, Thiruvananthapuram

, 
                     # Rajendra Institute of Medical Sciences (RIMS),Ranchi

                     # Grants Medical College & Sir J.J. Group of Hospitals, Mumbai.

• In the second phase of PMSSY, the Government has approved the setting up of two more AIIMS-like institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college institutions namely 

                     # Government Medical College, Amritsar, Punjab

                     # Government Medical College, Tanda, Himachal Pradesh

                     # Government Medical College, Madurai, Tamil Nadu 

                     # Government Medical College, Nagpur, Maharashtra

                     # Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh

                     # Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. 

• The estimated cost for each AIIMS-like institution is Rs. 823 crore. For upgradation of medical college institutions, Central Government will contribute Rs. 125 crore each.
•  In the third phase of PMSSY, it is proposed to upgrade the following existing medical college institutions namely

                    # Government Medical College, Jhansi, Uttar Pradesh

                    # Government Medical College, Rewa, Madhya Pradesh

                    # Government Medical College, Gorakhpur, Uttar Pradesh

                    # Government Medical College, Dharbanga, Bihar

                    # Government Medical College, Kozhikode, Kerala

                    # Vijaynagar Institute of Medical Sciences, Bellary, Karnataka 

                    # Government Medical College, Muzaffarpur, Bihar.

• The project cost for upgradation of each medical college institution has been estimated at Rs. 150 crores per institution, out of which Central Government will contribute Rs. 125 crores and the remaining Rs. 25 crore will be borne by the respective State Governments. 'PMSSY aims at correcting the imbalances in availability of affordable/reliable tertiary level healthcare in the country in general and augmenting facilities for quality medical education in the under-served States. 
• The scheme envisages setting up six institutions like the All India Institute of Medical Sciences (AIIMS), one each in the States of Bihar (Patna), Madhya Pradesh (Bhopal), Odisha (Bhubaneshwar), Rajasthan (Jodhpur), Chhattisgarh (Raipur) and Uttarakhand (Rishikesh); and upgradation of 13 existing medical institutions in the first phase. In the 2nd phase setting up of 2 more AIIMS like institutions and up gradation of 6 more medical college institutions will be taken up.

DOTS TB MDR XDR- TB

DOTS, is an acronym for Directly Observed Treatment, Short course. The DOTS strategy represents the most important public health breakthrough of the decade, in terms of lives which will be saved. It is based largely on research done in India in the field of TB over the past 35 years. As it is the only strategy effective in controlling TB on a mass basis, nearly 100 countries are following it.
DOTS has five components:
Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
Case detection by sputum smear microscopy Standardized treatment regimen directly observed by a health care worker or community health worker for at least the first two months A regular drug supply
A standardized recording and reporting system that allows assessment of treatment results
Other Notes
The technical strategy for DOTS was developed by Dr. Karel Styblo in the 1980s primarily in Tanzania.
In 1989, the World Health Organization and the World Bank began investigating the potential expansion of this strategy. In July 1990, the World Bank, under Richard Bumgarner's direction, invited Dr. Styblo and WHO to design a TB control project for China. By the end of 1991, this pilot project was achieving phenomenal results, more than doubling cure rates among TB patients. China soon extended this project to cover half the country.
In India, Government had adopted the revised strategy for TB in the form of DOTS.
Since 1993, DOTS has been pilot tested in 20 sites in India as RNTCP. In RNTCP the proportion of TB cases confirmed in the laboratory is double that of the previous programme, and the cure rate is nearly triple that of the previous programme. The operational feasibility of DOTS in the Indian context has been demonstrated, with 8 out of 10 patients treated in the programme being cured as compared to three out of 10 under the previous regime. DOTS has also been shown to prevent the emergence of multi-drug resistant
tuberculosis (MDRTB) and to reverse the trend of MDRTB in communities in which it has emerged. Also DOTS can cure TB even in HIV-positive patients. Entire country has been covered under DOTS Strategy by March 2006. The international Joint Monitoring Mission (JMM) in October 2006, has hailed it as the fastest expansion of DOTS in the world.

Isoniazid
Isoniazid / Laniazid or Nydrazid) is the classic antituberculosis medication, first discovered in 1912. It was found to be effective against tuberculosis in 1950s. However, Isoniazid is never used on its own to treat active tuberculosis because resistance quickly develops.

Rifampicin
Rifampicin is a bacteriocidal antibiotic drug. It has been used for TB along with isoniazid, ethambutol, pyrazinamide and streptomycin etc.

MDR-TB
TB that is resistant at least to isoniazid and rifampicin the two most powerful firstline anti-TB drugs is called the Multi-drug-resistant tuberculosis (MDR-TB). It develops because the when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill 100% of bacteria. This means that even if the patient forgets to take medicine, there are chances of developing MDR-TB. MDR-TB is treated with secondline of antituberculosis drugs such as a combination of several medicines called SHREZ (Streptomycin+isonicotinyl Hydrazine+Rifampicin+Ethambutol+pyraZinamide)+MXF+cycloserine.

XDR-TB
When the rate of multidrug resistance in a particular area becomes very high, the control of tuberculosis becomes very difficult. This gives rise to a more serious problem of extensively drug-resistant tuberculosis (XDR-TB). XDR-TB is caused by strains of the disease resistant to both first- and second-line antibiotics. This confirms the urgent need to strengthen TB control. Thus, Extensively-drug resistant TB (XDR-TB) is a sub-set of MDR-TB which is further resistant to at least two more drugs which are second line drugs and is thus virtually incurable. XDR TB was first described in March 2006 following a joint survey of laboratories by the WHO, IUATLD, and CDC, Atlanta.

indus water treaty

The Indus Waters Treaty (IWT), signed by India and Pakistan in 1960, has recently been seen both as the one agreement that has worked between India and Pakistan and as an anachronism which should be dissolved or renegotiated. On December 20, 2013, the Permanent Court of Arbitration (PCA) has issued a judgment which re-calibrates and modernises the IWT and, again makes it a critical and effective instrument in avoiding conflicts between India and Pakistan on use of the rivers of the Indus Basin.

It is first useful to reiterate the central elements of the treaty and the long-standing areas of contention. The IWT assigns use of the eastern rivers (Ravi, Beas and Sutlej) to India and use of the western rivers (Chenab, Jhelum and Indus) to Pakistan. The biggest sticking point in negotiating the treaty in the 1950s was the conditions under which India could use the hydro-electric potential of the Chenab and the Jhelum before the rivers reached Pakistan.

The principle incorporated into the IWT was that, indeed, India could develop this potential, but only under a set of well-defined limitations on the amount of manipulable storage which could be created by India in the process, thus assuring Pakistan that India would not have the ability to manipulate either the timing or the quantities of the flows reaching Pakistan.

In the 1990s, a difference arose about the Baglihar Dam being built by India on the Chenab. Pakistan claimed that low gates installed for flushing sediments violated the specifications of the treaty and endangered Pakistan’s water security because it gave India a capacity to manipulate the timing of flows into Pakistan.

Recipe for conflict

In 2005, a Neutral Expert was appointed to hear the case. His finding essentially said that new knowledge of sediment management technology meant that India had to be allowed to install low gates. His finding ignored the central balance — between India’s right to generate hydropower and Pakistan’s right to unmanipulated flows — in the IWT. Since India plans to build many other projects on the Chenab and Jhelum, if the Baglihar ruling established new ground rules, this would, essentially, give India a free hand to do whatever it liked, leaving Pakistan vulnerable in both perception and practice. This was a recipe for growing conflict and, eventually, even war over the Indus.

In 2010, Pakistan took a new case, that of the Kishenganga hydro-electric project on the Jhelum river, to the International Court of Arbitration. On December 20, 2013, the court issued its final judgment. The Kishenganga case comprised two elements — was India within its rights to build the project and was India able to insert low gates? On the first, limited and specific issue, the court interpreted the treaty literally and accurately and allowed India to proceed. This will somewhat limit the yield of a Pakistani hydropower project being built downstream, but it is not a systemic issue. The big and systemic issue was the second. Here, the court reinforced the hard constraints built into the IWT regarding the ability of India to embed manipulable storage into this and all future projects.

Convenience vs water security

The court pointed out that while it might be convenient for India to build low gates and practise sediment flushing, this was not the only way to manage sediments, and that convenience for India had to be balanced against the threat this would pose to Pakistan’s water security. The court explicitly stated that the Baglihar ruling did not constitute a precedent and implied that the Baglihar Neutral Expert had erred by not balancing engineering concerns with the diplomatic and security factors which were at the heart of the IWT.

The decision by the PCA means that India can, as laid out by the IWT, continue to develop much-needed hydropower projects on the Chenab and the Jhelum, but it must strictly respect the IWT-defined limits on manipulable storage, and must use methods other than the construction of low gates to flush silt.

The court also played close attention to an area which had been neglected in the original IWT, namely environmental flows (e-flows). The court mandated a small, constant release which was less than 10% of what Pakistan claimed to be necessary. Again, the court underlined the importance of balance. “Although the court considered this approach (to defining the e-flow) to be somewhat severe in environmental terms, the court concluded that [….] such an approach represents an appropriate balance between the needs of the environment and India’s right to power generation”. This principle of balance and reasonableness is particularly important because it is inevitable that Pakistan will ask that India release e-flows from the eastern rivers (especially the Ravi and the Sutlej) into areas of Pakistan which have suffered major environmental damage as India has diverted all flows to the east.

The bottom line is that the brilliant and balanced work of the PCA means a new dawn for water management in the Indus. Rumblings over “water wars on the Indus” should now dissipate, and, once again, relationships between India and Pakistan on the Indus should become stable and perhaps have a positive ripple effect on relatioins between the two countries.

Kishenganga project

The Hague-based International Court of Arbitration has allowed India to go ahead with construction of the 330-MW Kishenganga hydro-electric project in North Kashmir which was under dispute with Pakistan.

In its final order delivered on Friday, the court upheld India’s right under the bilateral Indus Waters Treaty to divert waters from the Kishenganga for power generation in Jammu and Kashmir.

The court, however, decided that India shall release a minimum flow of nine cubic metres per second (cumecs) into the Kishenganga river (known as Neelam in Pakistan) below the project at all times to maintain environmental flows.

Although the decision is binding on both the parties and cannot be appealed, the court, chaired by Judge Stephen M. Schwebel (United States) decided that either India or Pakistan may seek reconsideration of the final order through the bilateral Permanent Indus Commission and the mechanisms of the Indus Waters Treaty after seven years from the first diversion of waters from the Kishenganga/Neelam river.

On India seeking a clarification on the drawdown flushing technique for clearing sedimentation in the run-of-the river project, it is understood that India may have to adopt a different technique for flushing in future projects.

Pakistan had apprehended that the drawdown flushing technique involving depletion of storage levels will affect flows at its down stream Neelam project.

On May 17, 2010, Pakistan moved for arbitration against India under the provisions of the Indus Waters Treaty 1960 that regulates the use of waters in the shared rivers.

The Rs. 3600-crore Kishenganga project is designed to generate power by diverting water from a dam site on the Kishenganga to the Bonar Nallah, another tributary of the Jhelum, through tunnels.

Pakistan had challenged the project saying it was in violation of the treaty. However, the Arbitration Court has finally rejected Islamabad’s objections on this count.

The Ministry of External Affairs confirmed on Saturday that India had received the “final award” and the “court’s decision on India’s request for clarification” on Friday night.

“The quantum of 9 cumecs of natural flow of water that must be maintained in the Kishenganga at all times is “much lower” than the 100 cumecs of natural flow that Pakistan wanted India to ensure,” the Ministry said in a statement.

In its “Partial Award” delivered in February this year, the Court of Arbitration has already upheld India’s main contention that it has the right to divert waters of the western rivers, in a non-consumptive manner, for the optimal generation of power, the statement said.

MSP

                              

• The Minimum Support Prices were announced by the Government of India for the first time in 1966-67 for Wheat in the wake of the Green Revolution and extended harvest, to save the farmers from depleting profits. Since then, the MSP regime has been expanded to many crops. 
• Minimum Support Price is the price at which government purchases crops from the farmers, whatever may be the price for the crops.  The MSP is announced by the Government of India for 25 crops currently at the beginning of each season viz. Rabi and Kharif. Following are the 25 crops covered by MSP: 
• Kharif Crops:

                   Paddy,Jowar ,Bajra , Maize ,Ragi, Arhar(Tur), Moong ,Urad ,Cotton ,Groundnut 

                   Sunflower Seed, Soyabeen, Black Sesamum ,Nigerseed 

• Rabi crops:

                  Wheat, Barley ,Gram, Masur (Lentil) ,Rapeseed/Mustard ,Safflower, Toria 

• Other Crops 

                  Copra ,De-Husked ,Coconut ,Jute ,Sugarcane

• Rationale If there is a fall in the prices of the crops, after a bumper harvest, the government purchases at    the MSP and this is the reason that the priced cannot go below MSP. So this directly helps the farmers.

•  How MSP is decided? The government decided the support prices for various agricultural commodities after  taking into account the following: Recommendations of Commission for Agricultural Costs and Prices Views of State Governments Views of Ministries 

• Other relevant factors. Note: Price Support Scheme (PSS) for Oil seeds and Pulses The Department of Agriculture and Cooperation implements the Price Support Scheme for Oil Seeds and Pulses through the National Agricultural Cooperative Marketing Federation of India Ltd.(NAFED).NAFED is the nodal procurement agency for Oilseeds and pulses, apart from the Cotton Corporation of India. So, when the prices of oilseeds, pulses and cotton fall below MSP, NAFED purchases them from the farmers.

NAFED

1. National Agricultural Cooperative Marketing Federation of India Ltd.(NAFED) was established 2nd October 1958. Nafed is registered under the Multi State Co-operative Societies Act. (see text box) Nafed was setup with the object to promote Co-operative marketing of Agricultural Produce to benefit the farmers. 
2. Agricultural farmers are the main members of Nafed, who have the authority to say in the form of members of the General Body in the working of Nafed. 
3. The Department of Agriculture and Cooperation is implementing a Price Support Scheme (PSS) for the procurement of oilseeds and pulses at the Minimum Support Price (MSP) declared by the Government, through NAFED, which is the central nodal agency for this purpose. NAFED is the national level marketing agency for agricultural products in the Cooperative Sector. 
4. The core objective of NAFED is to organise, promote and develop marketing, processing and storage of agricultural, horticultural and forest produce, distribution of agricultural machinery, implements and other inputs, undertake inter-State, import and export trade,
5. wholesale or retail as the case may be and to act and assist for technical advice in agricultural production for the promotion and the working of its members and cooperative marketing, processing and supply societies in India. 
6. (NAFED website) NAFED and Multi State Cooperative Societies Act 1984 'Cooperative Societies' is a State Subject i.e. they are listed in the State List). So the cooperative societies formed under State Acts have to restrict their activities to only one State.
7. So, this is a road block to Multi State Cooperative Societies. To overcome this hurdle, Multi State Cooperative Societies Act was passed in 1942, which was replaced by a Multi State Cooperative Societies act 1984 . 
8. This 1984 Act was later replaced by 2002 Act. This act makes provision for creation of Federal Cooperative Societies.

siachen glacier

Why is Siachen Glacier important?

1. The Siachen glacier is considered to be the largest single source of fresh water on the Indian subcontinent.
2. It is located in the Karakoram range
3. Siachen is the source of the Nubra River that eventually feeds the mighty Indus— the major water source that irrigates the Punjab plains in Pakistan.
4. Siachen is near the Karakoram pass, forming almost a triangle with India, China and territory occupied by Pakistan touching the edges. 

How did the disagreement over the glacier start?

        

1. India and Pakistan have a disputed border in Jammu and Kashmir, most of it delineated as the Line of Control (LoC) with troop positions on either side.
2. While most positions were delineated as per the 1972 Shimla agreement, the boundary line was specified to only a point called NJ 9842, till the area from where Siachen starts.
3. The agreement stated that after this point, the boundary would proceed “north to the glaciers” without specifying which nation would have control over which area.
4. The matter remained non-controversial until the 1980s when the Indian Army discovered that Pakistan was issuing permission to foreign expeditions to trek in Siachen. Indian intelligence agencies found out that Pakistan army under orders from General Zia was planning to conduct a military operation to capture Siachen, from their supplier of High Altitude mountain warfare gear provider in London, (as Pakistan had placed orders for Arctic gear from the same supplier) Thus the Indian army launched Operation Meghdoot and Indian troops belonged to the Kumaon Regiment were air-lifted and moved into the glacier.

Where do the two sides disagree?

1. India’s stance is that the LoC runs from point NJ 9842 along the watersheds formed by the Saltoro ridge that puts the entire Siachen glacier within Indian territory.
2. Pakistan claims that the line joins point NJ 9842 with the Karakoram pass that lies towards the northeast, putting Siachen within its territory.

The ground position now is that the Indian Army controls the entire Saltoro ridge. There is no presence of Pakistani troops on the Siachen glacier. In fact, the nearest Pakistani locations are on the lower reaches of the Saltoro ridge.

How much does India control today?

1. As India managed to get the upper hand, it currently controls all heights along the glacier on the Saltoro ridge and uses the glacier as a logistics base.
2. Since 2007, India has been promoting treks and expeditions by civilians and foreigners in the vicinity of the glacier to reaffirm its claim on the region.
3. The Army has given permission to several groups of mountaineers to climb peaks in the Eastern Karakoram range that adjoins the glacier. The Army also holds a civilian Siachen expedition every year and will in the future invite even foreigners to trek up the glacier.

Where do negotiations stand?

1. A year after India took over the glacier in 1984, talks started.
2. After 13 rounds, both sides are now in agreement that the Siachen glacier should be demilitarised.
3. The disagreement is on how this withdrawal of troops will take place. The Indian position is that both nations should jointly demarcate the current troop positions in the region. This would involve an exhaustive process to determine and delineate current troops positions both on the ground and on a map. After this demarcation or “authentication” of troop positions, India believes, troops can be moved back to pre-1984 positions and the border issue can be solved with dialogue.
4. Pakistan agrees that the issue should be resolved with talks but is strongly against a demarcation of troop positions.
5. Pakistan believes that any joint demarcation or authentication of troops positions can be used as a claim by India for future talks to resolve the matter. It insists instead on a mutual withdrawal of troops to pre-1984 deployments for talks to begin.
6. India, however, has hardened its stance for authentication of troops positions after the 1999 Kargil conflict in which insurgents supported by the Pakistani Army occupied critical locations along the LoC.
7. India wants a demarcation so that it can take military action, if necessary, should Pakistan stealthily occupy troops positions even after vacating these as per the demilitarisation plan.

What is the way forward?

A number of suggestions have been made on how the problem can be resolved, including

1. declaring the area a peace park,
2. joint patrolling of the region
3. international peacekeeping force being deployed in the region.

However, the Indian Army stand, which is backed by the government, is very strict on the point of authentication of troop positions.
The argument is that a demarcation will not take anything away from Pakistan on the negotiating table as current troop positions is a hard, cold fact.
Marking the positions on a map, the Army believes, will facilitate a comfortable withdrawal of troops from both sides.
Pakistan, on the other hand, believes India’s “occupation” of the glacier is illegal and hence cannot be authenticated jointly by both sides, lest it get validation.