Social Justice

Context: Despite nearly three decades of the Transplantation of Human Organs and Tissues Act (THOTA), 1994, India’s deceased organ donation ecosystem remains underdeveloped. According to The Hindu, the deceased donor rate continues to be critically low, highlighting systemic, legal, and operational constraints.

Organ Donation Performance in India

India’s deceased organ donation rate stood at 0.77 per million population (pmp) in 2023, starkly lower than Spain’s 49.38 pmp, the global leader. An estimated 5 lakh Indians die annually due to non-availability of organs. Although over 50,000 Brainstem Death (BSD) cases are medically eligible each year, only 700–900 deceased donors are realised.

Further, 85% of transplants rely on living donors, unlike developed countries where 70–80% are from deceased donors. Alarmingly, only 2–3% of ICU deaths undergo BSD certification. The apnea test is mandatory for confirming irreversible loss of brainstem function and is central to BSD determination.

Legal and Institutional Framework

The THOTA, 1994 provides the statutory backbone for organ transplantation in India. It:

• Recognises Brainstem Death as legal death, enabling deceased donation.
• Regulates living donations, transplant hospitals, and penalises organ trade.
• Prescribes certification and consent norms (Form 10 for BSD declaration; Form 8 for consent).

Institutional mechanisms include:

• NOTTO: National apex body for organ allocation, registry, and coordination.
• ROTTO: Regional coordination across States.
• SOTTO: State nodal agencies for training, hospital networking, and awareness.

Key Challenges

• Low BSD Utilisation: Massive gap between eligible and certified BSD cases.
• Dual Death Certificate Ambiguity: Issuance of both BSD and cardiac death certificates causes legal uncertainty and delays.
• Restricted Certification Locations: BSD certification allowed only in registered transplant centres, excluding over 90% of public ICU hospitals.
• Doctor Approval Bottleneck: Less than 8% of government doctors are authorised for BSD certification.
• Consent Timing Errors: Families often approached before formal BSD certification, leading to 60–70% refusal rates in major public hospitals.

Way Forward

• Universal BSD Certification: Permit all ICU-equipped hospitals to certify BSD, as practiced in Spain.
• Single Death Certificate Rule: Recognise BSD as the final legal time of death; Kerala’s 2020 order is a best practice.
• Trained Transplant Coordinators: Deploy certified counsellors in ICUs; Tamil Nadu’s model increased donations by over 400%.
• Digital BSD Registry: Establish a real-time, integrated BSD and organ availability platform linked with NOTTO and SOTTO.

Context: The Union Government informed Parliament that India’s doctor–population ratio stands at 1:811, better than the WHO norm of 1:1000, highlighting quantitative progress in healthcare availability while masking structural challenges.

India’s healthcare system has undergone significant expansion over the last decade, driven by a shift towards universal health coverage, preventive care, and infrastructure strengthening. However, challenges related to financing, equity, and quality of care continue to demand policy attention.

Current Status of India’s Healthcare System

Public health expenditure has increased gradually to 1.9% of GDP (FY 2023–24), yet remains below the National Health Policy (2017) target of 2.5% by 2025. While financial protection has improved, Out-of-Pocket Expenditure (OOPE) still accounts for 39.4% of total health spending, exposing households to catastrophic health shocks.

India’s improved doctor–population ratio reflects expanded medical education capacity, but rural–urban disparities, uneven specialist distribution, and shortages in public facilities persist. The disease profile has also shifted decisively towards non-communicable diseases (NCDs), which account for over 60% of deaths, necessitating long-term, preventive, and primary-care-driven interventions.

A major structural reform has been the transition to Comprehensive Primary Health Care (CPHC) through the establishment of over 1.7 lakh Health and Wellness Centres, now renamed Ayushman Arogya Mandirs (AAMs). These centres focus on NCD screening, mental health, geriatric care, and preventive services.

Government Measures and Initiatives

The flagship Ayushman Bharat programme anchors India’s healthcare reforms through two pillars.

First, PM-JAY provides health insurance coverage of ₹5 lakh per family per year for secondary and tertiary care to about 12 crore vulnerable families, reducing financial hardship.

Second, Ayushman Arogya Mandirs strengthen grassroots healthcare delivery.

The National Health Mission (NHM) continues to support states in expanding healthcare access, improving maternal and child health, and addressing regional disparities.

Complementing this, the PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) focuses on building critical care blocks, disease surveillance units, and public health laboratories to enhance pandemic preparedness.

To tackle medicine affordability, the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) has expanded access to quality generic medicines through thousands of Janaushadhi Kendras, directly contributing to the reduction in OOPE.

Way Forward

India’s healthcare priorities must now focus on increasing public spending, addressing human-resource imbalances, strengthening urban and rural primary care, and integrating digital health solutions.

Greater emphasis on preventive care, mental health, and geriatric services is essential to manage the rising NCD burden.

Overall, India’s healthcare sector reflects meaningful progress, but achieving equitable, affordable, and quality healthcare for all will require sustained fiscal commitment, cooperative federalism, and systemic reforms.

The World Health Organisation (WHO) has issued its first-ever global guidelines on the use of GLP-1 (Glucagon-Like Peptide-1) receptor agonists for treating obesity, marking a major shift in international clinical and public-health policy. These medicines—originally developed for diabetes—have shown significant weight-loss benefits but raise concerns regarding affordability, long-term safety, and unequal access.

GLP-1 drugs mimic the natural hormone that increases insulin secretion, suppresses appetite, slows gastric emptying, and reduces glucagon levels. Popular therapies include liraglutide, semaglutide, and tirzepatide.

Key Features of the WHO Guidelines

1. Conditional Recommendations

WHO issued two conditional guidelines owing to limited long-term evidence and substantial cost barriers:

• GLP-1 Therapies for Adults: Medicines such as semaglutide and tirzepatide may be used for long-term treatment, except in pregnant women.
• Behavioural Interventions Mandatory: Drug therapy must be accompanied by structured dietary counselling, physical activity programmes, and regular follow-up.

2. Obesity as a Chronic Disease

The guidelines adopt a lifelong care model, positioning obesity as a chronic metabolic condition requiring sustained clinical management rather than short-term weight-loss attempts.

3. Three-Pillar Strategy

WHO recommends a multilevel approach that integrates:

• Population-level measures (healthy food policies, regulation of marketing, active-living environments)
• Targeted screening and early interventions
• Lifelong, person-centred care, including pharmacotherapy where appropriate

4. Health Equity Concerns

The guidelines highlight the limited global capacity to manufacture GLP-1 drugs and project that less than 10% of people with obesity worldwide will benefit by 2030 due to cost and supply constraints.

Global and Indian Burden of Obesity

Obesity is defined by WHO as BMI ≥ 30 in adults.

• Global Burden (2024): Over 1 billion people affected; 3.7 million deaths linked to obesity-related conditions.
• India (NFHS-5): 24% of women and 25% of men are overweight or obese.
• Projections: India may exceed 163 million adults with obesity by 2030, nearly doubling current levels.

Obesity’s rapid rise, combined with the expanding but inequitable availability of GLP-1 therapies, underscores the need for integrated public-health measures and affordable access strategies.

The United Nations (UN) and the World Health Organization (WHO) have issued a global alert on rising cervical cancer deaths as the world observed the first World Cervical Cancer Elimination Day on 17 November 2025. The day was officially designated by the 78th World Health Assembly (WHA) to accelerate international commitments towards eliminating cervical cancer as a public health threat.

About Cervical Cancer

Cervical cancer develops in the cervix— the lower part of the uterus—mainly due to persistent infection with high-risk Human Papillomavirus (HPV).
Importantly, cervical cancer is highly preventable, and early vaccination combined with periodic screening drastically reduces mortality.

Global Burden

• It is the 4th most common cancer in women globally, causing one death every two minutes (WHO).
• In 2022, the world recorded 660,000 new cases and 350,000 deaths.
• The South-East Asia region contributes nearly one-fourth of the global burden.
• 94% of global deaths occur in low- and middle-income countries, primarily due to limited access to screening, late detection and treatment shortages.

India’s Burden

India remains one of the worst-affected countries:

• India contributed around one-fifth of global cases and nearly a quarter of global deaths (2020).
• Cervical cancer is the second most common cancer among Indian women, after breast cancer.
• Screening levels remain extremely low: <10% of women have ever been screened; only 2% have undergone screening in the last five years (NFHS-5).

About Human Papillomavirus (HPV)

HPV is a double-stranded DNA virus infecting skin and mucosal surfaces.

• 200+ types exist—classified as low-risk (warts) and high-risk (cancer-causing).
• HPV types 16 & 18 account for ~99% of cervical cancer cases.

HPV Vaccination & Prevention Strategies

Vaccines

Six HPV vaccines are globally available, all targeting high-risk HPV 16 and 18.
India developed its first indigenous quadrivalent HPV vaccine (qHPV) called Cervavac, manufactured by the Serum Institute of India, with support from the Department of Biotechnology.

Target Group

Vaccination is most effective for girls aged 9–14 years, before sexual exposure.

WHO Elimination Strategy (2020)

To eliminate cervical cancer by 2030, WHO recommends the 90-70-90 targets:

• 90% of girls fully vaccinated by age 15
• 70% of women screened at ages 35 & 45
• 90% of women with cervical disease receive treatment

India’s Policy Steps

• NTAGI has recommended integrating the HPV vaccine into the Universal Immunisation Programme (UIP).
• The 2024–25 Union Budget approved phased free vaccination for girls aged 9–14, marking a major step toward national cervical cancer elimination.

Cervical cancer is among the few cancers that can be prevented, detected early, and cured. Scaling up vaccination, expanding screening, and strengthening health systems are essential for India and the world to meet the 2030 elimination goal.

Context: The Ministry of Consumer Affairs, Food & Public Distribution has issued the Vegetable Oil Products, Production and Availability (Regulation) Amendment Order, 2025 (VOPPA 2025) to enhance regulatory oversight and transparency in India’s edible oil sector.

The VOPPA Order, originally notified in 2011 under the Essential Commodities Act, 1955, governs the production, distribution, and trade of edible oils in India.

Objective of the Amendment

The amendment aims to:

• Prevent hoarding and artificial shortages,
• Improve transparency in production and trade data,
• Strengthen enforcement against misreporting, and
• Ensure consumer protection through stable and fair prices.

Key Provisions of VOPPA (Amendment) Order, 2025

• Mandatory Online Registration: All edible oil producers, refiners, and traders must register digitally with state and central authorities.
• Monthly Digital Reporting: Real-time data submission on stocks, production, and prices.
• Alignment with Essential Commodities Act (1955): Ensures definitional uniformity for better policy enforcement.
• Enhanced Penalties: Tighter action against hoarding, under-reporting, and stock manipulation.

Significance:

These reforms strengthen market surveillance, ensure accurate data flow for policy interventions, and improve food security resilience amid global supply disruptions.

India’s Edible Oil Sector: Overview

• Consumption: India is the world’s second-largest consumer of edible oils after China. Per capita consumption surpasses ICMR’s recommended intake levels.
• Import Dependence: Imports account for 55–60% of total demand, making India the largest global importer—ahead of China and the U.S.
• Composition of Imports:
  • Palm Oil: ~56% (mostly from Indonesia & Malaysia)
  • Soybean Oil: ~27%
  • Sunflower Oil: ~16%
• Domestic Production: Key oilseeds—soybean (34%), rapeseed–mustard (31%), and groundnut (27%)—constitute over 90% of domestic output.
• Structural Issues: Low productivity due to small rainfed farms, outdated processing tech, and limited irrigation.

Government Initiatives

• NMEO–Oil Palm (2021): Focuses on self-reliance in palm oil production in the North-East and Andaman–Nicobar Islands.
• NMEO–Oilseeds (2024): Promotes yield improvement and secondary oil sources (rice bran, cottonseed) using modern technologies.

Way Forward

• Develop strategic edible oil reserves to cushion price shocks.
• Promote research and hybrid seeds for higher oil content.
• Enhance domestic value chains through cooperatives and agri-startups.
• Strengthen digital traceability systems for transparent supply chains.

Conclusion

The VOPPA 2025 Amendment represents a critical reform for ensuring edible oil availability, stabilising prices, and reducing India’s heavy import dependence — aligning with national goals of food security and Atmanirbhar Bharat.