Advance Directive Policy Confirmation - Indian Health Service: Fill & Download for Free

The first COVID-19 case in India was detected on January 30, the same day that WHO declared it a public health emergency of international concern. India went into lockdown almost two months later. On June 8, after 10 weeks of lockdown, India started a phased reopening of its economy. With Unlock 1.0, the country is trying to balance attempts to revive the economy while dealing with increasing caseloads and new hotspots. On June 30, official COVID-19 cases stood at over 585,000, and more than 17,500 deaths (Figure 1). While recovery rates have improved to 63 percent and the death rate is relatively low considering that India is the third most-impacted country globally, COVID-19 in India is nowhere close to the peak (Figure 2).Recent analysis done jointly by Duke University’s Center for Policy Impact in Global Health and the Public Health Foundation of India assesses India’s pandemic preparedness and its policy response has been varied across the states. It also provides a snapshot of the current situation. But its main contribution is to identify the policy gaps that India must close quickly.India alertly implemented surveillance as early as January 17, even before the first cases were officially detected. This was followed by a series of travel advisories and restrictions, and efforts to repatriate and quarantine Indian nationals arriving from abroad. But low testing rates have always been a serious drawback. When the curfew and lockdown were imposed, only 6,500 samples had been tested nationwide, and the daily testing capacity in mid-March was just 1,400 samples.Testing capacity has increased in recent weeks—over 1,000 laboratories with daily testing capacity of more than 300,000 samples—but testing rates are still low. According to the FIND database from June 14, India tests around 4,100 people per million compared with a global average of over 29,000 tests per million.Given the key role of state governments in India’s health system, the response in India needs to be understood from a state level perspective. Currently, more than half of all COVID-19 cases are concentrated in three states: Maharashtra, Tamil Nadu, and Delhi (Figure 3).The daily new cases are also highest among these three states (Figure 4). While daily cases fell sharply in Kerala before increasing, it was the exact opposite in Punjab. This corresponds to when interstate movement of migrants was officially allowed beginning April 29.Although the first COVID-19 cases were detected in Kerala among a group of students returning from Wuhan, China, the state government’s COVID-19 response has been effective, with the state accounting for less than 1 percent of total confirmed cases in India. Kerala has received accolades from the U.N. for the COVID-19 response strategies it adopted . The state’s investment in public health care and experience tackling the Nipah outbreak in 2018 may have contributed to its capacity and preparedness to swiftly handle the current outbreak.Data on testing rates across India show that most states need to ramp up testing. On June 15, the average testing rate in India was 4,972 per million. Ladakh had the highest testing rate at 38,170 per million, followed by Goa (27,568 per million), Jammu and Kashmir (20,400 per million), and Delhi (14,693 per million).Maharashtra—essentially India’s New York state that has Mumbai, India’s financial center—accounts for almost a third of all cases. But it has a much lower testing rate of 5,445 per million compared with many other states, so the high number of cases in Maharashtra is not explained by a high test rate. States like Telangana, Gujarat, and Tamil Nadu have low testing rates coupled with a high percentage of infections. By increasing testing rates, these states will likely identify many more positive cases, which will help to isolate people and control spread. Kerala’s experience shows that testing needs to be complemented by effective contact tracing, isolation, and quarantine measures to effectively tackle the spread of infections.Outside health policy, India’s weak economic response is a big problem. The Atmanirbhar Bharat (“Self-reliant India”) stimulus package announced in May is not small at $110 billion; this is equivalent to 10 percent of India’s GDP. But it comprises mostly monetary interventions to provide liquidity with a longer-term outlook to boost the economy. In terms of funding responses and relief measures targeted at the poor and vulnerable, the $23 billion Pradhan Mantri Garib Kalyan Yojana relief package falls short as it mostly reallocates funding across existing budgets or allows people to make advance withdrawals on their social benefits rather than mobilizing additional funding. India needs to do more to help the families of low wage workers displaced from their jobs by the lockdown and the weakening economy.For the health sector, analysis points to three main problems:low levels of testing,implementation failures in containing the spread during lockdown, andserious impacts on other health services.India’s response is consistent with its 2019 scores on the Global Health Security Index. In terms of health security—pandemic preparedness and capacity—India is ranked 57th out of 195 countries. Its score of 46.5 was above the global average of 40.2, but much lower than Asian middle-income peers such as Indonesia and Thailand that had scores of 56.6 and 73.2, respectively. India scores high on communications with health care workers during a public health emergency, trade and travel restrictions, laboratory systems, immunization, and socioeconomic resilience. But it does less well in zoonotic disease prevention, emergency preparedness and response planning, capacity of health facilities, health care access, and medical countermeasures and personnel deployment.Based on the current status of COVID-19 and the lessons from its early response, India ought to be prioritizing five measures:Increase testing capacity. India can do this quickly by harnessing the capacity of the private sector for laboratories, test kits, and supplies. But the government will also have to increase the density and capacity of test sites and laboratories and improve procurement and supply chains. India’s domestic PPE kit production has been a great success story, which provides reasons for optimism.Assist poor workers. Steps to help poor migrant workers include programs offered by the Ministry of Housing and Urban Poverty Alleviation in their 2017 report. These policies include provision of affordable housing, emergency employment schemes, and access to social entitlements and service provisions. The recent announcement on provision of essential food supplies to 800 million people is a step in the right direction.Maintain regular health services. Maintain essential critical health services and disease programs to avoid a resurgence of vaccine preventable diseases, infectious diseases, and chronic illnesses. Both the central and state governments should look to expand strategic investments and partnerships with the private sector, development partners, and community health workers to strengthen surge capacity and ensure continuity of health provision.Enforce emergency measures. Enforce sensible social distancing, effective quarantine procedures, mandatory mask-wearing and hand hygiene habits, along with improved detection, containment, and mitigation.Enable responsible monitoring. Introduce and ensure national data privacy laws to improve India’s health emergency response and safeguard against data privacy concerns.Ref: How well is India responding to COVID-19?

You need to first understand the general attitude of people towards mental health conditions in order to understand why further technological advancements in this area are not encouraged much. To answer your question, I have mentioned the following barriers to funding of online consultations, starting from the Psychological barriers to the barriers at the funding agencies level.Psychological barriers to mental healthi. It’s a general human psychology that until people die, nothing is important or an emergency. The general perception is, it’s better to live with a mental illness than to die of any fatal disease.ii. People generally tend to believe what they see. So, if you have cancer or tumour, your affected organ or body part can be cut and seen. if not so, at least extreme physical pain is experienced and that is so unbearable that you seek immediate consultation. In that case people will sympathize with you. But if you have mental health disorder, you go through emotional pain & now that kind of pain is not visible! it’s also a taboo to express explicitly that kind of pain because it’s not normal, its mad and crazy. In that case you might raise few eyebrows!Social barriers to mental healthi. Generally, family members or caregivers don’t report issues with mental health disorders until & unless they are bothered by the symptoms of the person suffering from mental health condition or till the person becomes so violent or non-cooperative, that managing the person at home becomes extremely difficult.ii. Mental health disorders have no emergencies i.e. people don’t die out of mental illness (except for cases of suicide). You will never find someone admitted in ICU for mental health related issues. hence, in the context of medical treatment it is not an emergency and given the least priority when compared to medical importance of other fatal and life-threatening disorders.Barriers of mind set among practitionersi. Even among the medical practitioners Psychiatry or Clinical Psychology is the least preferred area of specialization. If you speak to them you will get to know that very few practitioners choose Psychiatry or Psychology voluntarily as a specialty of their choice. Most of them choose because they don’t have a choice! Studying human minds is an abstract concept, always intimidating and less rewarding.Barriers at the level of funding agenciesi. The current generation of medical & paramedical practitioners are a generation, that has been mentored in a less tech savvy environment and that is mentoring a more tech savvy generation. Hence, even though the concept of ‘online consultation’ is relevant but is taking time to seep in through the old, outdated and rigid systems of clinical practice.ii. Hence research proposals made by the practitioners are based more on their perception of utility, their area of expertise and comfort of practicing in a particular mode i.e face to face consultation. Anything new and unconventional such as online platform, needs thorough re-learning, cognitive effort, time and challenging a particular mental set, which the current practitioners are not willing to invest except few foresighted ones. However, such foresighted practitioners are few in number and the power of execution still rests at the hands of the less tech savvy adherents, them being the majority.iii. Even the patients have a traditional mind set that consulting a doctor face to face would be more effective than consulting online, hence the practice of face to face consultation is encouraged further and the government also sanctions projects which are based on mass practice.Online mental health services were not recognized much until the current COVID-19 outbreak. It was only after the COVID-19 outbreak that the government released the official Telemedicine guidelines, otherwise it was just at the policy level with the Modi governments Digital India initiative that showed up in the Niti Aayog Scheme.As the number of confirmed cases of coronavirus continues to rise in India, the healthcare industry is witnessing an increased trust and adherence to online consultations or telemedicine among consumers. This boom in telemedicine is due to the fact that people fear visiting hospitals as it could lead to direct contact with a person infected with the coronavirus. Such a trend is not only observed in India but is being seen across the globe as telemedicine becomes the first point of contact for most of the suitable suspects. Even the number of telepsychology consultations for mental health issues as a result of the COVID-19 outbreak has increased. More and more people are becoming aware of their mental health needs and social distancing, making teleconsultations their most convenient option at the moment. This clearly shows a positive development and shift towards online consultations.I am hopeful that going forwards the Indian funding agencies will take keen interest in online mental health services keeping these positive shifts in mind and create a space where this sector attracts significant revenues & funding.

Members of the President's Cabinet act as his official advisory group and head executive departments. The President appoints members of his cabinet and the Senate must confirm them. Here is a list of the 15 executive departments.Department of AgricultureEstablished: 1862The Department of Agriculture (USDA) supervises agricultural production to make sure prices are fair for producers and consumers, helps farmers financially with subsidies and development programs, and helps food producers sell their goods overseas. The department runs food assistance and nutrition programs. The USDA's inspection and grading programs make sure food is safe to eat.Department of CommerceEstablished: 1903The Department of Commerce promotes international trade, economic growth, and technological advancement. It also works to keep the United States competitive in international markets and to prevent unfair foreign trade practices. The department gathers statistics for business and government planners.Department of DefenseEstablished:1947The Department of Defense (DOD) oversees everything related to the nation's military security. The department directs the Army, Navy, Marine Corps, and Air Force, as well as the Joint Chiefs of Staff and several specialized combat commands. The nonmilitary responsibilities of the DOD include flood control, development of oceanographic resources, and management of oil reserves.Department of EducationEstablished: 1979The Department of Education took over many of the education programs previously managed by the Department of Health, Education, and Welfare and six other agencies. The department administers more than 150 federal education programs, including student loans, migrant worker training, vocational education, and special programs for the handicapped.Department of EnergyEstablished: Aug. 1977Congress created the Department of Energy (DOE) to address the country's energy problems of the 1970s. The department assumed the responsibilities of several government agencies that dealt with energy-related issues. DOE is responsible for the research and development of energy technology, energy conservation, the civilian and military use of nuclear energy, regulation of energy production and use, and the pricing and allocation of oil. The department sets standards to reduce the harmful effects of energy production.Department of Health and Human ServicesEstablished: 1953The Department of Health and Human Services (HHS) is perhaps the most far-reaching of the executive departments. It administers Social Security, which provides income to retirees and the disabled, and funds Medicare, a health-insurance program for persons over 65 years of age, and Medicaid, which helps states pay for medical care for the poor. Other HHS agencies offer social services for poor families, Native Americans, children, the elderly, migrants, refugees, and the handicapped. Other agencies under HHS are: the Public Health Service, which oversees institutes dealing with mental health and substance abuse; the Centers for Disease Control, which work to control preventable and infectious diseases; the National Institutes of Health, which conduct research on cancer, AIDS, child health and aging, and other issues; and the Food and Drug Administration, which ensures the safety of the nation's food supply and tests and approves all drugs.1. Originally Department of Health, Education and Welfare. Name changed in 1979 when Department of Education was activated.Department of Homeland SecurityEstablished: 2003The Department of Homeland Security works to protect the country against terrorism. The department was created in response to the September 11, 2001, terrorist attacks against the United States. It was established in the the largest government reorganization in more than a half-century. The department includes 22 agencies and 170,000 employees. The Secret Service, the Immigration and Naturalization Service, and the Coast Guard are just a few of the agencies that come under the new department.Department of Housing and Urban DevelopmentEstablished: 1965The Department of Housing and Urban Development (HUD) promotes community development, administers fair-housing laws, and provides affordable housing and rent subsidies.Department of the InteriorEstablished: 1849The Department of the Interior protects the natural environment and develops the country's natural resources. Components of the department include: the National Park Service, which manages more than 300 parks, monuments, rivers, seashores, lakes, outdoor recreation areas, and historic sites; the Fish and Wildlife Service, which oversees more than 400 wildlife refuges, research centers, wildfowl production areas, and fish hatcheries; the Bureau of Land Management; which supervises economic development and environmental protection of millions of acres of public land; and the Bureau of Indian Affairs, which helps Native Americans living on reservations. The Department of the Interior is also responsible for the following U.S. territories: the Virgin Islands, American Samoa, Guam, the Commonwealth of the Northern Marianas, the Trust Territory of Palau, and the Freely Associated States (Republic of the Marshall Islands and the Federated States of Micronesia).Department of JusticeEstablished: 1870The Attorney General, the chief law officer and legal counsel of the federal government, runs the Department of Justice. The department supervises U.S. district attorneys and marshals, supervises federal prisons and other penal institutions, and advises the President on petitions for paroles and pardons. The department represents the U.S. government in legal matters and gives legal advice to the President and other members of the Cabinet. The Federal Bureau of Investigation, which researches violations of federal laws, and the Immigration and Naturalization Service, which administers immigration laws, are components of the department.Department of LaborEstablished: 1913The Department of Labor protects the rights of workers, helps improve working conditions, and promotes good relations between labor and management. The Bureau of Labor Statistics tracks changes in employment, prices, and other national economic statistics.Department of StateEstablished: 1789The Department of State advises the President on foreign-policy issues, works to carry out the country's foreign policy, maintains relations between foreign countries and the United States, negotiates treaties and agreements with foreign nations, speaks for the United States in the United Nations and other major international organizations, and supervises embassies, missions, and consulates overseas.Department of TransportationEstablished: 1966The Department of Transportation (DOT) sets the nation's transportation policy. There are nine administrations within the department whose jurisdictions include highway planning, development and construction; aviation; urban mass transit; railroads; and the safety of waterways, ports, highways, and oil and gas pipelines. The department also supervises the Coast Guard, which is responsible for search and rescue at sea and the enforcement of laws that protect oceans and waterways from oil spills and other pollution.Department of the TreasuryEstablished: 1789The Department of the Treasury reports to Congress and the President on the financial state of the government and the economy, regulates the interstate and foreign sale of alcohol and firearms; supervises the printing of stamps for the U.S. Postal Service; operates the Secret Service, which protects the president, the vice president, their families, and other officials; curbs counterfeiting; and operates the Customs Service, which regulates and taxes imports. The Internal Revenue Service, a branch of the Treasury, regulates tax laws and collects Federal taxes.Department of Veterans AffairsEstablished: 1989The Department of Veterans Affairs replaced the Veterans Administration, an independent agency established in 1930. It provides benefits and services to veterans and their dependents. Through its agencies, the Veterans Health Administration, the Veterans Benefits Administration, and the National Cemetery System, the department offers pensions, education, rehabilitation, home loan guarantees, burial, compensation payments for disabilities or death related to military service, and a medical care program.