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GS Paper: GS2-13.Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

  • Court’s nudge on Hospital charges, a reform opportunity

    Why in the news? 

    The SC while hearing a PIL in February’24, directed the Central Government to find ways to regulate the rates of Hospital Procedures in the Private sector.

    • The SC also warned against applying Central Government Health Scheme (CGHS) rates for treatment services at private healthcare facilities until standardized rates are set.

    About Central Government Health Scheme (CGHS) Rates:

    CGHS is a health care scheme provided by the Indian Government for its central government employees and pensioners.

    • Commencement Year: 1954
    • Objective: To provide comprehensive health coverage to Central Government Employees (Allopathy/Homoeopathy)
    • Present change: The rates of the Central Government Health Scheme (CGHS) for general surgery have been revised since February 2024.

    Benchmark for Pricing:

    • Standard Treatment Guidelines (STGs): These can establish relevant clinical needs, the nature and extent of care, and the costs of total inputs required.
      • They address confounders and ensure clinical autonomy while enabling the valuation of healthcare resources consumed for precise cost determination.
    • Pooled payments by government: Formulating and adopting STGs require providers’ revenues to be tied to fewer payers.
      • This necessitates reimbursements from pooled payments with low Out-Of-Pocket (OOP) payment levels, supported by the government.
    • Coordination between payers and providers: Governments can support the agreement on pricing that provides a reasonable and sustainable surplus over input costs.
      • However, the ability of providers to access markets with OOP payments could hinder this effort.

    Challenges faced during benchmarking of the price:

    • Private sector issues 
        • Private sector dominance: In India, over half of the total health expenditure is OOP, with the private sector predominantly composed of small-scale providers. Standardizing rates faces implementation uncertainties, and enforcement mechanisms for adherence remain unclear.
        • Resistance from providers: Concerns arise about the feasibility of regulatory measures if providers do not adhere to prescribed procedure rates, as seen in various health schemes.
    • Weak implementation
      • Limitations of regulations: While price caps can influence behavior in the short term, weak enforcement mechanisms lead to temporary effects as the overall environment remains unchanged.
      • Enforcement challenges: Despite suggested measures, enforcement remains weak, with only a fraction of states and union territories implementing the Clinical Establishment Act.
    • Data-related issues: Although the insurance industry initiated STGs for hospitals in 2010, progress was hindered by a lack of representative and accurate costing data due to limited participation from private hospitals.

    Government Initiatives:

    • Developing STGs: The Pradhan Mantri Jan Arogya Yojana and the Department of Health Research have made significant strides in developing STGs for common conditions and adopting a comprehensive costing framework.
    • Efforts are also ongoing to create an Indian version of Diagnostics-Related Groups (DRGs)

    Way Forward:

    • Addressing anticipated challenges: Anticipated challenges in implementing rate standardization policies need to be identified and addressed proactively to ensure successful outcomes.
    • Evidence-based policy: Conduct rigorous research and evaluation to generate evidence on the impact of regulatory measures on affordability, care quality, and provider behavior, informing future policy decisions.
    • Ensuring broader stakeholder participation: It is essential to involve a wide range of stakeholders in the development and implementation of rate standardization policies to increase their effectiveness and acceptance.

    Mains PYQ 

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • Towards a less poor and more equal country

    Why in the news? 

    In March, World Inequality Lab, a Global Research Center focused on inequality and public policies, published in a paper titled, ‘Income and Wealth Inequality in India, 1922-2023: The Rise of the Billionaire Raj’. 

    Income and wealth inequality as per the World Inequality Lab: 

    • Income Inequality: In 2022-23, the top 1% of Indians received 22.6% of the national income, the highest in a century. The top 0.1% earned nearly 10% of the national income. Wealth inequality was also stark, with the top 1% holding 40.1% of the wealth in 2022-23, the highest since 1961.
    • Wealth Inequality Trends: Wealth concentration increased significantly between 1961 and 2023. The top 10% held 65% of the wealth in 2022-23, up from 45% in 1961. The bottom 50% and middle 40% saw declines in their share of wealth.
    • Comparison with Other Countries: India’s wealth inequality, while not as extreme as in Brazil and South Africa, increased threefold between 1961 and 2023. India’s income inequality is among the highest globally, surpassing South Africa, Brazil, and the U.S.
    • Impact of 1991 Economic Reforms: Inequality increased notably after the 1991 economic reforms in India. Growth in China has been broad-based compared to India, resulting in lesser income inequality despite higher growth rates in China.

    Present Dilemma in Human Development:

    • The Human Development Report (HDR) 2023-2024 ranked India 134 out of 193 countries. 
    • India is now the fifth-largest economy but it still ranks lower than Sri Lanka, Bhutan, and Bangladesh in human development. Its economic growth has not translated into growth in human development.

    Measures to Improve Human Development:

    • Investment in Education: Ensure access to quality education for all, from primary to higher levels. Focus on improving educational infrastructure, teacher training, and curriculum development.
    • Healthcare Access and Quality: Expand access to affordable and quality healthcare services, including preventive, primary, and specialized care. Invest in healthcare infrastructure, medical personnel, and technology.
    • Poverty Reduction: Implement social welfare programs to provide basic needs such as food, shelter, and clothing to the disadvantaged. Promote inclusive economic growth to create employment opportunities and increase household incomes.

    Conclusion: The Indian government has taken several steps including the creation and organization of women’s self-help groups, sending civil servants to areas with poor levels of human development,  and implementing land reforms. However, a major necessity of raising awareness is through an organic approach.

     

    Mains PYQ 

    Q Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive (UPSC IAS/2019)

     

  • SC allows termination of pregnancy of minor rape survivor

    Why in the news? 

    The Supreme Court on Monday used its extraordinary powers under Article 142 of the Constitution to do “complete justice” to permit the medical termination of pregnancy of a 14- year-old rape.Her pregnancy is nearing 30 weeks. The minor became aware of her condition only at a very late stage.

    Article 142

    • Article 142 of the Indian Constitution grants extraordinary powers to the Supreme Court of India to deliver complete justice. It empowers the Supreme Court to pass any order or issue any writ necessary for doing “complete justice” in any cause or matter pending before it, even if the case does not fall directly within its jurisdiction. 

    Distinctive features of Article 142:

    • Extraordinary Powers: Article 142 grants the Supreme Court of India extraordinary powers to deliver complete justice. These powers are exceptional and not restricted by the ordinary limitations of jurisdiction or procedure.
    • Wide Discretion: The provision grants the Supreme Court wide discretion in passing orders or issuing writs to achieve complete justice.  
    • Non-obstante Clause: Article 142 begins with a non-obstante clause, which means that the powers conferred by this article prevail over any other provision of the Constitution or law. This underscores the supremacy of the Supreme Court’s authority in exercising these powers.
    • Judicial Activism: Article 142 is often invoked to enable the judiciary to intervene in matters where existing laws or legal provisions are inadequate or where there are gaps in the law. This enables the court to play an active role in shaping legal principles and addressing societal concerns.

    Medical Termination of Pregnancy (MTP) Act 2020

    • Gestation Limits: The Act allows for the termination of pregnancy up to 20 weeks with the opinion of one registered medical practitioner.
    • For termination between 20 to 24 weeks, the opinion of two registered medical practitioners is required.
    • The upper gestation limit has been increased from 20 to 24 weeks for special categories of women, including survivors of rape, victims of incest, differently-abled women, and minors.
    • Medical Board: In cases of substantial foetal abnormalities diagnosed by a Medical Board, the upper gestation limit does not apply.
    • The Medical Board consists of a gynaecologist, a paediatrician, a radiologist or sonologist, and other notified members.
    • Privacy Protection: The Act ensures the protection of privacy for women who have terminated their pregnancy. The name and other details of the woman are not to be revealed except to authorized individuals.

    Conclusion: 

    Need to take Measures to prevent rape in society by providing education on consent, promoting gender equality, ensuring swift and awareness about severe punishment for perpetrators, enhancing support for survivors, and fostering a culture of respect.

    Mains PYQ

    Q ‘Constitutional Morality’ is rooted in the Constitution itself and is founded on its essential facets. Explain the doctrine of ‘Constitutional Morality’ with the help of relevant judicial decisions.

  • Centre releases curriculum framework for three to six-year-olds

    Why in the news? 

    For the first time ever, the Central government has released curriculum advisable to be taught to children aged three to six-years-old

    Objective of Aadharshila 

    • The early childhood education curriculum is expected to bridge foundational literacy and numeracy gaps which may arise in later school years

    Who Launched?

    • The Ministry of Women and Child Development (MWCD) has released the National Curriculum for Early Childhood Care and Education 2024 titled ‘Aadharshila,’ on the lines of the National Education Policy 2020 and the National Curriculum Framework.

    Where? 

    • Aadharshila (translated as foundation stone) is a detailed 48-week curriculum meant for learning in the age-group of three to six-year-olds in anganwadis.

    Significance Aadharshila’s Curriculum

    • Structure of Curriculum: The curriculum is organized on a weekly basis, comprising 48 weeks of learning over a three-year duration. It is designed to cater to children aged three to six attending anganwadis.
    • Initiation Phase: The curriculum begins with four weeks of initiation, focusing on academic activities to help children transition from home to the anganwadi center. These activities are engaging and involve fun and free play.
    • Exploration Phase: The subsequent 36 weeks are dedicated to exploration, free play, conversation, creation, and appreciation. Activities during this phase include storytelling, singing rhymes, art and craft, and other engaging activities. Storytelling themes often revolve around conflict resolution, responsibility, and cooperation.
    • Learning Objectives: Children learn various concepts such as colors, shapes, numbers, body parts, family and friends, listening and responding to instructions, basic counting, and themes like seasons, festivals, and food.

    Anganwadi 

    • Anganwadi services in India are a part of the Integrated Child Development Services (ICDS) scheme, which was launched on 2 October 1975.
    • The main objective of the Anganwadi programme is to improve the nutritional and health status of children in the age group of 0-6 years, to lay the foundation for proper psychological, physical, and social development of the child, and to reduce the incidence of mortality, morbidity, malnutrition, and school dropout.

    Conclusion: The release of ‘Aadharshila’ marks a significant step in early childhood education, aiming to bridge foundational gaps. To enhance its effectiveness, continuous monitoring, teacher training, and community involvement are essential.

    Mains PYQ 

    Q National Education Policy 2020 isin conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient education system in India. Critically examine the statement (UPSC IAS/2020) 

  • The advent of a holistic approach to ‘one health’

    Why in the news? 

    In the past, we have seen that there is interdependence between humans, animals, and the environment has been made increasingly evident with the emergence of pandemics such as COVID-19.

    • It is not just humans who are affected by pandemics but also livestock — an example being the outbreak of lumpy skin disease that has spread across countries.

    Why an integrated idea like the ‘One Health’ Mission is needed?

    One Health is an interdisciplinary approach that recognizes the interconnectedness of human health, animal health, and environmental health. It emphasizes collaboration across various sectors, including medicine, veterinary science, ecology, and public health, to address health challenges comprehensively.

    Key features of National One Health Mission:

    • Intersectoral Collaboration: The mission aims to coordinate, support, and integrate all existing One Health initiatives in the country, including the Ministries of Health and Family Welfare, Fisheries, Animal Husbandry and Dairying, Environment, and Science and Technology
    • Integrated Disease Surveillance: The mission implements integrated disease surveillance within and across human, animal, and environmental sectors to address communicable diseases, including zoonotic diseases, and improve overall pandemic preparedness and integrated disease control.
    • Consolidation of data: The mission creates an integrated, science-based environment where researchers from various disciplines can use laboratories as necessary and generate requisite inputs for One Health Science, including databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists.

     Challenges in National One Health Mission

    • Limited Database: There have been limited efforts to develop databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists to understand and respond to the drivers that threaten health and optimize the effectiveness of public health systems in achieving these goals within each sector.
    • Lack of Awareness and Understanding: The lack of awareness and understanding of the One Health concept among stakeholders hinders collaborative efforts required to address complex public health issues
    • Funding Constraints: Funding constraints are a significant barrier to implementing One Health interventions, especially in low- and middle-income countries that may need more resources to invest in One Health initiatives

    Conclusion: To address challenges in the National One Health Mission, efforts must focus on enhancing data collection, raising awareness among the stakeholders, and securing adequate funding. These measures are essential for effective implementation and holistic health management.

  • Why have ‘Madrasas’ been in the spotlight in Uttar Pradesh? | Explained

    Why in the news? 

    Recently the three-judge Supreme Court Bench stayed a ruling of the Allahabad High Court on the U.P. Board of Madrasa Education Act 2004 calling it an infringement of the Fundamental Rights guaranteed under the Constitution.

    • Earlier, the HC had dubbed the U.P. Board of Madrasa Education Act “Unconstitutional” and asked for immediate closure of the madrasas. It called for the relocation and integration of the madrasa students with regular schools.

    Why are madrasas in the spotlight?

    • Uttar Pradesh has approximately 25,000 madrasas, out of which 16,500 are recognized by the U.P. Madrasa Education Board.
      • Only 560 madrasas receive grants from the government, leading to complaints of delayed payment and salary arrears.
      • Irregular madrasas, often lacking resources, provide only elementary learning.
    • In 2022, the U.P. Government ordered a survey to identify unrecognised or illegal madrasas.
    • A Special Investigation Team (SIT) was formed to investigate alleged foreign funding sources for the madrasas, claiming over ₹100 crore had been received from abroad over three years. However, evidence supporting these claims was not made public.

    About Uttar Pradesh Board of Madarsa Education Act, 2004:

    • The Act sought to oversee and administer the operations of madrasas (Islamic educational institutions) in Uttar Pradesh, providing guidelines for their establishment, recognition, curriculum, and management.
    •  It led to the formation of the Uttar Pradesh Board of Madarsa Education, tasked with regulating and supervising madrasa activities throughout the state.

    Concerns Regarding the Act:

    • Limited Curriculum: Upon examination of madrasa syllabi, the High Court noted a curriculum heavily focused on Islamic studies, with limited emphasis on modern subjects.
    • Conflict with Higher Education Standards: The Act raised concerns regarding its conflict with Section 22 of the University Grants Commission (UGC) Act, 1956, which led to questions about its compliance with higher education norms

    Conclusion: Madrasas in Uttar Pradesh are under scrutiny due to a recent Supreme Court stay on the Allahabad High Court ruling, citing infringement of fundamental rights. Concerns persist over grants, quality of education, and compatibility with higher education standards.

  • Implementing Universal Health Coverage

    Why in the news?

    On the eve of World Health Day (7th April), many countries aim to implement UHC (Universal Health Coverage) in the same way as India introduced its National Health Policy, in 2017. However, there exist challenges in India too for implementing it.

    Background:

    • On December 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
    • In India, the high-level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).

    BACK2BASICS:

    About National Health Policy, 2017:

    It aims to achieve Universal Health Coverage and deliver quality healthcare services to all at an affordable cost. It focuses on improving health status through preventive, promotive, curative, palliative, and rehabilitative services with an emphasis on quality.

     

    What are the challenges in the Implementation of UHC in India? 

    • Federal Issue: Health is a state subject in India, but UHC policy is envisaged at the national level. This can lead to challenges in coordination between the central government and state governments.
      • While the Directive Principles of State Policy provide a basis for the right to health, the absence of a specific constitutional guarantee may create challenges in ensuring consistent and enforceable healthcare rights.
    • Migrant Population and Urban Slums:  Due to issues such as overcrowding, poor sanitation, and limited infrastructure, a significant portion of the population living in urban slums face issues with the availability and accessibility of Primary Health Services is hard to provide.
    • Lack of Finance: Implementing UHC requires significant financial resources. Reducing out-of-pocket expenditure and strengthening primary healthcare services necessitate substantial investments, which may strain government budgets and require innovative financing mechanisms to ensure sustainability.
    • Lack of Healthcare Infrastructure and Human Resources:  India faces shortages in both infrastructure and human resources, particularly in rural and underserved areas, which hinders efforts to improve healthcare accessibility and quality.
    • The vicious cycle of poverty: The vicious cycle of poverty and poor health perpetuates inequality in various spheres of life which eventually leads to the accessibility of health services.

    Suggestive Measures:

    • Addressing Urban Migrants’ Health Needs: Establishing mobile healthcare units or clinics that can reach migrant communities in urban and peri-urban areas, providing essential primary healthcare services.
    • Reducing Out-of-Pocket Expenditure: Simplifying the reimbursement process by digitizing healthcare payment systems and integrating them with government identification or mobile banking platforms to facilitate easy reimbursement for medical expenses.
    • Creating Inclusive Health Systems: Introducing multilingual and culturally sensitive health information materials and services to bridge language barriers and ensure accessibility for diverse urban populations.
    • Implementing Community-Based Primary Healthcare: Establishing community health centers or clinics in urban and peri-urban areas staffed by trained community health workers who can provide basic healthcare services and referrals.

    Conclusion: Building Constitutional backing, enhancing coordination, and federal with fiscal consensus with adequate infrastructure in addressing urban health needs can improve the reach of the Universal Health Program in India.

    Mains PYQ

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    PYQ Relevance:

    Mains: 
    Q) Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015) 
    Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC CSE 2022) 

    Prelims:
    With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker?  (UPSC CSE 2012) 
    1) Accompanying women to the health facility for antenatal care checkups
    2) Using pregnancy test kits for early detection of pregnancy
    3) Providing information on nutrition and immunization
    4) Conducting the delivery of babySelect the correct answer using the codes given below:
    (a) 1, 2 and 3 only
    (b) 2 and 4 only
    (c) 1 and 3 only
    (d) 1, 2, 3 and 4

    Note4Students: 

    Prelims: National Health Policy; Ayushman Bharat;

    Mains: Health Issues in India; Universal Health Coverage;

    Mentor comments: Indian Health Policies since Independence have neglected diverse perspectives critical for public health systems at the local level. This diversity impacts the nature of policies made, “because we are looking only from a certain lens”. Recently, with the passage of World Health Day 2024, WHO promoted the idea that ‘Health Equity’ is a source of optimism for millions of people, going beyond social justice or legislative change. Now the issue is with the theme of World Health Day ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject (Seventh Schedule) and the ‘Universal Health Coverage’ policy is envisaged at the National level, there is a need for discourses on implementation. 

    Let’s learn. 

    —

    Why in the News?

    The World Health Organization (WHO) has declared health to be a fundamental human right. 

    • India’s ‘Health Equity’ issues require a comprehensive approach that goes beyond improvements in healthcare facilities.
    About World Health Day 2024:

    World Health Day (April 7) unites every country around ‘Health Equity’, an essential topic at the heart of global health and justice. 

    Theme for 2024: “My Health, My Right”.Although over 140 nations recognize health as a Constitutional right, the WHO Council on the ‘Economics of Health for All’ reported that more than half the world’s population needs complete access to essential health services. 

    There is an alarming gap in Indian health-care access, which was highlighted especially during the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. 

    What is meant by Health Equity?

    ‘Health Equity’ ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. 

    WHO’s idea behind Health Equity – Ensuring Everyone’s Right to Health:

    • Aim: To eliminate unfair and preventable health disparities among different social and economic categories.
    • Significance:
      • Builds Equality: True health equity addresses the root causes of health inequities, such as poverty, discrimination, and limited access to resources.
      • Universal Coverage: Pandemics, climate change, and sociopolitical unrest exacerbate health inequities, particularly in diverse countries like India.
    What does the Indian Statistics say?

    1) 2011 Census: 

    Infectious diseases, such as tuberculosis, are 1.5 times more common in slums due to overcrowding and poor sanitation as compared to non-slum areas, according to the Indian Council of Medical Research. Disparities across caste and gender are profound. 

    2)National Family Health Survey (NFHS)-5 (2019-21) 

    Minorities: SCs and STs experience higher child mortality and lower immunization rates. 59% of women in the lowest wealth quintile suffer from anemia, demonstrating the intersection of caste, gender, and economic status in health outcomes.Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The economic effect of NCDs could surpass $6 trillion by 2030.

    3)Public Health Foundation of India:
    Shortage of Doctors: The WHO data indicates that there are only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of Health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas. 
    • Limitations in India:
      • Diversity: The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India.
      • Comprehensive Planning: Achieving health equity requires a comprehensive approach beyond legislative reform, addressing socioeconomic determinants of health.
      • Collaboration and Coordination: Realizing health potential demands collective effort by governments, communities, and individuals to remove barriers.
      • Accessibility: Health equity includes targeting marginalized and vulnerable groups, climate change disproportionately impacting low-income and vulnerable people, and conflicts disrupting healthcare provision.

    Initiatives Taken by Government:

    • Ayushman Bharat Initiative: This initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
    • National Health Mission (NHM): It includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), thus reducing the healthcare gap between rural and urban India. It expands its access by strengthening infrastructure and providing essential services to vulnerable populations.

    Way Forward:

    • Requires a Comprehensive Approach: To move India towards Universal Health Coverage and a more equitable future, the government, civil society, healthcare providers, and communities need to work together.
    • Tap Organizations Together: Organizations (Non-Governmental organizations and Civic Societies) with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programs. 
    • Successful collaborations: Need for open communication, respect for one another, and common goals because this can strongly emphasize empowering communities, sharing knowledge, and building capacity. For Example, WHO, the Global Fund and Gavi support health initiatives.
    • Building R&D: Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.

  • Two States: a comparison on access to life-saving C-sections

    Why in the News?

    The study released by IIT Madras highlights the concerns related to high rates of C-section deliveries among women in Tamil Nadu, particularly in private hospitals.

    • This indicates the necessity for corrective measures to address the situation.

    What is a Caesarean section? 

    It is also known as C-section or cesarean delivery, which is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen.

    It is often performed because vaginal delivery would put the mother or child at risk.

     

    Changes in the share of births delivered by C-sections in public and private sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.

    • High C-section Rate in Public Hospitals: In public sector hospitals in Tamil Nadu, nearly 40% of women underwent C-sections during 2019-21.
    • High C-section Rate in Private Hospitals: Close to 64% of women underwent C-sections in private sector hospitals in Tamil Nadu during 2019-21, which is significantly higher than both the national average of around 50% and Chhattisgarh’s rate of 59%.
    • Higher than the National Average: The rate of C-section deliveries in Tamil Nadu’s public sector hospitals is substantially higher than the national average, which is approximately 16%. Additionally, it surpasses the rate in Chhattisgarh, where it stands at 10%.

    Reasons behind the increase in C-section rates despite a decrease in pregnancy complications:

    • Regional Disparities: In Chhattisgarh, the likelihood of a woman undergoing a C-section in a private hospital is ten times higher than in a public hospital. This suggests potential disparities in access to high-quality healthcare services between public and private sectors, with implications for maternal health outcomes.
    • Socioeconomic Factors: The study assumes that poorer households opt for public hospitals while richer households prefer private ones for deliveries. This socioeconomic divide may contribute to inequitable access to healthcare services at the national level.
    • Higher Likelihood in Private Health Facilities: Women delivering in private health facilities are more likely to undergo C-sections compared to those in public facilities, with a notable disparity observed in Chhattisgarh.
    • Maternal Age and Weight Status: Factors such as maternal age (35-49) and overweight status increase the likelihood of C-section delivery.
    • High gap between Poor and Rich: In India, the gap in C-section prevalence between the poor and non-poor narrowed in private facilities, but Tamil Nadu exhibited a concerning trend where a higher percentage of the poor underwent C-sections compared to the non-poor.

    Recommendations by the World Health Organization (WHO): Cesarean delivery rates should ideally not exceed 10-15% to achieve the lowest maternal and neonatal mortality rates. When C-section rates go beyond 10%, there is no significant decrease in maternal mortality. In 2021, global C-section rates surpassed 20%, and they are projected to increase to 30% by 2030.

    Conclusion: Access to C-sections in Tamil Nadu shows disparities, with high rates in both public and private hospitals. Addressing regional, and socioeconomic factors and adhering to WHO recommendations are crucial for equitable maternal healthcare.

    PYQ Mains 

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

     https://www.indiatoday.in/health/story/rise-in-c-section-deliveries-despite-decrease-in-pregnancy-complications-iit-madras-study-2521773-2024-04-01

  • [27 March 2024] The Hindu Op-ed: A cry for help, a call for reflection and action

    [27 March 2024] The Hindu Op-ed: A cry for help, a call for reflection and action

    PYQ Relevance:

    Mains: 

    Q) The Right of Children to Free and Compulsory Education Act, 2009 remains inadequate in promoting an incentive-based system for children’s education without generating awareness about the importance of schooling. Analyse. (UPSC IAS/2022) 

    Q) Professor Amartya Sen has advocated important reforms in the realms of primary education and primary health care. What are your suggestions to improve their status and performance? (UPSC IAS/2016) 

    Note4Students: 

    Prelims: NA;

    Mains: Governance; Education;

    Mentor comments: In contemporary Indian society, there is a noticeable shift in family structures with a weakening of crucial connections between children and their families. This in turn impacts a child’s ability to engage with their society and environment. The unyielding quest for scholastic distinction often overshadows the social facets of a student’s existence, driving them to sacrifice interpersonal bonds and pursuits that are essential for a well-rounded persona. It is disconcerting to find young students voicing their inner turmoil on social media, signaling distress which ultimately increases suicidal cases as highlighted by the NCRB Report.

    Let’s learn. 

    —

    Why in the News?

    The unyielding quest presents the issue with educational systems often cause many an Indian student to go into a spiral, with tragic outcomes.

    • The transformation of socio-economic dynamics is not only instilling a sense of despondency among youth but is also becoming a cause for stress in their academic endeavors.
    What does the Recent Report say?

    In 2022, according to data in the “Accidental Deaths and Suicides in India 2022” report by the National Crime Records Bureau (NCRB), over 13,044 Indian students ended their lives — 7.6% of the total suicide fatalities in that year. 
    In 2023, there were reports of youngsters preparing for various competitive exams in Kota ending their lives.
    Based on police records, 15 students faded away in 2022; 18 in 2019, and 20 in 2018. 

    Coaching Industry and Governance in Kota:

    • Every year, over 2,00,000 aspirants from every corner of India flock to Kota in pursuit of ‘academic excellence’, to prepare rigorously for ‘coveted’ entrance examinations such as the JEE and the National Eligibility-cum-Entrance Test (NEET).
    • The number of suicides (students) rose from 10,335 in 2019, to 12,526 in 2020, to 13,089 in 2021. As in NCRB data (2018), nearly 95,000 students faded away between 2007-18.

    Preventive Measures Taken by Local Institutes and Governance:

    • By Local Institutes in Kota:
      • Hostels have been equipped with ‘anti-suicide features’ that include devices fixed to ceiling fans to prevent children from harming themselves and iron grills across balconies and passageways. 
      • In the push towards professional development, there is specialized training in mess administration, psychological support, behavioral counseling, and an emphasis on overall student welfare. 
    • By Local Government in Kota:
      • The local government has stopped all routine testing in coaching institutes for over two months as a temporary measure. 
      • The Kota police have pushed hostel wardens to become more proactive by endorsing campaigns such as “Knock on the Door.” At the same time, kitchen workers and meal service providers have been encouraged to alert authorities immediately if they notice students missing their meals or leaving their food untouched.

    Challenges wrt. present Educational purveyors and Social Facets in India:

    • Intense Competitions: India with an increase in Population, lacks the generation of suitable job opportunities, moreover, a limited number of seats in government institutions, and the high fees charges in private institutions have all created a climate where there is intense competition. 
    • Social and Family Expectations: The relentless strain of competition plays on the young student, which is made worse by the pressures imposed on the child by parents without understanding their child’s wishes. Many face harsh criticism for failing to ‘meet expectations’. 
    • Lack of Government Interventions: According to the All India Survey on Higher Education (AISHE) report (2019-20), only 21.4% of colleges are under governmental administration, with 78.6% under private entities (as reported by the Union Education Ministry). 
    • Poverty Issue: A study in 2008 in The Lancet revealed that nearly 61% of global suicide fatalities were concentrated in Asia. Numerous families in India, face financial constraints that prevent them from providing their children with supplementary educational resources such as coaching and tuition. 
    • Lack of support from faculties: There are numerous instances of faculty members in institutions often chastising students for their subpar academic performance when they should be offering encouragement and assistance instead.

    Way Forward:

    • Building a welfare environment: Creating an atmosphere of empathy and acceptance is crucial to cancel out any potential negative consequences for our younger generation.
    • Discovering the unyielding quest: The unsolvable puzzle for scholastic distinction often overshadows the social facets of a student’s existence, driving them to sacrifice interpersonal bonds and pursuits that are essential for a well-rounded persona. This needs to be worked upon.
    • Investing in Social Infrastructure: Moreover, pupils from socioeconomically underserved communities are confronted with the stark actualities of endemic discrimination, thereby intensifying their hardships. So, there is an urgent need for our social infrastructure to grow more supportive and accommodative and support these young lives.

    https://www.thehindu.com/opinion/lead/a-cry-for-help-a-call-for-reflection-and-action/article67995431.ece