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

  • Norovirus Cases detected in Kerala

    norovirus

    The Kerala Health Department confirmed two cases of the gastrointestinal infection norovirus in class 1 students in Ernakulam district.

    What is Norovirus?

    • Norovirus is an important cause of acute non-bacterial gastroenteritis in children as well as adults worldwide.
    • It leads to diarrhoea, vomiting, nausea, and abdominal pain. Being a diarrhoeal disease, it can lead to dehydration, so drinking plenty of fluids is recommended.
    • The virus was first discovered in connection with an outbreak of acute diarrhoeal disease in Norwalk, Ohio, in 1968 and was called the Norwalk Virus.
    • Later, several stomach flu viruses closely linked to the Norwalk virus were found and together, these are now called Noroviruses.
    • Many stomach flu outbreaks typically in cruise ships have been traced to NoV.

    How deadly is this?

    • Norovirus is not new; it has been circulating among humans for over 50 years and is thought to be one of the primary causes of gastroenteritis.
    • The virus is estimated to kill 200,000 persons globally every year, with most deaths occurring among those below the age of five years and those over the age of 65 years.
    • The virus is capable of surviving low temperatures, and outbreaks tend to be more common during the winter and in colder countries — that is why it is sometimes referred to as “winter vomiting disease”.

    What is the incidence of infection in India?

    • Cases of norovirus are not as common in India as in many other places — at the same time.
    • The infection has been reported in previous years as well, mainly from Southern India, and especially from Kerala.
    • A 2021 study from Hyderabad reported that norovirus was detected in 10.3% samples of children who came in with acute gastroenteritis.

    Can norovirus infection cause a large-scale outbreak?

    • Even though more cases of norovirus are being detected, experts say that this is unlikely to lead to a large-scale outbreak.
    • There is no epidemiological study to co-relate of these cases.

     

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  • Menstrual leave and the question of gender equality

    Menstrual

    Context

    • On January 19, Kerala Chief Minister Pinarayi Vijayan announced on social media that the state government will grant menstrual leave for female students in all state universities under the Department of Higher Education.

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    Background

    • The announcement came shortly after the Cochin University of Science and Technology (CUSAT) decided to provide menstrual leave to all its female students after a representation made by the students’ union.
    • Vijayan has described the government’s decision as part of its commitment to realising a gender-just society. The government’s claim should inaugurate a wider conversation.

    Menstrual

    What is Menstruation?

    • Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman’s monthly cycle.
    • It is a normal process for girls and women who have reached puberty.
    • Every month, girl or women’s body prepares for pregnancy.
    • If no pregnancy occurs, body gets rid of the lining in the uterus.
    • The menstrual blood is partly blood and partly tissue from inside the uterus.
    • The length of a period can be different for each person, but usually lasts for 3-7 days.

    What is the idea behind the Menstrual leave?

    • Paid leaves: Menstrual leave is a Policy of allowing women to take paid leave from work or school during their menstrual period.
    • Allows to rest: This leave is specifically for the days when a woman is menstruating and is intended to allow her to rest and manage symptoms such as cramps and fatigue, which can be particularly severe for some women.
    • Reducing the stigma: The idea behind menstrual leave is to help reduce the stigma associated with menstruation and acknowledge that it is a normal and natural bodily process.

    Did you know?

    • The menstrual cycle can be affected by external factors such as stress, changes in temperature and altitude, and even exposure to certain chemicals and toxins.
    • This can cause changes in the length of the cycle, the intensity of bleeding, and the severity of symptoms.
    • There is also a small percentage of women who experience menorrhagia, which is an excessive bleeding during menstruation. This can be caused by hormonal imbalances, fibroids, endometriosis, and other underlying medical conditions.

    Menstrual

    Debate over the mandatory Period leave

    Advantages:

    • Acknowledging the pain and discomfort: Making period leave available to students and, going forward, to women in the workforce, perhaps would be an important step towards acknowledging and addressing the often-debilitating pain and discomfort that so many are often forced to work through.
    • Will help create workplaces more inclusive: Instituting period leave would help create workplaces and classrooms that are more inclusive and more accommodating.
    • Reducing the stigma associated with menstruation: By making menstrual leave official leaves can help to reduce the stigma associated with menstruation and acknowledge that it is a normal and natural bodily process.
    • Increase productivity: By allowing women to take time off during their menstrual period, they can return to work or school more refreshed and better able to focus on their responsibilities, which can lead to increased productivity.

    Menstuation

    Concerns:

    • Context within which such policy decisions are taken matters: In a traditional society like India, where menstruation remains a taboo topic, it is possible that a special period leave could become another excuse for discrimination.
    • The examples of similarly traditional societies like South Korea and Japan are not encouraging: Both countries have laws granting period leave, but recent surveys showed a decline in the number of women availing of it, citing the social stigma against menstruation.
    • Medicalising normal biological process: There is also the risk of medicalising a normal biological process, which could further entrench existing biases against women.
    • Mandatory leaves may hamper women hiring: There is a possibility that the perceived financial and productivity cost of mandatory period leaves could make employers even more reluctant to hire women.
    • Reinforcing gender stereotypes: Implementing menstrual leave could reinforce the stereotype that women are weaker and less capable than men, which could have negative consequences for women in the long term.

    Conclusion

    • The ongoing conversation around menstrual leave and menstrual health is crucial and welcoming. It is also encouraging to see the governments are recognizing the importance of this issue. However, implementing menstrual leave as a legal requirement comes with its own set of challenges. It’s important for governments to navigate these challenges while ensuring that the ultimate goal of gender justice and equality is met.

  • Assessing the Learning of the School Children

    Context

    • The Covid pandemic had caused schools to shut down in March 2020, and India had one of the longest school closures in the world primary schools were closed for almost two years. The impact of the pandemic on the education sector was feared to be twofold learning loss associated with long school closures, and higher dropout rates, especially among older children, due to squeezed family budgets.

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    ASER survey during the pandemic

    • Assessing the learning losses: Estimates from these three state-level surveys could be used to understand the extent of children’s learning losses. These state level estimates are extremely useful as they are the only ASER estimates of learning we have between 2018 and 2022.
    • Rising learning level pre-pandemic: For the country as a whole, learning levels had been rising slowly between 2014 and 2018, after being stagnant for several years. For example, at the all-India level, the proportion of children in Class III who could read a Class II level text (a proxy for grade-level reading) had risen from 23.6 per cent in 2014 to 27.2 per cent in 2018.
    • Big fall during pandemic: ASER 2022 shows a big drop in this proportion to 20.5 per cent. This 7-percentage point fall is huge, given how slowly the all-India numbers move and confirms fears of large learning losses caused by the pandemic.
    • Higher losses in math: In math also, learning levels had risen slowly between 2014 and 2018. The 2022 estimates show a drop here as well although much smaller than in the case of reading.

    Case study of three states- Karnataka Chhattisgarh and West Bengal

    • Assess learning levels in three states: Karnataka, Chhattisgarh and West Bengal in 2021, when schools were still closed or had just reopened. While these are not national estimates, they provide an interim measurement that is more reflective of pandemic-induced learning losses than the estimates for 2022.
    • Reading and math losses: Across all three states, there were large learning losses in both reading and math in 2021 in excess of 7 percentage points, except in the case of Std V in West Bengal. The loss in reading is a little higher, though not by much.
    • Learning losses was much below 2014 levels: In both reading and math, the 2021 learning levels in these three states fell below their 2014 levels. A year later, ASER 2022 data shows that across all three states, there has been a recovery in both reading and math (except Karnataka in reading and West Bengal in reading in Std V) after schools reopened in 2021-22.
    • Recovery still below pandemic: In other words, while the 2022 learning levels were still below or in some cases close to the 2018 levels, comparing 2018 with 2022 hides the dramatic fall in learning levels observed between these two points and the subsequent recovery that has happened in the last year.

     Impact of New Education Policy

    • Focus on foundational competency: Another big development during 2020-21 was the introduction of the new National Education Policy (NEP) in 2020. For the first time, there was a big focus on the early years and the importance of foundational competencies.
    • Foundational Literacy and Numeracy (FLN): Once schools reopened, states moved quickly and almost all states have made a major push in the area of Foundational Literacy and Numeracy (FLN) under the NIPUN Bharat mission (National Initiative for Proficiency in Reading with Understanding and Numeracy). This push is reflected in the ASER 2022 data.
    • Directive for NEP Implementation: As part of the survey, ASER field investigators visited one government school in each of the sampled village to record enrolment, attendance and school facilities. This year we also asked whether schools had received any directive from the government to implement FLN activities in the school and whether teachers had been trained on FLN. At the all-India level, 81 per cent schools responded that they had received such a directive and 83 per cent said that at least one teacher in the school had been trained on FLN.

    Recovery of learning losses

    • Partial recovery in some states: Extrapolating from the experience of the three states for which we have 2021 data, we can assume that other states also experienced large learning losses during the pandemic. However, once schools reopened, states made a concerted effort to build or re-build foundational competencies, which has resulted in a partial and in some cases, a full recovery.
    • Earliest open, recovered faster: The extent of the recovery varies across states depending on how long their schools were closed as well as when they initiated learning recovery measures. For instance, Chhattisgarh was one of the earliest states to reopen their primary schools in July 2021, giving them a longer period to work with children, as compared to, for instance, Himachal Pradesh or Maharashtra, where schools reopened much later.
    • Remarkable recovery by Chhattisgarh: Taking into account the 2021 figures, the 2022 estimates for Chhattisgarh point to a remarkable recovery, in both reading and math, that is hidden if we just compare 2022 with 2018.
    • Lack of data for many states: In the absence of a 2021 measurement for other states, it is difficult to say what the original pandemic-induced learning loss was from which states are aiming to recover.

    Conclusion

    • As per the ASER survey learning losses of the student have been recovered quickly than expected. NEP looks very promising for better learning outcomes for children and college students. Every state and union territory should implement the NEP in its entirety.

    Mains Question

    Q. Analyze the learning outcomes and recovery of children based on ASER survey. What is impact of NEP on recovery of learning outcome after pandemic?

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  • Highlights of ASER 2022

    aser

    Pratham’s Annual Survey of Education Report (ASER) 2022 — the first full-fledged one after the pandemic has now been published.

    ASER Survey

    • This is an annual survey (published by the education non-profit Pratham) that aims to provide reliable estimates of children’s enrolment and basic learning levels for each district and state in India.
    • ASER has been conducted every year since 2005 in all rural districts of India. It is the largest citizen-led survey in India.
    • It is also the only annual source of information on children’s learning outcomes available in India.
    • The survey is usually done once in two years.

    How is the survey conducted?

    • ASER tools and procedures are designed by ASER Centre, the research and assessment arm of Pratham.
    • The survey itself is coordinated by ASER Centre and facilitated by the Pratham network. It is conducted by close to 30,000 volunteers from partner organizations in each district.
    • All kinds of institutions partner with ASER: colleges, universities, NGOs, youth groups, women’s organizations, self-help groups, and others.
    • The ASER model has been adapted for use in several countries around the world: Kenya, Uganda, Tanzania, Pakistan, Mali, and Senegal.

    Assessment parameters

    • Unlike most other large-scale learning assessments, ASER is a household-based rather than school-based survey.
    • This design enables all children to be included – those who have never been to school or have dropped out, as well as those who are in government schools, private schools, religious schools or anywhere else.
    • In each rural district, 30 villages are sampled. In each village, 20 randomly selected households are surveyed.
    • Information on schooling status is collected for all children living in sampled households who are in the age group 3-16.
    • Children in the age group 5-16 are tested in basic reading and basic arithmetic. The same test is administered to all children.
    • The highest level of reading tested corresponds to what is expected in std 2; in 2012 this test was administered in 16 regional languages.
    • In recent years, this has included household size, parental education, and some information on household assets.

    Highlights of ASER 2022

    The ASER 2022 report, which surveyed 6.99 lakh children aged 3 to 16 across 616 rural districts, however, bears some good news. School-level enrolment continues to grow strong and fewer girls are now out of school.

    (1) Enrolment

    • India has recorded a 95% enrolment for the last 15 years in the 6-14 age group.
    • Despite the pandemic forced school closure, the figure rose from 97.2% in 2018 to 98.4% in 2022.
    • Only 1.6% children are now not enrolled.
    • There is a clear increase in government school (6-14) enrolment across states — it rose from 65.6% in 2018 to 72.9% in 2022.
    • This is contrast to the trend in the 2006-14 period, which marked a steady decline in government school enrolment for the 6-14 age group.
    • From 10.3% of 11-14 year old girls not enrolled in schools in 2006, the proportion came down to 4.1% in 2018 and is at 2% in 2022. Save Uttar Pradesh, where it is at 4%, the number is lower across states.

    (2) Learning Loss

    • The ASER 2022 report says that children’s basic reading ability has dropped to ‘pre2012 levels, reversing the slow improvement achieved in the intervening years’.
    • The decline is seen across gender and across both government and private schools and is more acute in lower grades.
    • Percentage of children in Class III in govt or private schools who can read at Class II level dropped from 27.3% in 2018 to 20.5% in 2022.
    • Class V students who can at least read a Class II level text fell from 50.5% in 2018 to 42.8% in 2022.
    • Nationally, 69.6% of Class VIII students can read at least basic text in 2022, falling from 73% in 2018.

    (3) Arithmetic abilities

    • Students in Class III who are able to at least do subtraction dropped from 28.2% in 2018 to 25.9% in 2022.
    • For Class V, students who can do division has also fallen from 27.9% in 2018 to 25.6% in 2022.
    • Class VIII has done better with an improvement recorded — proportion of children who can do division has increased from 44.1% in 2018 to 44.7% in 2022.
    • ASER says that this increase is driven by improved outcomes among girls as well as among children enrolled in government schools, whereas boys and children enrolled in private schools show a decline over 2018 levels.

    (4) Tuition dependency

    • Rural India has been reporting an uptick in Class I-VIII paid tuition classes and it has moved up from 26.4% in 2018 to 30.5% in 2022.
    • In UP, Bihar, and Jharkhand, the proportion of children taking paid private tuition increased by 8 percentage points.

    (5) English proficiency

    • ASER recorded English abilities last in 2016 and the trend stays similar till date.
    • Children’s ability to read simple English sentences was at 24.7% in 2016 and is found at 24.5% in 2022.
    • Class VIII has shown some improvement from 45.3% in 2016 to 46.7% in 2022.
    • Children’s basic reading ability has dropped to pre-2012 levels, reversing the slow improvement achieved in the intervening years, while the basic maths skills have declined to 2018 levels nationally.

    (6) Schools improvement

    • Average teacher attendance increased from 85.4% in 2018 to 87.1% in 2022, while average student attendance persists at 72% as before.
    • Textbooks had been distributed to all grades in 90.1% of primary schools and in 84.4% of upper primary schools.
    • Fraction of schools with useable girls’ toilets increased from 66.4% in 2018 to 68.4% in 2022.
    • There were 76% schools with drinking water facilities compared with 74.85% in 2018, but there are interstate variations.
    • In 2022, 68.9% schools had a playground, up slightly from 66.5% in 2018.

    Way forward

    • In the past 10 years, we’ve seen improvement, but it has been in small bits. So it means that we really need to shake up things.
    • It is a critical thing for improving the productivity of the country. Business as usual is not going to work.
    • Again, it’s not a new message, but it’s a message that needs to be reiterated.
    • There are Anganwadi everywhere and their enrollment has gone up. Integration between the Anganwadi system and the school system is urgently needed because the work starts there.

     

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  • Mental Health Problem and effective policy

    Mental Health

    Context

    • The fifth Global Mental Health Summit, co-sponsored by over half a dozen organisations engaged with mental health, was held in Chennai to discuss mental health in the context of human rights, ethics and justice. Highlighting the importance of mental health, it gave a call for action against the continued neglect by society at large and the governments at central and state levels, in particular.

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    Findings of national mental health survey

    • The National Mental Health Survey (NMHS): The latest National Mental Health Survey (NMHS) conducted by National Institute of Mental Health and Neuro Sciences (NIMHANS) in collaboration with the Ministry of Health and Family Welfare and WHO, was published in 2016.
    • Prevalence of mental disorder: According to the survey, the prevalence of mental disorders among adults in India is around 10.6%. The most common disorders were anxiety disorders (7.3%) and mood disorders (4.5%).
    • Higher among women than men: The survey also found that the prevalence of mental disorders was higher among women than men, and that the majority of people with mental disorders did not receive any treatment.
    • Prevalence of mental disorders is higher in urban areas: It also found that the prevalence of mental disorders was higher in urban areas than in rural areas, and that there was a higher prevalence of mental disorders among people with lower levels of education and income.
    • Gap in treatment coverage for people with mental disorder : The survey highlighted that there is a significant gap in treatment coverage for people with mental disorders, and that the majority of people with mental disorders do not receive any treatment.
    • Plan for mental health: The survey has provided an important information for Indian government and mental health professional to plan and implement mental health programs and policies in the country.

    Mental Health

    What constitutes good policy making on mental health?

    • Policy should be based on research and findings: Policies should be based on sound research and evidence from scientific studies. This helps to ensure that policies are effective in addressing mental health issues and are not based on assumptions or stereotypes.
    • Active engagement of stakeholders: Policy making should involve a wide range of stakeholders, including people with lived experience of mental health issues, mental health professionals, and representatives from relevant government departments and non-governmental organizations.
    • A comprehensive and integrated approach: Mental health policies should be comprehensive and address a wide range of issues, including prevention, early intervention, treatment, and recovery. They should also be integrated with other policies, such as those related to education, housing, and employment.
    • Ensure easy access to mental health care: policies should ensure that people have access to appropriate and affordable mental health care, including both medication and psychosocial therapies.
    • Public awareness and Sensitization : policies should ensure that people with mental health issues are treated with dignity and respect, and that their human rights are protected.

    Case study: How India tackled HIV/AIDS?

    • Active surveillance system: The need for crafting strategic interventions based on epidemiological evidence from an active surveillance system.
    • Modelling different options: The importance of modelling different options of addressing the wide array of interventions required in different geographies, among different target groups, to provide the data related to cost effectiveness as well as efficacy of the interventions required for scaling up.
    • Proactive advocacy of systemic issues among all influencers: The proactive advocacy of systemic issues among all influencers the media, judiciary, politicians, police and other intersectoral departments whose programmes and activities have had a direct bearing on the key populations being worked on.
    • Community engagement: The use of peer leaders and civil society that was allocated over 25 per cent of the budget. Though a central sector programme was fully funded by the central government, every intervention was formulated with active participation and dialogue among the states and constituencies of local leaders.

    Mental Health

    Strategy for better implementation of mental health policy

    • Clear goals and objectives: Having clear and measurable goals and objectives can help to ensure that policies are implemented effectively and that progress can be tracked.
    • Training and capacity building: Providing training and capacity building for mental health professionals, as well as for other relevant stakeholders such as community leaders, can help to ensure that policies are implemented effectively.
    • Community engagement: Involving communities in the planning and implementation of mental health policies can help to ensure that policies are responsive to the specific needs and priorities of local populations.
    • Monitoring and evaluation: Regularly monitoring and evaluating the implementation of policies can help to identify any barriers or challenges, and make adjustments as necessary.
    • Multi-sectoral approach: Adopting a multi-sectoral approach that involves collaboration between different sectors, such as health, education, social welfare, housing, and employment can help to ensure that policies are implemented in a coordinated and effective manner.
    • Policy flexibility: Policies should be flexible enough to adapt to changing circumstances, and be responsive to feedback and suggestions from the community and stakeholders.

    latest research in mental health domain

    • The growing recognition of the importance of early intervention in mental health: Research has shown that early intervention can prevent mental health issues from becoming more severe, and can help individuals to recover more quickly.
    • The use of technology in mental health: There has been an increase in the use of technology, such as mobile apps, virtual reality, and teletherapy, to deliver mental health care. Studies have shown that these technologies can be effective in improving mental health outcomes.
    • The impact of the COVID-19 pandemic on mental health: The pandemic has had a significant impact on mental health, and research has been conducted to understand the extent of the impact and to develop strategies to mitigate it.
    • Advancements in brain imaging and genetics: Researchers are using brain imaging techniques and genetic studies to gain a better understanding of the underlying causes of mental disorders and to develop more effective treatments.
    • The use of personalized medicine in mental health: There is growing interest in the use of personalized medicine, which involves using genetic and other information to tailor treatment to the individual patient, to improve mental health outcomes.
    • The benefits of nature-based interventions for mental health: Studies have shown that spending time in nature can have a positive impact on mental health, including reducing symptoms of stress, anxiety, and depression.
    • The importance of social determinants of mental health: Research has highlighted the importance of social determinants such as poverty, education, and social support in mental health.
    • The importance of addressing mental health in the workplace: Studies have highlighted the impact of workplace stress and burnout on mental health and the importance of workplace interventions to promote mental well-being.

    Do you know Neuralink?

    • Neuralink is a gadget that will be surgically inserted into the brain using robotics. In this procedure, a chipset called the link is implanted in the skull.
    • Neuralink can be used to operate encephalopathy. It can also be used as a connection between the human brain and technology which means people with paralysis can easily operate their phones and computer directly with their brain.

    Mental Health

    Conclusion

    • Mental health problems and not related to age of persons. From children to old age all can suffer from this menace. Government of the must formulated, implement the effective, resulted oriented mental health policy as earliest as possible

    Mains Question

    Q. What factors need to be taken care while drafting sound mental health policy? Suggest a strategy for better implementation of metal health policy.

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  • Malnutrition in the North-eastern states of India

    Context

    • Between the National Family Health Survey (N

      nutrition

      FHS)-4 (2015–16) and the fifth round (2019–2020), there has been a considerable increase in the number of malnourished children in India, and the progress made during the first half of the decade appears to have been undone. Malnutrition in the North-eastern states of India is worse than the country average.

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    What is malnutrition?

    • Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
    • For a child’s motor, sensory, cognitive, social, and emotional development, malnutrition has substantial long-term effects. It impedes productivity and academic progress.

    nutrition

    The term malnutrition covers two broad groups of conditions

    • Undernutrition: Undernutrition includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
    • Overnutition: The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).

    Did you know?

    • Stunting, or low height for age, is a recognized risk factor for children’s delayed development.
    • According to a study, a 1% reduction in adult height as a result of childhood stunting is linked to a 1.4% reduction in economic productivity.
    • Children who are stunted, earn 20% less as adults.

    Malnutrition in North East India

    • Upsurge in stunting: Four states in the Northeast Meghalaya, Mizoram, Nagaland and Tripura have seen an upsurge in stunting among children under the age of five. Stunting is highest in Meghalaya at 46.8 %, followed by Nagaland (32.7%), Tripura (32.3 %), and Mizoram (28.9%). In Mizoram, Nagaland, and Tripura, the percentage of kids who are stunted, wasting, underweight, or overweight has increased
    • Levels of stunting decreased in Assam: The NFHS-5 shows Assam, Manipur and Sikkim have shown a drop in stunting levels. In Assam, stunting has decreased by almost one percentage point, although rates of overweight (2.3% to 4.9%), underweight (29.8% to 32.8%), and stunting (17% to 21.7%) have all increased, whereas that of wasting and underweight have decreased by more than 2% in each instance.
    • Sikkim performs better than other NE states: As the number of stunted, wasting, and underweight children has dropped, Sikkim has done considerably better than other NE states so has Manipur, with a decrease in wasting from 6.8% to 9.9% in under-five children.
    • Increase in no of overweight people in every NE state: Every state in the Northeast saw an increase in the number of overweight people, which amplifies the growing double burden of malnutrition in the states.

    Appropriate foods and feeding practices show Higher immunity

    • Feeding practices adequate only in Meghalaya and Tripura:  The percentages of breastfeeding children receiving adequate complementary foods have improved only in Meghalaya and Tripura. Early initiation of breastfeeding is on the decline in six out of the eight northeastern states, with highest levels in Sikkim (33.5%) and Assam (15.3%).
    • Reduction in exclusive breastfeeding rates (EBF): Sikkim, Tripura, and Manipur all exhibit a notable reduction in exclusive breastfeeding (EBF) rates. EBF in Sikkim is the lowest at 28.3 percent, far lower than the national average of 63.7 percent. Tripura demonstrated a gain of 39.5 percentage points in the practice of timely introduction of semi-solid food, whereas Meghalaya, Mizoram, Nagaland, Sikkim, and Arunachal Pradesh showed a slight fall.
    • All NE states except Assam performed well on diet adequacy: Minimum Adequate Diet (or diet adequacy) is a combined indicator of feeding frequency and diet variety. From 8% to 29.8%, there is a significant range throughout the northeastern states. All states, with the exception of Assam, have performed better on this measure than the nation as a whole.
    • The situation with obesity is more complicated: Only Meghalaya and Nagaland have seen decreases, while the other six states have seen increases. It is heartening to see a declining trend in underweight women (BMI < 18.5) in all eight northeastern states.
    • Anaemia is increased: In six of the eight northeastern states, anaemia among women of reproductive age has increased, with Tripura worst at 67.2%, and Assam at 65.9%.

    nutrition

    How malnutrition can be tackled in NE?

    • Finding out the causes: Stunting among children in the Northeast is caused by a number of factors, including poor maternal health, a lack of antenatal care, inadequate infrastructure and healthcare facilities, inadequate feeding and nutrition for women, and limited access to education, clean drinking water, and sanitary facilities.
    • For instance: Lack of toilets, drinking water and cooking fuels in the home environment have an impact on child malnutrition, according to a 2015 study on indigenous peoples in the Northeast.
    • Improving the maternal nutrition: Manipur, Mizoram, and Sikkim fare better than the national average in most measures. Newborns’ chances of being stunted are decreased by better maternal nutrition prior to conception, throughout pregnancy, and after delivery. According to data for Sikkim, Manipur, and Mizoram, the risk of stunting decreases as the number of underweight mothers decreases.
    • Upgrading the service availability: In the northeastern states, the use of supplementary food at the anganwadi centres (ANC) varies greatly, from about 35% in Arunachal Pradesh to 70% in Tripura. A low of 20.7% in Nagaland and a high of 79.4% in Manipur is the ANC coverage across the Northeast.
    • Improving the required intake of Iron and Folic acid: All states have lower percentages of iron and folic acid (IFA) intake than the national average of 26%, with the exception of Manipur where 30.3% of pregnant women completed the full 180-day course of IFA tablets. Nagaland has the lowest rate, at just 4.1%. Overall, the NE states show a wide variation in service availability and uptake.

    nutrition

    Note it down: The innovative programmes to enhance mother and child health

    • Nutrition gardens: For example, the Assam government encouraged women in rural communities to develop “nutrition gardens” where they could grow vegetables.
    • My school my Farm: “Kan Sikul, Kan Huan (My School, My Farm)” programme in the most impoverished and disaster-prone area in Mizoram-Lawngtlai.
    • Lunchbox exchange: The “dibbi adaan pradaan (lunchbox exchange)” initiative in Hailakandi district of Assam for promoting better nutrition and variety in menu.

    Conclusion

    • Malnutrition in the Northeast has to be addressed holistically through the scaling up of direct nutrition interventions and the coupling of them with nutrition-sensitive measures to close the nutrition gap. In the long run, it could be beneficial to improve the monitoring and evaluation of current interventions by building on the POSHAN Abhiyaan and health projects.

    Mains question

    Q. What is Malnutrition? Malnutrition in the North-eastern states of India is worse than the country average. Discuss.

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  • Vishwaguru aspirations and the internationalization of Indian higher education

    education

    Context

    • The 2020 National Education Policy (NEP) was a pathbreaking moment in the annals of Indian higher education. The policy envisions a complete overhaul and re-energising of the higher education system. The just announced University Grants Commission (Setting up and Operation of Campuses of Foreign Higher Educational Institutions in India) Regulations, 2023, have re-ignited debates on the internationalization of Indian higher education.

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    education

    Major factors that influence Internationalization of higher education

    • Prohibitive costs of higher education, especially in developed countries: Indian students must pay approximately Rs 70 lakh per annum to study at Harvard, Yale or Stanford and over Rs 55 lakh per annum to study at Oxford or Cambridge. Tuition fees alone would be about 15 times more expensive than Indian private universities. The new proposal vitiates the NEP’s vision of equity and inclusion as it envisages higher education only for the super-rich.
    • The establishment costs of top university campuses make the project unviable: The vision of uniform academic standards in both the parent university and its international campus is a noble aspiration. However, the reality is international campuses have become a second-rate option, primarily accessible to those unable to get admission to the main campus. The quality and excellence in teaching and research on overseas campuses cannot match those in their primary location.
    • The landscape of global higher education has dramatically changed post-Covid: The idea of brick-and-mortar international campuses has given way to building solid partnerships, student and faculty mobility, exchange and immersion programmes, joint teaching and research opportunities, collaborative conferences and publications and the development of online and blended degree programmes. The global thinking around international collaborations has changed.

    Steps to become a global leader in international education

    • Greater autonomy to Indian universities as well as Institutions of Eminence (IoE): Indian universities, both public and private, are generally highly regulated and poorly governed. The ingrained institutional habit of regulatory bodies instructing universities on what they should be doing must stop. The government must pay greater attention to the IoEs and expand their scope and scale so that they become natural destinations for international students.
    • Establishing universities more of global orientation and outlook: Establish global universities in India led by the public and the private sector to cater to the needs and aspirations of international students. India’s Gross Enrolment Ratio (GER) is lopsided. The national GER is approximately 22 per cent but there are states, such as Tamil Nadu, with a GER of 52 per cent. We must build more public and private universities across the country, with greater autonomy, resources and better governance structures, minimising the role of the regulatory bodies.
    • Provide more resources to all the Indian universities: Indian universities face acute resource scarcity. The NEP has envisaged a six per cent annual investment in higher education and a National Research Foundation to allocate additional resources. Government must encourage CSR and philanthropic initiatives with more tax incentives to enable private sector contributions to public and private universities.
    • Breaking the barriers, bias and prejudices and hierarchy: The NEP envisages breaking the long-standing barriers between public and private institutions. But many biases and prejudices persist. An institutionalised hierarchy in the Indian higher education system replicates the caste system. First, the IITs and the IIMs are placed high in the pecking order, followed by the central universities. Next come the IISERs, NITs and much lower down are the state public universities.
    • Establish a liberal and progressive regulatory ecosystem for Indian universities to attract international students: Much more than reforms in the education sector will be needed if India is to become a sought-after international destination for students from developing countries. Government must reform its visa processes and the FRRO registration procedures. There must be a significant improvement in the quality of infrastructure and hostels on university campuses. The safety, security and well-being of the students, especially women, must be ensured. Other forms of university towns and education cities can create a comprehensive ecosystem that will enable students and faculty to study, work and live in these communities.

    education

    What should be the India’s approach?

    • Focus on becoming global higher education destination in our own right: Instead of enabling the creation of international campuses of universities from developed countries, we need to focus on becoming a global higher education destination in our own right.
    • Assume leadership role to realise Vishwaguru aspiration: We will not realise the Vishwaguru aspiration by inviting prestigious foreign universities to locate campuses. We must assume the leadership role we had over 2,000 years ago when Nalanda, Takshashila, Vallabhi and Vikramshila attracted faculty and students from around the world.
    • High quality education in affordable cost: We can be truly global leaders in providing high-quality education at an affordable cost. Likewise, we can produce high-quality research at a relatively lower cost.
    • For instance: Indian scientists made a successful mission to Mars with a modest budget of $74 million, less than the production cost of $108 million for Gravity, a Hollywood film.

    education

    Conclusion

    • The vision of India becoming a Vishwaguru cannot be achieved by outsourcing Indian higher education to international universities. Instead of enabling the creation of international campuses of universities from developed countries, it must focus on becoming a global higher education destination in its own right.

    Mains question

    Q. India strives to become a global leader in international education. Discuss what steps need to take and what should be the India’s approach?

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  • UGC norms to setup Foreign Universities in India

    foreign universities

    The University Grants Commission (UGC) has unveiled draft regulations for ‘Setting up and Operation of Campuses of Foreign Higher Educational Institutions in India’.

    Quest for Foreign Universities in India: A quick recap

    • The government had in 1995 drafted the Foreign Education Bill which had to be shelved.
    • Another attempt was made in 2006, but the draft law could not cross the Cabinet stage.
    • Then in 2010, the UPA-2 government brought the Foreign Educational Institutions Bill, which failed to get enough support in the Parliament.
    • The bill lapsed in 2014 as UPA lost power.
    • The New Education Policy, 2020 allows for establishment of foreign university campuses in India.

    Procedure for Universities coming to India

    • The process for getting approval for setting up a campus in India will be strictly online in the beginning. Interested institutions have to apply at the UGC portal with a non-refundable fee, and then submit some documents.
    • After the applications are received, a committee formed by the Commission will examine these applications on these factors:
    1. Credibility of the institution
    2. Programmes to be offered by the institution
    3. Their potential to strengthen academic opportunities in India
    4. Proposed infrastructure

    UGC (Setting up and Operation of Campuses of Foreign Higher Educational Institutions in India) Regulations 2023: Key questions answered

    • UGC approval compulsory: All foreign universities that wish to set up their campus in India will be allowed to do so only after getting approval from the UGC.
    • Reputed institutions: To set up a campus in Indian foreign universities will either have to be in the top 500 to apply or will have to be “highly reputed” in their respective countries (if the varsity does not participate in global rankings). If their ranking is between 500 and 100, but the subject-wise ranking is higher than overall, then in such cases, the institutions will be permitted to set up their campuses only for those ranked subjects.
    • Quality assurance: Additionally, the UGC will reserve the right to inspect these Indian campuses of foreign HEIs at any time, and they will not be outside the purview of anti-ragging and other criminal laws.
    • Offline classes only: All the foreign universities that open their branches in India will be allowed to conduct offline classes only, i.e. foreign universities can offer only full-time programmes in physical mode.
    • Freedom to choose admission process, fee, and faculty: All foreign varsities will have the freedom to come up with their own admission process. However, the universities will have to ensure “quality of education imparted at their Indian campuses is on par with their main campus.”
    • Admissions to all: Foreign higher educational institutes will have the freedom to enroll Indian as well as international students on their Indian campuses.
    • International funds transfer: To ensure that there is no chaos in funds transfer, all matters related to funding will be as per the Foreign Exchange Management Act 1999.
    • Safeguarding of students’ interest: FHEI shall not discontinue any course or programme or close the campus without the commission’s prior approval. In the case of a course or programme disruption or discontinuation, the parent entity shall be responsible for providing an alternative to the affected students.
    • Equivalence with degrees awarded by Indian HEIs: The qualifications awarded to the students in the Indian campus shall be recognised and treated as equivalent to the corresponding qualifications awarded by the FEHI in the main campus located in the country of origin.
    • Securing India’s national interest: FEHIs shall not offer any such programme or course which jeopardises the national interest of India or the standards of higher education in India. The operation of FEHIs shall not be contrary to the sovereignty and integrity of India, the security of the state, friendly relations with foreign states, public order, decency, or morality.

    Why such move?

    • Increase in domestic enrolment: India has more than 1000 universities and 42,000 colleges. Despite having one of the largest higher education systems in the world, India’s Gross Enrolment Ratio (GER) in higher education is just 27.1%, among the worlds’ lowest.
    • Education quality improvement: The lack of quality in Indian education is reflected in the QS World University Rankings 2022. IIT Bombay was the top-ranking Indian institute in the list with a ranking of 177. Only eight Indian universities made it to the top 400.
    • Paving the way: London Business School, King’s College in London, the University of Cambridge, and New York University have started preliminary discussion with the GIFT City authorities and the regulator to establish facilities at the GIFT International Financial Services Centre.

    Benefits of the move

    • Human capital generation: This move would complement efforts to provide high quality human capital to India’s financial services industry.
    • Decreased overseas spending: Indian students’ overseas spending is set to grow from current annual $28 billion to $80 billion annually by 2024.
    • Reduce FOREX spending: Apart from fostering a competition in quality, International branch campuses can also help in reducing the foreign exchange outflow.
    • Prevents brain-drain: Education attracts opportunities. Atmanirbhar Bharat push will retain the domestic talent. More than eight lakh Indians gave up their citizenship in the last seven years.
    • Increase India’s soft power: Opening the door for foreign universities can improve India’s soft power as it will provide further impetus to the government’s Study in India programme that seeks to attract foreign students.

    Challenges

    • Regulatory challenges: The following factors may deter foreign higher educational institutions from investing in India-
    1. Multi-layer regulatory framework governing different aspects of higher education
    2. Lack of a single regulatory body overlooking the collaborations/ investments and
    3. Multiple approvals required to operate in India
    • Implementation issues: While NEP has taken the right steps to boost the education sector and pave the way for a globally-compatible education system, its implementation has been slow and requires clarity.
    • Higher possibility of Brain Drain: A policy challenge that stands before the GoI is to facilitate such tie-ups in a way that the Indian talent chooses to and is incentivised to remain in India and the Indian educational infrastructure is developed to match global standards.

    Conclusion

    • The intent of the GoI, with respect to international universities setting up campuses in India, is clear from the provisions in the NEP.
    • However, much clarity is awaited for the proper implementation.

     

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  • Digital healthcare Services

    healthcare

    Context

    • India leveraged information and communications technologies (ICTs) during the pandemic. Digital health solutions played a crucial role in bridging the gap in healthcare delivery as systems moved online to accommodate contactless care.

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    India’s spectacular demonstration of digital public good (DPG) so far

    • Aadhar and UPI are like the building blocks of DPG: India has demonstrated its digital prowess by building digital public goods the digital identity system Aadhaar, the DPGs built on top of Aadhaar and the Unified Payments Interface.
    • Aadhar for PDS and UPI for payments: While Aadhaar has become central to India’s public service delivery architecture, UPI has transformed how payments are made.
    • One of the largest internet users: Our digital public infrastructure has reached the last mile, enabled by 1.2 billion wireless connections and 800 million internet users.
    • Some examples of DPGs developed during the pandemic: For instance, the Covid Vaccine Intelligence Network (CoWIN) and the Aarogya Setu application. CoWIN propelled India to adopt a completely digital approach to its vaccination strategy. Aarogya Setu provided real-time data on active cases and containment zones to help citizens assess risk in their areas.
    • Increasing use of Telemedicine platforms: Telemedicine platforms saw a steep increase in user acquisitions, as 85 per cent of physicians used teleconsultations during the pandemic, underscoring the need to better incorporate cutting-edge digital technologies into healthcare services.

    Acknowledging the current need?

    • Although the impact of the pandemic on health services put the spotlight on the benefits of digital innovation and technology-enabled solutions, private entities, health technology players, and the public sector have been driving digitisation in the sector for some time now.
    • It has become clear that a comprehensive digital healthcare ecosystem is necessary to bring together existing siloed efforts and move toward proactive, holistic, and citizen-centric healthcare.

    Government efforts in this direction?

    • Shared public goods for healthcare: Recognising this need, the government has created shared public goods for healthcare and developed a framework for a nationwide digital health system. This brought healthcare to a turning point in India.
    • Ayushman Bharat Digital Mission (ABDM): The PM launched the Ayushman Bharat Digital Mission on September 27, 2021, under the aegis of the National Health Authority. Within a year of its launch, ABDM has established a robust framework to provide accessible, affordable, and equitable healthcare through digital highways. The ABDM has implemented vital building blocks to unite all stakeholders in the digital healthcare ecosystem.
    • The Ayushman Bharat Health Account (ABHA): ABHA creates a standard identifier for patients across healthcare providers. With the ABHA and its associated Personal Health Record (PHR) app, citizens can link, store, and share their health records to access healthcare services with autonomy and consent. With more than 300 million ABHAs and 50 million health records linked, the mission is growing at a massive rate.
    • The Health Facility Registry (HFR) and the Health Professional Registries (HPR) for central digital health information: HFR and HPR accounts provide verified digital identities to large and small public and private health facilities and professionals. This enables them to connect to a central digital ecosystem while serving as a single source for verified healthcare provider-related information. HFR and HPR improve the discovery of healthcare facilities and help health professionals build an online presence and offer services more effectively. The
    • Drug registry for centralised repository of approved drugs: It is a crucial building block designed to create a single, up-to-date, centralised repository of all approved drugs across all systems of medicine.
    • Unified Health Interface (UHI) enables a connect between healthcare providers with end users: It aims to strengthen the health sector by enabling all healthcare service providers and end-user applications to interact with each other on its network. This will provide a seamless experience for service discovery, appointment booking, teleconsultations, ambulance access, and more. The UHI is based on open network protocols and can address the current challenge of different digital solutions being unable to communicate with each other.

    What the government is planning next in this domain?

    • To give UHI the necessary push, the government is repurposing Aarogya Setu and CoWIN: Aarogya Setu is being transformed into a general health and wellness application. At the same time, CoWIN will be plugged with a lite Hospital Management Information System (HMIS) for small clinics, to bring digitisation to the masses.
    • Addressing well the patient registration process at the hospital counters: Another use-case of ABDM is scan and share, which uses a QR code-based token system to manage queues at hospital counters. It uses the foundational elements of ABHA and PHR to streamline the outpatient registration process in large hospitals
    • Expanding healthcare digital initiative worldwide: The government is also planning to expand its digital initiatives in the healthcare sector with Heal by India, making India’s healthcare professionals’ services available worldwide.
    • Platform for organ donation: Additionally, a platform is being developed to automate the allocation of deceased organ and tissue donations, making the process faster and more transparent.

    Way ahead

    • Digitise insurance claim settlement process: With the implementation of digital solutions, the next step is to digitise and automate the insurance claim settlement process through the Health Claim Exchange platform.
    • Making claim settlement process inexpensive and transparent: There is need to make claim-related information verifiable, auditable, traceable and interoperable among various entities, enabling claim processing to become inexpensive, transparent and carried out in real time.
    • Bringing together global efforts for digital health: India assumes the G20 presidency this year. The G20 Global Initiative on Digital Health calls for the creation of an institutional framework for a connected health ecosystem to bring together global efforts for digital health.
    • Accelerating UHC by scaling up the technologies: It also calls for the scaling-up of technologies such as global DPGs to accelerate Universal Health Coverage.

    Conclusion

    • The ABDM has proven to be a valuable asset and its adoption across states has been accelerated by the National Health Authority. It aims to build the foundation for a sustainable digital public infrastructure for health, enabling India to achieve universal health coverage. The mission embodies G20’s theme of “Vasudhaiva Kutumbakam” or “One Earth. One Family. One Future”

    Mains question

    Q. India has demonstrated spectacular success in digital public goods, specifically in Digital health. Discuss how the government efforts are taking shape in this direction and suggest a way ahead in short.

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  • Contamination of medicine: India; The Pharmacy of the world needs a relook in drug regulations

    medicine

    Context

    • Merely two months after the World Health Organisation (WHO) sounded an alert over deadly contamination in four brands of cough syrup manufactured by a Sonepat-based pharmaceutical company that were subsequently linked to the deaths of 72 children in Gambia, another Indian pharmaceutical company stands accused of a similar crime. This time, it is Uzbekistan which has accused a Noida-based pharmaceutical company of selling contaminated cough syrup that has allegedly killed 18 children in that country.

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    Thorough analysis

    • Unacceptable levels of Ethylene/ Diethylene glycol: In both cases, lab tests reportedly found unacceptable levels of diethylene glycol (DEG) or ethylene glycol (EG) or both in the cough syrups.
    • Ideally these chemicals should not be found in any medicine: Both DEG and EG are deadly chemicals that should not be found in any medicine.
    • Then how these chemicals end up in medicines: The typical reason these chemicals end up in medicine is because pharmaceutical manufacturers do not adequately test industrial solvents purchased from chemical traders and used to manufacture cough syrups despite the fact that the law mandates such testing for contamination.
    • Proximity in two cases: Given the physical proximity of the manufacturers implicated in the Gambian and Uzbekistan cases, there is a very high possibility that the same batch of contaminated industrial solvent was used by both companies.

    medicine

    Contamination of medicines in India

    • India has a tumultuous history of DEG contamination in medicines: Between 1972 and 2020, India has seen at least five mass DEG poisonings in Chennai, Mumbai, Bihar, Gurgaon and Jammu. The incident in Gurgaon led to the death of 33 children and the incident in Jammu of at least 11 children.
    • Difficult to diagnose deaths due to adulterated medicine: The final reported toll in such cases is definitely an undercount because it is notoriously difficult for doctors to diagnose such deaths and attribute them to adulterated medicine.
    • Lethargy and denial is a pattern with drug regulators in India: In August 2020, about eight months after the DEG-related deaths of the children in Jammu were first reported by PGIMER, Chandigarh, the same hospital reported that another two-year-old child from Baddi had died in its facility after consuming a different brand of cough syrup manufactured by the same company that was responsible for the deaths earlier in Jammu. This was a death that could have been easily avoided if the regulators had conducted and published a thorough root cause analysis after the Jammu incident and followed it up by a nationwide recall of all cough syrups manufactured at the same facility. This never happened.

    medicine

    Critique: Whether the Ministry of Health and the Central Drugs Standard Control Organization have learnt their lessons from these previous incidents?

    • Government will handle the issue just as any other public relation crisis: The present government is likely to handle this crisis as yet another public relations crisis instead of a public health crisis. Assumption is based on the observation of the official response from the government to the tragedy in Gambia.
    • Instead of condoling, accused them for not testing before prescribing: Far from condoling the deaths of 72 Gambians, the initial press release from the Ministry of Health gaslit the Gambians by accusing them of not testing the cough syrups before prescribing them to patients.
    • False presumption that the drug regulator is doing its job well: This was an absurd allegation because nobody tests drugs that are purchased before releasing them for patient use, even in India. The presumption is that the drug regulator is doing its job to ensure quality control.
    • Government’s information czars accusing WHO: The first step of this PR strategy was to keep leaking to journalists that the WHO was not co-operating with the information requests made by an expert committee set up by the Government of India to investigate the deaths in Gambia. This despite the government fully knowing that the responsibility of investigating the deaths lay not with the WHO but with the sovereign authorities in Gambia.
    • Rare mention of sympathy: The common thread running through these events is a communications strategy aimed at denial and intimidation. There is rarely a mention of sympathy for lives lost or a commitment to protect public health.
    • Even China does better than India: An iron fist in a titanium glove is the best way to describe the government’s response to any allegations of quality issues afflicting the Indian pharmaceutical industry. In 2007, when a Chinese chemicals manufacturer was implicated in the deaths of 365 people in Panama who consumed cough syrup manufactured with an adulterated industrial solvent, the Chinese arrested the manufacturer and publicly promised to punish him.

    medicine

    What should be done immediately?

    • The immediate public health response in these cases of DEG contamination should be aimed at limiting further deaths.
    • This means tracing the origins of the contaminated industrial solvent used to manufacture the syrups.

    Conclusion

    • What India needs right at the moment is to accept the fact that there is a major quality problem with the Indian pharmaceutical industry. Allegations cannot be morphed from one to another. Perhaps the need of the hour is to have meaningful and comprehensive conversation on actual regulatory reform.

    Mains question

    Q. It is said that India has a tumultuous history of DEG contamination in medicines. The recent deaths in Gambia and Uzbekistan supports this statement. What the critique has to say over India’s response in such cases.

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