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

  • Bridging the health policy to execution chasm

    Context

    In April this year, the Union government released a guidance document on the setting up of a ‘public health and management cadre’ (PHMC) as well as revised editions of the Indian Public Health Standards (IPHS) — for ensuring quality health care in government facilities.

    Background

    • The need for a public health cadre and services in India rarely got any policy attention.
    • Limited understanding: The reason was that even among policymakers, there was limited understanding on the roles and the functions of public health specialists and the relevance of such cadres, especially at the district and sub-district levels.
    • However, the last decade and a half was eventful.
    • The initial threat of avian flu in 2005-06, the Swine flu pandemic of 2009-10; five more public health emergencies of international concern between years 2009-19; the increasing risks and regular emergence and re-emergence of of new viruses and diseases (Zika, Ebola, Crimean-Congo Hemorrhagic fever, Nipah viruses, etc.) in animals and humans, resulted in increased attention on public health.
    • National Public health Act: In 2017, India’s National Health Policy 2017 proposed the formation of a public health cadre and enacting a National Public Health Act.
    • The COVID-19 pandemic changed the status quo.
    • In the absence of trained public health professionals at the policy and decision making levels, India’s pandemic response ended up becoming bureaucrat steered and clinician led.

    Different cadres and its implications

    • Lack of career progression opportunities: At present, most Indian States (with exceptions such as Tamil Nadu and Odisha) have a teaching cadre (of medical college faculty members) and a specialist cadre of doctors involved in clinical services.
    • This structure does not provide similar career progression opportunities for professionals trained in public health.
    • Limited interest: It is one of the reasons for limited interest by health-care professionals to opt for public health as a career choice.
    • The outcome has been costly for society: a perennial shortage of trained public health workforce.

    Public health cadre

    • The proposed public health cadre and the health management cadre have the potential to address some of these challenges.
    • With the release of guidance documents, the States have been advised to formulate an action plan, identify the cadre strengths, and fill up the vacant posts in the next six months to a year.
    • A public health workforce has a role even beyond epidemics and pandemics.
    • A trained public health workforce ensures that people receive holistic health care, of preventive and promotive services (largely in the domain of public health) as well as curative and diagnostic services (as part of medical care).

    Revised version of IPHS and significance

    • This is the second revision in the IPHS, which were first released in 2007 and then revised in 2012.
    • The regular need for a revision in the IPHS is a recognition of the fact that to be meaningful, quality improvement has to be an ongoing process.
    • The development of the IPHS itself was a major step.
    • The revised IPHS is an important development but not an end itself.
    • In the 15 years since the first release of the IPHS, only a small proportion — around 15% to 20% — of government health-care facilities meets these standards. .
    • If the pace of achieving IPHS is any criteria, there is a need for more accelerated interventions.
    • Opportunities such as a revision of the IPHS should also be used for an independent assessment on how the IPHS has improved the quality of health services.

    Implementation challenges

    • The effective part of implementation is interplay: policy formulation, financial allocation, and the availability of a trained workforce.
    • In this case, policy has been formulated.
    • Financial allocations: Then, though the Government’s spending on health in India is low and has increased only marginally in the last two decades; however, in the last two years, there have been a few additional — small but assured — sources of funding for public health services have become available.
    • The Fifteenth Finance Commission grant for the five-year period of 2021- 26 and the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) allocations are available for strengthening public health services and could be used  as States embark upon implementing the PHMC and a revised IPHS.
    • Availability of trained workforce: The third aspect of effective implementation, the availability of trained workforce, is the most critical.
    • As States develop plans for setting up the PHMC, all potential challenges in securing a trained workforce should be identified and actions initiated.

    Conclusion

    The public health and management cadres and the revised IPHS can help India to make progress towards the NHP goal. To ensure that, State governments need to act urgently and immediately.

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    Back2Basics: Indian Public Health Standards (IPHS)

    • IPHS are a set of uniform standards envisaged to improve the quality of health care delivery in the country.
    • The IPHS documents have been revised keeping in view the changing protocols of the existing programmes and introduction of new programmes especially for Non-Communicable Diseases.
    • Flexibility is allowed to suit the diverse needs of the States and regions.
    • These IPHS guidelines will act as the main driver for continuous improvement in quality and serve as the bench mark for assessing the functional status of health facilities.

  • Ensuring a sustainable vaccination programme

    Context

    COVID-19, which disrupted supply chains across countries and in India too, marks an inflection point in the trajectory of immunisation programmes.

    UIP: Showcasing India’s strength in managing large scale vaccination

    • India’s Universal Immunisation Programme (UIP), launched in 1985 to deliver routine immunisation, showcased its strengths in managing large-scale vaccine delivery.
    • This programme targets close to 2.67 crore newborns and 2.9 crore pregnant women annually.
    • Full immunisation: To strengthen the programme’s outcomes, in 2014, Mission Indradhanush was introduced to achieve full immunisation coverage of all children and pregnant women at a rapid pace — a commendable initiative.
    • India’s UIP comprises upwards of 27,000 functional cold chain points of which 750 (3%) are located at the district level and above; the remaining 95% are located below the district level.
    • The COVID-19 vaccination efforts relied on the cold chain infrastructure established under the UIP to cover 87 crore people with two doses of the vaccine and over 100 crore with at least a single dose.

    Why strong service delivery network is essential?

    • While we have, over the years, set up a strong service delivery network, the pandemic showed us that there were weak links in the chain, especially in the cold chain.
    • Nearly half the vaccines distributed around the world go to waste, in large part due to a failure to properly control storage temperatures.
    • In India, close to 20% of temperature-sensitive healthcare products arrive damaged or degraded because of broken or insufficient cold chains, including a quarter of vaccines.
    • Wastage has cost implications and can delay the achievement of immunisation targets.

    Measures and initiatives in strengthening vaccine supply chains

    • The Health Ministry has been digitising the vaccine supply chain network in recent years through the use of cloud technology, such as with the Electronic Vaccine Intelligence Network (eVIN).
    • Developed with support from Gavi, the Vaccine Alliance, and implemented by the UN Development Programme through a smartphone-based app, the platform digitises information on vaccine stocks and temperatures across the country.
    • This supports healthcare workers in the last mile in supervising and maintaining the efficiency of the vaccine cold chain.

    Way forward

    • Electrification: There is a need to improve electrification, especially in the last mile, for which the potential of solar-driven technology must be explored to integrate sustainable development.
    • For instance, in Chhattisgarh, 72% of the functioning health centres have been solarised to tackle the issue of regular power outages.
    • This has significantly reduced disruption in service provision and increased the uptake of services.

    Conclusion

    India has pioneered many approaches to ensure access to public health services at a scale never seen before. Robust cold chain systems are an investment in India’s future pandemic preparedness; by taking steps towards actionable policies that improve the cold chain, we have an opportunity to lead the way in building back better and stronger.

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  • Public health engineering

    Context

    As we confront the public health challenges emerging out of environmental concerns, expanding the scope of public health/environmental engineering science becomes pivotal.

    Why does India need a specialised cadre of public health engineers

    • Achieving SDGs and growing demand for water consumption: For India to achieve its sustainable development goals of clean water and sanitation and to address the growing demands for water consumption and preservation of both surface water bodies and groundwater resources, it is essential to find and implement innovative ways of treating wastewater.
    •  It is in this context why the specialised cadre of public health engineers, also known as sanitation engineers or environmental engineers, is best suited to provide the growing urban and rural water supply and to manage solid waste and wastewater.
    • Limited capacity: The availability of systemic information and programmes focusing on teaching, training, and capacity building for this specialty cadre is currently limited.
    • Currently in India, civil engineering incorporates a course or two on environmental engineering for students to learn about wastewater management as a part of their pre-service and in-service training.
    • However, the nexus between wastewater and solid waste management and public health issues is not brought out clearly.
    • India aims to supply 55 litres of water per person per day by 2024 under its Jal Jeevan Mission to install functional household tap connections.
    • The goal of reaching every rural household with functional tap water can be achieved in a sustainable and resilient manner only if the cadre of public health engineers is expanded and strengthened.
    • Different from the international trend: In India, public health engineering is executed by the Public Works Department or by health officials. This differs from international trends.

    Way forward

    • Introducing public health engineering as a two-year structured master’s degree programme or through diploma programmes for professionals working in this field must be considered to meet the need of increased human resource in this field.
    • Interdisciplinary field: Furthermore, public health engineering should be developed as an interdisciplinary field.
    • Engineers can significantly contribute to public health in defining what is possible, identifying limitations, and shaping workable solutions with a problem-solving approach.
    • Public health engineering’s combination of engineering and public health skills can also enable contextualised decision-making regarding water management in India.

    Conclusion

    Diseases cannot be contained unless we provide good quality and adequate quantity of water. Most of the world’s diseases can be prevented by considering this. Training our young minds towards creating sustainable water management systems would be the first step.

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  • Report flags Risk of Fortified Rice

    A report has flagged issues due to threats posed to anaemic persons over iron over-nutrition created by rice fortification.

    Highlights of the report

    • No prior education: The activists discovered that neither field functionaries nor beneficiaries had been educated about the potential harms.
    • No warnings issued: There were no warning labels despite the food regulator’s rules on fortified foods.
    • No informed choice: The right to informed choices about one’s food is a basic right. In the case of rice fortification, it is seen that no prior informed consent was ever sought from the recipients.

    What are the risks highlighted?

    • Thalassemia, sickle cell anaemia and malaria are conditions where there is already excess iron in the body, whereas TB patients are unable to absorb iron.
    • Consumption of iron-fortified foods among patients of these diseases can reduce immunity and functionality of organs.

    Endemic zones identified

    • Jharkhand is an endemic zone of sickle cell disorder and thalassemia, with a prevalence of 8%-10%, which is twice the national average.
    • Jharkhand is also an endemic zone for malaria — in 2020, the State ranked third in the country in malaria deaths.

    What is Fortification?

    • The Food Safety and Standards Authority of India (FSSAI) has explicitly defined fortification.
    • It involves deliberate increasing of the content of essential micronutrients in a food so as to improve the nutritional quality of food and to provide public health benefit with minimal risk to health.

    Types of food fortification

    Food fortification can also be categorized according to the stage of addition:

    1. Commercial and industrial fortification (wheat flour, cornmeal, cooking oils)
    2. Biofortification (breeding crops to increase their nutritional value, which can include both conventional selective breeding, and genetic engineering)
    3. Home fortification (example: vitamin D drops)

    How is fortification done for rice?

    • Various technologies are available to add micronutrients to regular rice, such as coating, dusting, and ‘extrusion’.
    • The last mentioned involves the production of fortified rice kernels (FRKs) from a mixture using an ‘extruder’ machine.
    • It is considered to be the best technology for India.
    • The fortified rice kernels are blended with regular rice to produce fortified rice.

    How does the extrusion technology to produce FRK work?

    • Dry rice flour is mixed with a premix of micronutrients, and water is added to this mixture.
    • The mixture is passed through a twin-screw extruder with heating zones, which produces kernels similar in shape and size to rice.
    • These kernels are dried, cooled, and packaged for use. FRK has a shelf life of at least 12 months.
    • As per guidelines issued by the Ministry of Consumer Affairs, Food and Public Distribution, the shape and size of the fortified rice kernel should “resemble the normal milled rice as closely as possible”.
    • According to the guidelines, the length and breadth of the grain should be 5 mm and 2.2 mm respectively.

    But why does rice have to be fortified in the first place?

    • India has very high levels of malnutrition among women and children.
    • According to the Food Ministry, every second woman in the country is anaemic and every third child is stunted.
    • Fortification of food is considered to be one of the most suitable methods to combat malnutrition.
    • Rice is one of India’s staple foods, consumed by about two-thirds of the population. Per capita rice consumption in India is 6.8 kg per month.
    • Therefore, fortifying rice with micronutrients is an option to supplement the diet of the poor.

    What are the standards for fortification?

    • Under the Ministry’s guidelines, 10 g of FRK must be blended with 1 kg of regular rice.
    • According to FSSAI norms, 1 kg of fortified rice will contain the following: iron (28 mg-42.5 mg), folic acid (75-125 microgram), and vitamin B-12 (0.75-1.25 microgram).
    • Rice may also be fortified with zinc (10 mg-15 mg), vitamin A (500-750 microgram RE), vitamin B-1 (1 mg-1.5 mg), vitamin B-2 (1.25 mg-1.75 mg), vitamin B-3 (12.5 mg-20 mg) and vitamin B-6 (1.5 mg-2.5 mg) per kg.

    How can a beneficiary distinguish between fortified rice and regular rice?

    • Fortified rice will be packed in jute bags with the logo (‘+F’) and the line “Fortified with Iron, Folic Acid, and Vitamin B12”.

    Advantages offered

    • Health: Fortified staple foods will contain natural or near-natural levels of micro-nutrients, which may not necessarily be the case with supplements.
    • Taste: It provides nutrition without any change in the characteristics of food or the course of our meals.
    • Nutrition: If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittently supplement.
    • Economy: The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 percent of the total food value.
    • Society: It upholds everyone’s right to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger

    Issues with fortified food

    • Against nature: Fortification and enrichment upset nature’s packaging. Our body does not absorb individual nutrients added to processed foods as efficiently compared to nutrients naturally occurring.
    • Bioavailability: Supplements added to foods are less bioavailable. Bioavailability refers to the proportion of a nutrient your body is able to absorb and use.
    • Immunity issues: They lack immune-boosting substances.
    • Over-nutrition: Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micro-nutrients, treatment failure, and increased mortality risk.

     

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  • India Hypertension Control Initiative (IHCI)

    A project called the India Hypertension Control Initiative (IHCI) finds that nearly 23% out of 2.1 million Indians have uncontrolled blood pressure.

    What is the IHCI?

    • Recognizing that hypertension is a serious, and growing, health issue in India, the Health Ministry, the ICMR, State Governments, and WHO-India began a five-year initiative to monitor and treat hypertension.
    • The programme was launched in November 2017.
    • In the first year, IHCI covered 26 districts across five States — Punjab, Kerala, Madhya Pradesh, Telangana, and Maharashtra.
    • By December 2020, IHCI was expanded to 52 districts across ten States — Andhra Pradesh (1), Chhattisgarh (2), Karnataka (2), Kerala (4), Madhya Pradesh (6), Maharashtra (13), Punjab (5), Tamil Nadu (1), Telangana (13) and West Bengal (5).

    What is Hypertension?

    • Hypertension is defined as having systolic blood pressure level greater than or equal to 140 mmHg or diastolic blood pressure level greater than or equal to 90 mmHg.
    • The definition also assumes taking anti-hypertensive medication to lower his/her blood pressure.

    Why need IHCI?

    • India has committed to a “25 by 25” goal, which aims to reduce premature mortality due to non-communicable diseases (NCDs) by 25% by 2025.
    • To achieve India’s target of a 25%, approximately 4.5 crore additional people with hypertension need to get their BP under control by 2025.

    What has the IHCI found so far?

    • Its most important discovery so far is that nearly one-fourth of (23%) patients under the programme had uncontrolled blood pressure, and 27% did not return for a follow-up in the first quarter of 2021.
    • There were an estimated 20 crore adults with hypertension in the country.
    • There weren’t enough validated high-quality digital blood pressure monitors in several health facilities, which affected accuracy of hypertension diagnosis.

    How prevalent is the problem of hypertension?

    • About one-fourth of women and men aged 40 to 49 years have hypertension.
    • Southern States have a higher prevalence of hypertension than the national average, according to the latest edition of the National Family Health Survey.
    • While 21.3% of women and 24% of men aged above 15 have hypertension in the country, the prevalence is the highest in Kerala where 32.8% men and 30.9% women have been diagnosed with hypertension.
    • Kerala is followed by Telangana where the prevalence is 31.4% in men and 26.1% in women.

     

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  • MTP Act 2021

    Context

    The issue of abortion is in the news again, internationally.

    Criminal law provisions related to termination of pregnancy

    • Under the general criminal law of the country, i.e. the Indian Penal Code, voluntarily causing a woman with child to miscarry is an offence attracting a jail term of up to three years or fine or both, unless it was done in good faith where the purpose was to save the life of the pregnant woman.
    • A pregnant woman causing herself to miscarry is also an offender under this provision apart from the person causing the miscarriage, which in most cases would be a medical practitioner.

    Background of the MTP Act

    • In 1971, after a lot of deliberation, the Medical Termination of Pregnancy (MTP) Act was enacted.
    • This law is an exception to the IPC provisions above.
    • Who, when, where, why and by whom? The law sets out the rules — of when, who, where, why and by whom — for accessing an MTP.
    •  This law has been amended twice since, the most recent set of amendments being in the year 2021 which has, to some extent, expanded the scope of the law.
    • The law does not recognise and/or acknowledge the right of a pregnant person to decide on the discontinuation of a pregnancy.
    • The law provides for a set of reasons based on which an MTP can be accessed.

    Reasons allowed for MTP

    • Reasons: The continuation of the pregnancy would involve a risk to the life of the pregnant woman or result in grave injury to her physical or mental health.
    • The law explains that if the pregnancy is as a result of rape or failure of contraceptive used by the pregnant woman or her partner to limit the number of children or to prevent a pregnancy, the anguish caused by the continuation of such a pregnancy would be considered to be a grave injury to the mental health of the pregnant woman.
    • The other reason for seeking an MTP is the substantial risk that if the child was born, it would suffer from any serious physical or mental abnormality.
    •  A pregnant person cannot ask for a termination of pregnancy without fitting in one of the reasons set out in the law.
    • Gestational age of pregnancy: The other set of limitations that the law provides is the gestational age of the pregnancy.
    • The pregnancy can be terminated for any of the above reasons, on the opinion of a single registered medical practitioner up to 20 weeks of the gestational age.
    • From 20 weeks up to 24 weeks, the opinion of two registered medical practitioners is required.
    • Any decision for termination of pregnancy beyond 24 weeks gestational age, only on the ground of foetal abnormalities can be taken by a Medical Board as set up in each State, as per the law.
    • The law, as an exception to all that is stated above, also provides that where it is immediately necessary to save the life of the pregnant woman, the pregnancy can be terminated at any time by a single registered medical practitioner.

    Issues with the MTP Act provisions

    • While India legalised access to abortion in certain circumstances much before most of the world did the same, unfortunately, even in 2020 we decided to remain in the logic of 1971.
    • Right to health and right to life: By the time the amendments to the MTP Act were tabled before the Lok Sabha in 2020, a number of cases came before the courts.
    • In these cases, the courts had articulated the right of a pregnant woman to decide on the continuation of her pregnancy as a part of her right to health and right to life, and therefore non-negotiable.
    • Violation of right to privacy: In right to privacy judgment of the Supreme Court of India it was held that the decision making by a pregnant person on whether to continue a pregnancy or not is part of such a person’s right to privacy as well and, therefore, the right to life.
    • The standards set out in this judgment were also not incorporated in the amendments being drafted.
    • Not in sync with central laws: The new law is not in sync with other central laws such as the laws on persons with disabilities, on mental health and on transgender persons, to name a few.
    • In conflict with other laws: The amendments also did not make any attempts to iron out the conflations between the MTP Act and the Protection of Children from Sexual Offences (POCSO) Act or the Drugs and Cosmetics Act, to name a few.

    Conclusion

    While access to abortion has been available under the legal regime in the country, there is a long road ahead before it is recognised as a right of a person having the capacity to become pregnant to decide, unconditionally, whether a pregnancy is to be continued or not.

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  • Highlights of the National Family Health Survey (NFHS) 5 Part: II

    The Total Fertility Rate (TFR), the average number of children per woman, has further declined from 2.2 to 2.0 at the national level between National Family Health Survey (NFHS) 4 and 5.

    What is NFHS?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • The IIPS is the nodal agency, responsible for providing coordination and technical guidance for the NFHS.
    • NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children’s Fund (UNICEF).
    • The First National Family Health Survey (NFHS-1) was conducted in 1992-93.

    Objectives of the NFHS

    The survey provides state and national information for India on:

    • Fertility
    • Infant and child mortality
    • The practice of family planning
    • Maternal and child health
    • Reproductive health
    • Nutrition
    • Anaemia
    • Utilization and quality of health and family planning services

    Modifications in NFHS 5

    NFHS-5 includes new focal areas that will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention. The areas are:

    • Expanded domains of child immunization
    • Components of micro-nutrients to children
    • Menstrual hygiene
    • Frequency of alcohol and tobacco use
    • Additional components of non-communicable diseases (NCDs)
    • Expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above.

    Highlights of the NFHS 5 Part-II

    (a) Fertility Rate

    • There are only five States — Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) Manipur (2.17) —which are above replacement level of fertility of 2.1.

    (b) Institutional Births

    • The institutional births increased from 79% to 89% across India and in rural areas around 87% births being delivered in institutions and the same is 94% in urban areas.
    • As per results of the NFHS-5, more than three-fourths (77%) children aged between 12 and 23 months were fully immunised, compared with 62% in NFHS-4.
    • The level of stunting among children under five years has marginally declined from 38% to 36% in the country since the last four years.
    • Stunting is higher among children in rural areas (37%) than urban areas (30%) in 2019-21.

    (c) Decision making

    • The extent to which married women usually participate in three household decisions (about health care for herself; making major household purchases; visit to her family or relatives) indicates that their participation in decision-making is high, ranging from 80% in Ladakh to 99% in Nagaland and Mizoram.
    • Rural (77%) and urban (81%) differences are found to be marginal.
    • The prevalence of women having a bank or savings account has increased from 53% to 79% in the last four years.

    (d) Rise in obesity

    • Compared with NFHS-4, the prevalence of overweight or obesity has increased in most States/UTs in NFHS-5.
    • At the national level, it increased from 21% to 24% among women and 19% to 23% among men.
    • More than a third of women in Kerala, Andaman and Nicobar Islands, AP, Goa, Sikkim, Manipur, Delhi, Tamil Nadu, Puducherry, Punjab, Chandigarh and Lakshadweep (34-46 %) are overweight or obese.

     

    Also read

    National Family Health Survey- 5 Part: I

     

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  • Civil Registration System Report, 2020

    The Civil Registration System (CRS) report 2020 was released at least a month before its schedule.

    What is Civil Registration System (CRS)?

    • The CRS collates data on all births and deaths registered with local authorities across India.
    • The CRS report is released by the Registrar-General of India.
    • It releases its report around 18 months after a year ends.

    Significance of the 2020 Report

    • The 2020 report was released at least a month before schedule.
    • Such data can be of significance during a pandemic as possible covid-19 deaths may not have been categorized as such in official records.
    • The CRS can help us reach an estimate by using the “excess deaths” approach.
    • It is the difference between the total number of deaths registered in a pandemic year and the number of deaths that normally take place in a year.

    Why was the data released ahead of schedule?

    • India and the WHO are locked in a tussle over the latter’s excess death estimates that would give a sense of pandemic-linked fatalities globally in 2020-21.
    • India has reportedly stalled WHO’s efforts to release the data, claiming flawed methodology.
    • WHO is set to release its estimates today, a possible reason that India released CRS data early.

    Why is India contesting the WHO approach?

    • One key objection by India is that WHO has classified it as a Tier 2 country and hence used a different modelling process to estimate excess deaths from that used for Tier 1 countries.
    • WHO says all countries that made available their full all-cause mortality data for the pandemic period were classified as Tier 1.
    • India is in Tier 2 because it didn’t share official data with WHO.
    • Hence, alternative data and modelling methods had to be adopted, adjusting for factors such as income levels, covid-19 reporting rates, and test positivity rates.

    What does the 2020 data show?

    (a) Covid deaths

    • The CRS report for 2020 has recorded deaths of 8.12 million Indians, 6.2% more than 2019.
    • Normally, an unusual increase in deaths would be linked to the pandemic. However, in India, not all deaths are registered.
    • Thus, a rise could simply be because of more families getting deaths registered.
    • The CRS for 2021, which saw more Covid deaths, may not be out until next year.

    (b) Improvements in sex ratio

    • Highest Sex Ratio at Birth (SRB) based on registered events has been reported by Ladakh (1,104) followed by Arunachal Pradesh (1,011), A&N Islands (984), Tripura (974), and Kerala (969).
    • The lowest sex ratio was reported by Manipur (880), followed by Dadra and Nagar Haveli and Daman and Diu (898), Gujarat (909), Haryana (916) and Madhya Pradesh (921).

     

     

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  • Autism Support Network to give Specialised Care in Rural India

    The Centre for Autism and Other Disabilities Rehabilitation Research and Education (CADRRE), a not-for-profit organization will launch “Pay Autention — a different mind is a gifted mind”, India’s first bridgital autism support network.

    Pay ‘Autention’

    • The initiative shall pave the way for small towns and rural India to access specialised care and support and help create an auxiliary network of champions for the differently-abled.
    • This platform shall also enable mentoring, skilling and meaningful livelihoods for people with autism.
    • In the first phase, the initiative will primarily focus on supporting children with autism, and subsequently, in the second stage, it will focus on young adults, empowering them with life skills and career readiness.
    • The content is designed and delivered in collaboration with specialists from CADRRE who have expertise in training children with autism.
    • The project aims to create a network of grassroots champions, enable early identification, first-level care, teach social skills, ways to ease activities of daily living, hold workshops for sensory and motor development.
    • It also focuses on art and craft, dance, music therapy, physical and mental fitness, communication skills and enable support for academics.

    What is Autism?

    • Autism, also called autism spectrum disorder (ASD), is a complicated condition that includes problems with communication and behaviour.
    • It can involve a wide range of symptoms and skills.
    • ASD can be a minor problem or a disability that needs full-time care in a special facility.
    • People with autism have trouble with communication. They have trouble understanding what other people think and feel.
    • This makes it hard for them to express themselves, either with words or through gestures, facial expressions, and touch.
    • People with autism might have problems with learning. Their skills might develop unevenly.
    • For example, they could have trouble communicating but be unusually good at art, music, math, or memory.

    What are the signs of Autism?

    Symptoms of autism usually appear before a child turns 3. Some people show signs from birth. Common symptoms of autism include:

    • A lack of eye contact
    • A narrow range of interests or intense interest in certain topics
    • Doing something over and over, like repeating words or phrases, rocking back and forth, or flipping a lever
    • High sensitivity to sounds, touches, smells, or sights that seem ordinary to other people
    • Not looking at or listening to other people
    • Not looking at things when another person points at them
    • Not wanting to be held or cuddled
    • Problems understanding or using speech, gestures, facial expressions, or tone of voice
    • Talking in a sing-song, flat, or robotic voice
    • Trouble adapting to changes in routine

    What causes Autism?

    • Exactly why autism happens isn’t clear. It could stem from problems in parts of your brain that interpret sensory input and process language.
    • Autism is four times more common in boys than in girls. It can happen in people of any race, ethnicity, or social background.
    • Family income, lifestyle, or educational level doesn’t affect a child’s risk of autism. But there are some risk factors:
    1. Autism runs in families, so certain combinations of genes may increase a child’s risk.
    2. A child with an older parent has a higher risk of autism.
    3. Pregnant women who are exposed to certain drugs or chemicals, like alcohol or anti-seizure medications, are more likely to have autistic children
    4. Other risk factors include maternal metabolic conditions such as diabetes and obesity.

    Prevalence of Autism in India

    • Prevalence and incidence statistics about autism in India is 1 in 500 or 0.20% or more than 2,160,000 people.
    • According to a study, an estimated three million people live with autistic spectrum disorder (ASD) on the Indian subcontinent.

     

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  • The post-pandemic world needs better public schools

    Context

    The pandemic has thrown a harsh light on the vulnerabilities and challenges faced by the world in education. There is an immense learning gap due to existing inequalities.

    Need for investment in learning systems

    • In India, we have to accept that unless we mobilise learning resources and institutions at the government level, the divides will continue to expand and learners will continue to fall between the cracks.
    • Systems have to be put into place to find a variety of methods to equip all learners — privileged, poor, middle-class and alternatively-abled.
    •  The challenge is about returning to school.
    • In wealthier nations, schools have always been the first to open and last to close and citizens have benefited from the public school system.
    • In India, across states, there is a sense of despair due to unemployment and lack of financial resources, which has snowballed due to the pandemic, resulting in greater inequality.
    • Sending children to school, as opposed to keeping them at home, is a huge financial investment, particularly in the private school system.
    • Parents have refrained from sending their children back to school due to a lack of funds.

    Viewing education through government school lens

    • The big shift that we as a nation have to make is viewing education through a government school lens.
    • This will only take place if states provide the opportunity for free, compulsory, neighbourhood education.
    • Radical reforms have to be implemented to restructure government schools and ensure quality.
    • The government, both at the Centre and in the states, should build good-quality primary, middle and high schools and provide facilities that the best private schools have to offer.
    • Online learning is not the way forward: We are subsumed by the myth that technology has expanded potential.
    • The concern is that online learning will create greater inequality, not only in the global South but even in the most well-resourced corners of the planet.
    • Online learning is not the way forward.
    • The UNESCO’s International Commission on the Futures of Education states in its report, “the core commitments that should always be remembered are public education and common good”.
    • It says, “This is not the time to step back and weaken these principles but rather to affirm and reinforce them.”
    • We must take the opportunity to protect and advance public education.
    • We cannot allow the government health system and government education to be opposed to one another. Their synergies must overlap

    Conclusion

    Public education is crucial to societies, communities and individual lives. It is the only thing that will enable us to live with dignity and purpose.

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