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

  • Extending outpatient health care coverage

    Context

    Over the past two decades, initiatives announced to extend health care coverage to the indigent sections have come under criticism due to their near-exclusive focus on hospitalisation (inpatient, IP) care.

    Significance of outpatient health care

    • What is outpatient health care: Outpatient (OP) health care, mainly comprising doctor consultations, drugs, and tests, can be called ‘the elephant in the room’ of Indian public health care policy.
    • OP expenses have the majority share in total out-of-pocket (OOP) expenditure on health.

    Why do we need to extend OP care coverage?

    • How IP care differs from OP care? IP care comprises high-impact and unavoidable episodes that are less prone to misuse than OP care, for which demand is considerably more sensitive to price and is thus more prone to overuse under health insurance.
    • IP insurance prioritised: This logic, among other reasons, has led to IP insurance schemes being prioritised.
    • [1] OP care and preventive care is neglected: While a price-sensitive demand for OP care entails that it could be misused under insurance, it also means that OP care is the first to come under the knife when there is no insurance.
    • In India, where there are many public IP insurance schemes but no OP coverage, this incentive is further amplified.
    • The mantra of ‘prevention is better than cure’ thus goes for a toss.
    • [2] Against economic sense: It defies economic sense to prioritise IP care over OP care for public funds.
    • Preventive and primary care services which often come with externalities, elicit little felt need and demand, and must therefore be the primary recipients of public investment.
    • Not conducive to epidemiological profile: Greater investments in IP care today translate to even greater IP care investments in future, further reduction in primary care spending, and ultimately lesser ‘health’ for the money invested.
    • None of these are conducive to the epidemiological profile that characterises this country.

    Issues with using private commercial insurance to extend OP care coverage nationwide

    • Some recent policy pronouncements by the Centre have conveyed an inclination to expand healthcare coverage with little fiscal implications for the government.
    • Challenges:
    • [1] The OP practices are under-regulated and there is a lack of standards.
    • [2] The difficulty to monitor OP clinical and prescribing behaviours and the concomitant higher likelihood of malpractices.
    • [3] Low public awareness of insurance products and a low ability to discern entitlements and exclusions.
    • [4] Add to it the inexperience that a still under-developed private OP insurance sector brings.
    • All these entail tremendous and largely wasteful costs and administrative complexity, and it would be of little help even if the government was to step in with considerable subsidies.

    Suggestion

    • Need for fiscal and time commitment: Significant improvements in healthcare are implausible without significant fiscal and time commitments.
    • No perfect model: There is no ‘perfect’ model of expanding healthcare — the emphasis must be on finding the best fit.
    • Implementing even such a best fit could involve adopting certain modalities with known drawbacks.
    • Expand public spending: The focus must be on expanding public OP care facilities and services financed mainly by tax revenues.
    • For India, wisdom immediately points to successful countries that are (or were, at one point) much closer to its socioeconomic fabric, such as Thailand, than countries like the U.S. which we currently look to emulate.
    • Now, the sparse number and distribution of public facilities offers various modes of rationing care, and their expansion is likely to result in a considerable spike in demand.
    • Contracting with private players: Contracting with private players based on objective and transparent criteria would also be called for, with just enough centralised supervision to deter corruption while preserving local autonomy.
    • To deter supply-side malpractices, low-powered modes of provider payment, such as capitation, may be considered for private providers wherever possible.

    Conclusion

    There are several compelling reasons for extending outpatient health care coverage even though there are several challenges to overcome to achieve this.

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  • Risks of mandatory Iron Fortification

    Many things have been said about the necessity for mandatory iron fortification of foods in India.

    Iron fortification

    • Iron fortification of food is a methodology utilized worldwide to address iron deficiency.
    • A critical problem in some food fortification programs is the lack of bioavailability of iron compounds.

    Why need iron fortification?

    Ans. Prevalence of Anaemia

    • Iron deficiency anaemia is due to insufficient iron.
    • National Family Health Survey (NFHS)-5 provides insights into anaemia prevalence in the country, indicating that 57.2% of women ages 15 to 49 are anaemic, up from 49.7% in NFHS-4.
    • Without enough iron, the body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin).
    • Severe anemia during pregnancy increases your risk of premature birth, having a low birth weight baby and postpartum depression.
    • Some studies also show an increased risk of infant death immediately before or after birth.

    Concerns over iron fortification

    Ans. Fear of diabetes and heart ailments

    • Iron increases the risk for many non-communicable diseases like diabetes, hypertension and even high blood cholesterol.
    • A US based survey shows that high ferritin level had a four-fold higher risk of having diabetes.
    • The Comprehensive National Nutrition Survey of Indian adolescents to resulted in such scary outcomes.
    • There was a clear and significant risk for each of these conditions as serum ferritin increased.

    India’s vulnerability

    Ans. India is world capital of diabetes and hypertension

    • No less than 50% of Indian children, aged 5-19 years, already had a biomarker of either high blood sugar or high blood lipids, even when thin or stunted.
    • Thus, the risk of chronic disease is already very high in our children.
    • Thus mandatory cereal fortification has severe hazards for India.

    Why mandatory fortification is not a feasible option?

    • Occurrence of deficiencies: We do not even know if anaemia is as rampant to warrant such mandatory measures.
    • Manipulating food choices: When mandatory fortification is enforced in parts of the population that do not need this, it removes their choice of foods, or autonomy.
    • Morbidities due to excess: It could even be unethical if the risk of other morbidities is increased.
    • No successful example: Rice fortification has not been shown to work in a combined analysis.

    Conclusion

    • Food fortification is not a magic bullet.
    • It should be viewed as a complementary strategy for the prevention and control of micronutrient deficiencies.
    • As dietary patterns and deficiency states change, monitoring and periodic evaluation will be essential in helping to make necessary changes.

     

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  • How lack of public data on pandemic could harm us

    Context

    Questions are being asked about India’s preparedness as the cases with the Omicron variant of the Coronavirus has been on the rise in the country.

    Where does India stand?

    [1] The Positives

    • Addressing oxygen shortage: The extreme shortages of oxygen that we saw barely six months ago will hopefully not be a feature of a third wave.
    • Vaccinated population: We have now vaccinated more than 50% of the adult population with both doses of vaccine, and approximately 85% have received one or two doses.
    • Ramping up testing to deal with a spike should not require an increase in capacity.
    • More vaccine doses: We have more vaccine doses than in May 2021 and the potential for oral antiviral therapy in the near future.

    [2] The negatives

    • Lack of data: An urgent and important one is the lack of publicly available data on the pandemic from Government sources, particularly in regard to testing, but also in terms of being able to correlate disease severity with age, prior medical conditions, locations and other variables.
    • Data from the Indian Council of Medical Research (ICMR), India’s premier medical research agency, remains inaccessible.
    • The National Centre for Disease Control (NCDC) has not responded.
    • The CoWIN data contains valuable information but it is of little value for future planning and prediction unless it can be tied to testing data and clinical information at the level of individuals.
    • ICMR data not correlated to CoWIN platform data: The Indian Council of Medical Research holds data on every COVID-19 test conducted in India.
    • However, these data are not correlated to the vaccine data in the CoWIN platform.
    • Data with States is inaccessible: Data on hospitalisations, etc. are apparently available at the State level, but seem inaccessible.

    What we can know from the data about pandemic

    • Infer the probability of reinfection: If we knew that a person had tested positive on successive tests separated by, say four months or more, with a negative test in-between, that would suggest a reinfection.
    • We could then infer the probability of such a reinfection.
    • Probability of vaccine breakthrough infection: With information about testing and vaccination status, we could compute the probability of a vaccine breakthrough event.
    • To know the efficacy of single vaccine dose: By checking to see whether the positive test happened after the first but before the second dose of vaccine, or after the second dose, the relative efficacy of such single vaccine doses at preventing disease could be derived.
    • Effect of the vaccine on disease severity: By examining symptoms reported after a vaccine breakthrough event, we could understand the extent to which vaccines reduce disease severity.
    • Impact of new variant: Add to this a layer of sequence information, and we could study the impact of new variants.

    Role of the volunteer organisation

    • The most trustworthy and granular data on cases in India have resulted from the remarkable and public-spirited work of a volunteer organisation, Covid19India.org.
    • Their work has now been taken over by several other voluntary groups, all operating on the same broad principles of data accessibility: covid19bharat.org, incovid19.org and covid19tracker.in.

    Way forward

    • Commitment towards data accessibility: We need to stress on data availability because this is the one area where a swift realignment is possible.
    • The more widely data are shared, the greater the likelihood of integration of the rapidly shifting scientific frontier with clinical practice.
    • Learning from the experience of South Africa: With the advantages of a relatively high-quality surveillance system among low- and middle-income countries (LMIC) countries, bolstered by a commitment towards transparency and data accessibility, South Africa’s rapid sharing allowed the world to prepare swiftly for the appearance of the highly mutated Omicron variant.
    • It is clear that pre-emptive decisions on vaccination and other measures could be made faster and better if more integrated data were available.

    Consider the question “Why availability and accessibility of data is important in dealing with the Covid-19 pandemic? What are the challenges facing health data accessibility in India?”

    Conclusion

    Now, more than ever before is the time for us to urgently reassess our attitude towards data for public health purposes and the role of national health agencies in sharing data, generated with public funds, with scientists in India and across the world.

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  • Amendment to the NDPS Act

    The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2021 was passed by Lok Sabha.

    Must read:

    [Burning Issue] Substance Abuse in India

    About NDPS Act

    • The Narcotic Drugs and Psychotropic Substances Act, commonly referred to as the NDPS Act was promulgated in 1985.
    • It prohibits a person from the production/manufacturing/cultivation, possession, sale, purchasing, transport, storage, and/or consumption of any narcotic drug or psychotropic substance

    What is the 2021 amendment?

    • The 2021 Bill amends the Narcotic Drugs and Psychotropic Substances Act, 1985 and seeks to rectify a drafting “anomaly” created by a 2014 amendment to the parent legislation.
    • It contains a legislative declaration about what one section refers to.
    • It says Section 2 clause viii(a) corresponds to clause viii(b) in Section 27, since 2014 when the provision was first brought in.
    • Section 27A of the NDPS Act, 1985, prescribes the punishment for financing illicit traffic and harbouring offenders.

    Earlier amendment in 2014

    • In 2014, a substantial amendment was made to the NDPS Act to allow for better medical access to narcotic drugs.
    • It defined “essential drugs”; under Section 9 and allowed the manufacture, possession, transport, import inter-State, export inter-State, sale, purchase, consumption and use of essential narcotic drugs.
    • But before the 2014 amendment, a Section 2(viii)a already existed and contained a catalogue of offences for which the punishment is prescribed in Section 27A.

    What is Section 21A?

    • Section 27A reads: Whoever indulges in financing, directly or indirectly or harbours any person engaged in any of the aforementioned activities, shall be punishable with rigorous imprisonment.
    • The term shall not be less than ten years and may extend to twenty years.
    • The accused shall also be liable to fine which shall not be less than one lakh rupees but which may extend to two lakh rupees.

    What was the drafting “anomaly”?

    • While defining “essential drugs” in 2014, the legislation re-numbered Section 2.
    • The catalogue of offences, originally listed under Section 2(viii)a, was now under Section 2(viii)b.
    • In the amendment, Section 2(viii)a defined essential narcotic drugs.
    • However, the drafters missed amending the enabling provision in Section 27A to change Section 2(viii)a to Section 2(viii)b.

    What was the result of the drafting error?

    • Section 27A punished offences mentioned under Section 2(viiia) sub-clauses i-v.
    • However, Section 2 (viiia) sub-clauses i-v, which were supposed to be the catalogue of offences, does not exist after the 2014 amendment. It is now Section 2(viiib).
    • This error in the text meant since 2014, Section 27A was inoperable.

    When was the error noticed?

    • In June this year, the Tripura High Court, while hearing a reference made by the district court, flagged the drafting error, urging the Centre to bring in an amendment and rectify it.
    • In 2016, an accused had sought bail before a special judge in West Tripura in Agartala, citing this omission in drafting.

    Why can’t it be applied retrospectively?

    • Article 20(1) of the Constitution says that no person shall be convicted of any offence except for violation of the law in force at the time of the commission.
    • The person shall not be subjected to a penalty greater than that which might have been inflicted under the law in force at the time of the commission of the offence.
    • This protection means that a person cannot be prosecuted for an offence that was not a “crime” under the law when it was committed.

    Does the latest amendment make it retrospective?

    • In September, the government brought in an ordinance to rectify the drafting error, which Lok Sabha. “It shall be deemed to have come into force on the 1st day of May 2014,” the Bill reads.
    • Retrospective application is permitted in clarificatory amendments.
    • This 2021 amendment is not a substantive one, that is why the retrospective is allowed.

     

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  • Tobacco Consumption in India

    Tobacco use is known to be a major risk factor for several non-communicable diseases in India.

    Tobacco abuse in India

    • In India, 28.6% of adults above 15 years and 8.5% of students aged 13-15 years use tobacco in some form or the other.
    • This makes the country the second-largest consumer of tobacco in the world.

    Concern: No action against Tobacco

    • India bears an annual economic burden of over ₹1, 77,340 crores on account of tobacco use.
    • There has been no major increase in taxation of tobacco products to discourage the consumption of tobacco in the past four years since the introduction of GST.
    • Only in 2020-21, the Union Budget had the effect of increasing the average price of cigarettes by about 5%.
    • Yet, the excise duty on tobacco in India continues to remain extremely low.

    A worrying trend

    • No increase in tax: The absence of an increase in tax means more profits for the tobacco industry and more tax revenue foregone for the government.
    • Revenue losses: This revenue could have easily been utilized during the COVID-19 pandemic.
    • Losses due to GST: There has been a 3% real decline in GST revenues from tobacco products in each of the past two financial years.

    Present governance of Tobacco

    • GST slab: Tobacco at present is a highly taxed commodity. It is kept in the 28% GST slab (other than for tobacco leaves which is taxed at 5%).
    • Heavy cess: Tobacco and its various forms are also subject to a heavy burden of cess, given that the commodity is seen as a sin good.
    • Statutory warning: The government also uses pictures of cancer patients on the packages of cigarettes to discourage its use.

    Federal issues

    • Excise taxes on many tobacco products used to be regularly raised in the annual Union Budgets before the GST.
    • Similarly, several State governments used to regularly raise value-added tax (VAT) on tobacco products.
    • During the five years before the introduction of the GST, most State governments had moved from having a low VAT regime on tobacco products to having a high VAT regime.

    Implication of such policies

    • Increased consumption: The lack of tax increases in post-GST years might mean that some current smokers smoke more now and some non-smokers have started smoking.
    • Reverse trend in decline: This could potentially lead to a reversal of the declining trend in prevalence.
    • Affordability: Tobacco products are more affordable post-GST as shown in recent literature from India.
    • Missing up national target: This might jeopardise India’s commitment to achieving 30% tobacco use prevalence reduction by 2025 as envisaged in the National Health Policy of 2017.

    Way forward

    • Several countries in the world have high excise taxes along with GST or sales tax and they are continuously being revised.
    • We must adhere to the WHO recommendation for a uniform tax burden of at least 75% for each tobacco product.
    • The Union government should take a considerate view of public health and significantly increase excise taxes — either basic excise duty or NCCD — on all tobacco products.
    • Taxation should achieve a significant reduction in the affordability of tobacco products to reduce tobacco use prevalence and facilitate India’s march towards sustainable development goals.

     

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  • Global Health Security Index, 2021

    Countries across all income levels remain dangerously unprepared to meet future epidemic and pandemic threats, according to the new 2021 Global Health Security (GHS) Index.

    About GHS Index

    • The GHS Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations.
    • It is a project of the Johns Hopkins Centre for Health Security, the Nuclear Threat Initiative (NTI) and the Economist Intelligence Unit (EIU) and was first launched in October 2019.
    • It assesses countries across 6 categories, 37 indicators, and 171 questions using publicly available information.
    • It benchmarks health security in the context of other factors critical to fighting outbreaks, such as political and security risks, the broader strength of the health system, and country adherence to global norms.

    Parameters assessed

    The report is based on a questionnaire of 140 questions, organized across 6 categories, 34 indicators, and 85 sub-indicators. The six categories are:

    1. Prevention: Prevention of the emergence or release of pathogens
    2. Detection and Reporting: Early detection and reporting for epidemics of potential international concern
    3. Rapid Response: Rapid response to and mitigation of the spread of an epidemic
    4. Health System: Sufficient and robust health system to treat the sick and protect health workers
    5. Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms
    6. Risk Environment: Overall risk environment and country vulnerability to biological threats

    Global performance

    • In 2021, no country scored in the top tier of rankings and no country scored above 75.9, the report showed.
    • The world’s overall performance on the GHS Index score slipped to 38.9 (out of 100) in 2021, from a score of 40.2 in the GHS Index, 2019.
    • This, even as infectious diseases are expected to have the greatest impact on the global economy in the next decade.
    • Some 101 countries high-, middle- and low-income countries, including India, have slipped in performance since 2019.

    Indian scenario

    • India, with a score of 42.8 (out of 100) too, has slipped by 0.8 points since 2019.
    • Three neighboring countries — Bangladesh, Sri Lanka and Maldives — have improved their score by 1-1.2 points.

    Conclusion

    • Health emergencies demand a robust public health infrastructure with effective governance.
    • The trust in government, which has been a key factor associated with success in countries’ responses to COVID-19, is low and decreasing, the index noted.

     

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  • What the NFHS data reveals about inequality in India

    Context

    The release of the NFHS data (and the Niti Aayog’s study on developing a multi-dimensional index of poverty — MPI) has led to a considerable amount of discussion, and justifiably so.

    Understanding the progress and development: MPI

    • The MPI is an Oxford-based initiative that develops an exclusive broadly non-monetary living standard index of poverty.
    • MPI indices are the third in the series of global studies on poverty.
    • Global studies on poverty: Global studies started with the World Bank’s income/consumption-based measure of absolute poverty.
    • The UN expanded the monetary index adding health and education indicators via the Human Development Index (HDI).

    Evolution of poverty over time

    • Like with the other poverty indices (World Bank and HDI), most information and useful policy analysis comes via a study of the inter-temporal evolution of poverty. 
    • Regional inequality: Ajit Ranade acknowledges that regional inequality has existed for some time, but he argues that poverty incidence across Indian states even as per the MPI is astoundingly unequal.
    • T N Ninan talks about the simultaneous existence of Africa’s Sahel region and the Philippines in India.
    • He finds that the two Indias are not getting any closer.
    • Indeed, India’s development trajectory has not been uniform, but the regional imbalance of development cannot be viewed at a fixed point in time.

    Analysing the NHFS data

    • A detailed examination of the summary statistics reported in the NFHS data (large and small states of India for the two years 2015-16 and 2019-21), reveals the opposite result.
    • Convergence: The analysis reveals remarkable convergence in living standards, a convergence possibly unparalleled in Indian history and in the space of just five years.
    • NFHS reports the averages for all states, and for 131 variables, for two years 2015-16 and 2020-21.
    • Seventeen of these 131 welfare indicators are used to construct indices under four classifications.
    • Improvement in lives of girls/women: The first classification concerns itself with the improvement in the lives of girls/women (five indicators, for example, sex ratio, fertility, female education).
    • Housing conditions: The second bucket consists of housing conditions (three indicators, for example, improved sanitation, clean fuel).
    • Children’s welfare: The third list consists of children’s welfare (four indicators such as adequate diet, stunting)
    • Women’s welfare: The fourth classification includes women’s empowerment (five indicators, for example, owning a house, less spousal violence).
    • Given that Niti Aayog’s report primarily relies on the NFHS-4, these findings can be used as the baseline scenario to evaluate the delta — that is, the per cent change in indicators between NFHS-4 and NFHS-5.
    • The table reports the results for several states.

    • Seventeen indicators imply a maximum possible score of 1,700.
    • Kerala performs the best with an aggregate index of 1,300 in NFHS-5 — a very small 1.5 per cent increase from its 2015-16 value.
    • In contrast, Bihar increases its index by 56 per cent.
    • Punjab does better than Tamil Nadu and today has a higher index – 1,240 versus 1,178 in 2020-21.
    • UP (along with Rajasthan and MP) performs the best — a 60 plus per cent increase in the welfare index, more than five times the increase in the rich states.

    Major findings from the NHFS data

    • Convergence: Higher improvement by less developed states is evidence in support of catch-up, which suggests that regional imbalances are reducing, and in some indicators, rapidly so.
    • States such as UP, Bihar and Jharkhand are fast approaching similar standards for select indicators as some of the “developed” states.
    • Result of targeted intervention: This acceleration in catch up is no coincidence, but rather an outcome of an approach that involves targeted interventions to improve developmental outcomes.
    • The approach was not just limited to sanitation, proper fuel or electricity — interventions that are targeted to an individual household — but also to the holistic development of an entire region.

    Consider the question “What does NHFS-5 data reveal about the inequality in India?”

    Conclusion

    India has been, and was, not one but several Indias. What is remarkable about its recent history is the rapid process of uneven change — where progress is considerably higher for the poorer states — the convergent, and inclusive pattern of development. That is the real story behind the NFHS-4 and NFHS-5 numbers.

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  • The NIRF’s ranking of education institutions on a common scale is problematic

    Context

    The ranking of State-run higher education institutions (HEIs) together with centrally funded institutions using the National Institutional Ranking Framework, or the NIRF, is akin to comparing apples and oranges.

    Institute data

    • According to an All India Survey on Higher Education (AISHE) 2019-20 report, there are 1,043 HEIs.
    • Of these, 48 are central universities.
    • 135 are institutions of national importance,
    • 1 is a central open university,
    • 386 are State public universities,
    • 5 are institutions under the State legislature act,
    • 14 are State open universities,
    • 327 are State private universities,
    • 1 is a State private open university,
    • 36 are government deemed universities,
    • 10 are government aided deemed universities.
    • 80 are private deemed universities.

    Comparison of financial health of State HEI with Central HEIs

    • A close study of the above data shows that 184 are centrally funded institutions (out of 1,043 HEIs in the country) to which the Government of India generously allocates its financial resources in contrast to inadequate financial support provided by State governments to their respective State public universities and colleges.
    • The Central government earmarked the sums, ₹7,686 crore and ₹7,643.26 crore to the IITs and central universities, respectively, in the Union Budget 2021.
    • Ironically, out of the total student enrolment, the number of undergraduate students is the largest (13,97,527) in State public universities followed by State open universities (9,22,944).

    How NIRF ranks the education institutions?

    • Parameters set by the core committee of experts: The NIRF outlines a methodology to rank HEIs across the country, which is based on a set of metrics for the ranking of HEIs as agreed upon by a core committee of experts set up by the then Ministry of Human Resources Development (now the Ministry of Education), Government of India
    • The NIRF ranks HEIs on five parameters: teaching, learning and resources; research and professional practice; graduation outcome; outreach and inclusivity, and perception.

    Where do State HEIs lag on NIRF parameters?

    • Teaching, learning and resources include metrics viz. student strength including doctoral students, the faculty-student ratio with an emphasis on permanent faculty, a combined metric for faculty with the qualification of PhD (or equivalent) and experience, and financial resources and their utilisation.
    • Low faculty strength in State HEIs: In the absence of adequate faculty strength, most State HEIs lag behind in this crucial NIRF parameter for ranking.
    • The depleting strength of teachers has further weakened the faculty-student ratio with an emphasis on permanent faculty in HEIs.
    • Research and professional practise encompasses a combined metric for publications, a combined metric for quality of publications, intellectual property rights/patents and the footprint of projects, professional practice and executive development programmes.
    • Need for modernisation of laboratories: As most laboratories need drastic modernisation in keeping pace with today’s market demand, it is no wonder that State HEIs fare miserably in this parameter as well while pitted against central institutions.

    Issues with comparing State HEIs with Central HEIs

    • The difference in financial allocations diregarded: The financial health of State-sponsored HEIs is an open secret with salary and pension liabilities barely being managed.
    • Hence, rating such institutions vis-à-vis centrally funded institutions does not make any sense.
    • No cost-benefit analysis carried out: No agency carries out a cost-benefit analysis of State versus centrally funded HEIs on economic indicators such as return on investment the Government made into them vis-à-vis the contribution of their students in nation building parameters such as the number of students who passed out serving in rural areas, and bringing relief to common man.
    • While students who pass out of elite institutions generally prefer to move abroad in search of higher studies and better career prospects, a majority of State HEIs contribute immensely in building the local economy.
    • Issues in embracing technologies: State HEIs are struggling to embrace emerging technologies involving artificial intelligence, machine learning, block chains, smart boards, handheld computing devices, adaptive computer testing for student development.

    Consider the question “What are the challenges in the ranking of Higher Education Institutions in India? What are the issues faced by State HEI?”

    Conclusion

    Ranking HEIs on a common scale purely based on strengths without taking note of the challenges and the weaknesses they face is not justified. It is time the NIRF plans an appropriate mechanism to rate the output and the performance of institutes in light of their constraints and the resources available to them.

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  • What the latest NFHS data says about the New Welfarism

    Context

    The second and final phase of NFHS-5 was released which covered 11 states (including Uttar Pradesh (UP), Tamil Nadu, Punjab, Rajasthan, Madhya Pradesh (MP), Jharkhand, Haryana, and Chhattisgarh) and about 49 per cent of the population.

    Major findings

    [1] Success of New Welfarism

    • Figure one plots household access to improved sanitation, cooking gas and bank accounts used by women.
    • The improvements are as striking as they were based on the performance of the phase 1 states.
    • In all cases, access has increased significantly, although claims of India being 100 per cent open defecation-free still remain excessive.

    [2] Child-related outcomes

    • India-wide, stunting has declined although the pace of improvement has slowed down post-2015 compared with the previous decade.
    • For example, stunting improved by 0.7 percentage points per year between 2005 and 2015 compared to 0.3 percentage points between 2015 and 2021.
    • On diarrhoea too, adding the new data reverses the earlier finding.
    • However, on anaemia and acute respiratory illness, there seems to have been deterioration.
    • The new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 and phase 2 states.
    •  The interesting pattern is that nearly all the phase 2 states show large improvements, whereas most of the phase 1 states exhibited a deterioration in performance.

    [3] Catch up by the laggard states

    • If the new child stunting numbers are right, a different picture of India emerges.
    • Apparently, Madhya Pradesh now has fewer stunted children than Gujarat; Uttar Pradesh and Jharkhand are almost at par with Gujarat; Chhattisgarh fares better than Gujarat, Karnataka, and Maharashtra; and Rajasthan and Odisha fare better than Gujarat, Karnataka, Maharashtra, West Bengal, Telangana and Himachal Pradesh!
    • On child stunting, the old BIMARU states (excepting Bihar) are no longer the laggards; the laggards are Gujarat, Maharashtra, and Karnataka, and to a lesser extent, West Bengal, Andhra Pradesh and Telangana.
    • Indeed, the decline in stunting achieved by the poorer states such as UP, MP, Chhattisgarh and Rajasthan would be all the more remarkable given the overall weakness in the economy between 2015 and 2021.

    Conclusion

    When commentators speak of two Indias, it is now important to ask: Which ones and on what metrics.

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  • Assisted Reproductive Technology (Regulation) Act, 2021

    The Lok Sabha has passed the Assisted Reproductive Technology- ART (Regulation) Bill,, 2020 that proposes the establishment of a national registry and registration authority for all clinics and medical professionals serving in the field.

    Key highlights of the Bill:

    Definition of ART

    • The Bill defines ART to include all techniques that seek to obtain a pregnancy by handling the sperm or the oocyte (immature egg cell) outside the human body and transferring the gamete or the embryo into the reproductive system of a woman.
    • Examples of ART services include gamete (sperm or oocyte) donation, in-vitro-fertilisation (fertilising an egg in the lab), and gestational surrogacy (the child is not biologically related to surrogate mother).
    • ART services will be provided through: (i) ART clinics, which offer ART related treatments and procedures, and (ii) ART banks, which store and supply gametes.

    Regulation of ART clinics and banks

    • The bill provides that every ART clinic and bank must be registered under the National Registry of Banks and Clinics of India.
    • It will act as a central database with details of all ART clinics and banks in the country.
    • State governments will appoint registration authorities for facilitating the registration process.
    • Clinics and banks will be registered only if they adhere to certain standards (specialised manpower, physical infrastructure, and diagnostic facilities).
    • The registration will be valid for five years and can be renewed for a further five years.

    Conditions for gamete donation and supply

    • Screening of gamete donors, collection and storage of semen, and provision of oocyte donor can only be done by a registered ART bank.
    • A bank can obtain semen from males between 21 and 55 years of age, and oocytes from females between 23 and 35 years of age.
    • An oocyte donor should be an ever-married woman having at least one alive child of her own (minimum three years of age).
    • The woman can donate oocyte only once in her life and not more than seven oocytes can be retrieved from her.
    • A bank cannot supply gamete of a single donor to more than one commissioning couple (couple seeking services).

    Conditions for offering ART services:

    • ART procedures can only be carried out with the written informed consent of both the party seeking ART services as well as the donor.
    • The party seeking ART services will be required to provide insurance coverage in the favour of the oocyte donor (for any loss, damage, or death of the donor).
    • The Bill also requires checking for genetic diseases before the embryo implantation.

    Rights of a child born through ART

    • A child born through ART will be deemed to be a biological child of the commissioning couple and will be entitled to the rights and privileges available to a natural child of the commissioning couple.
    • A donor will not have any parental rights over the child.

    National and State Boards:

    • The Bill provides that the National and State Boards for Surrogacy constituted and will for the regulation of ART services.
    • Key powers and functions of the National Board include:
    1. Advising the central government on ART related policy matters
    2. Reviewing and monitoring the implementation of the Bill
    3. Formulating code of conduct and standards for ART clinics and banks
    4. Overseeing various bodies to be constituted under the Bill
    5. State Boards will coordinate enforcement of the policies and guidelines for ART as per the recommendations, policies, and regulations of the National Board

    Offences and penalties

    Offences under the Bill include:

    1. Abandoning, or exploiting children born through ART,
    2. Selling, purchasing, trading, or importing human embryos or gametes,
    3. Using intermediates to obtain donors,
    4. Exploiting commissioning couple, woman, or the gamete donor in any form, and
    5. Transferring the human embryo into a male or an animal
    • These offences will be punishable with a fine between 5 and 10 lakh rupees for the first contravention.
    • For subsequent contraventions, these offences will be punishable with imprisonment for a term between eight and 12 years, and a fine between 10 and 20 lakh rupees.
    • Any clinic or bank advertising or offering sex-selective ART will be punishable with imprisonment between five and ten years, or fine between Rs 10 lakh and Rs 25 lakh, or both.
    • No court will take cognisance of offences under the Bill, except on a complaint made by the National or State Board or any officer authorised by the Boards.

     

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