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Subject: Governance

Important aspects of Society

  • Surrogacy Law faces challenge in Court

    A person has approached the Delhi High Court to question why marital status, age or gender should be the criteria for prohibiting someone from commissioning a surrogacy.

    Why in news?

    • Under the Surrogacy (Regulation) Act, 2021 a married couple can opt for surrogacy only on medical grounds.
    • The petitioner have challenged in the court the surrogacy law and the Assisted Reproductive Technology (Regulation) Act, 2021 which provides a regulatory framework for surrogacy.

    Issues raised by the petition

    • Currently, the laws does not allow single men to have child through surrogacy.
    • Married women can only avail surrogacy services if they are unable to produce a child due to medical conditions.
    • Otherwise, for women to avail of surrogacy services, they must be aged between 35 and 45 and widowed or divorced.
    • Women can only offer surrogacy if they are aged between 25 and 35 and married with at least one biological child.
    • The laws also require a surrogate to be genetically related to the couple who intend to have a child through this method, their petition said.

    Basis of the Petition

    • The personal decision of a single person about the birth of a baby through surrogacy, i.e., the right of reproductive autonomy is a facet of the right to privacy guaranteed under Article 21 of the Constitution.
    • Thus, the right to privacy of every citizen or person affecting a decision to bear or beget a child through surrogacy cannot be taken away.

    Distinct features of the Surrogacy (Regulation) Act, 2021

    • Definition of surrogacy: It defines surrogacy as a practice where a woman gives birth to a child for an intending couple with the intention to hand over the child after the birth to the intending couple.
    • Regulation of surrogacy: It prohibits commercial surrogacy, but allows altruistic surrogacy which involves no monetary compensation to the surrogate mother other than the medical expenses and insurance.
    • Purposes for which surrogacy is permitted: Surrogacy is permitted when it is: (i) for intending couples who suffer from proven infertility; (ii) altruistic; (iii) not for commercial purposes; (iv) not for producing children for sale, prostitution or other forms of exploitation; and (v) for any condition or disease specified through regulations.
    • Eligibility criteria: The intending couple should have a ‘certificate of essentiality’ and a ‘certificate of eligibility’ issued by the appropriate authority ex. District Medical Board.

    Eligibility criteria for surrogate mother:

    • To obtain a certificate of eligibility from the appropriate authority, the surrogate mother has to be:
    1. A close relative of the intending couple;
    2. A married woman having a child of her own;
    3. 25 to 35 years old;
    4. A surrogate only once in her lifetime; and
    5. Possess a certificate of medical and psychological fitness for surrogacy.
    • Further, the surrogate mother cannot provide her own gametes for surrogacy.

    Also read:

    [Burning Issue] Surrogacy in India

     

     

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  • What is National Intelligence Grid (NATGRID)?

    The Ministry of Home Affairs (MHA) has curtailed the tenure of the Chief Executive Officer (CEO) of the National Intelligence Grid (NATGRID) and moved him to the Border Security Force (BSF).

    What is NATGRID?

    • NATGRID is an intelligence-sharing network that collates data from the standalone databases of the various agencies and ministries of the Indian government.
    • It is a counter terrorism measure that collects and collates a host of information from government databases including tax and bank account details, credit/debit card transactions, visa and immigration records and itineraries of rail and air travel.
    • It will also have access to the Crime and Criminal Tracking Network and Systems (CCTNS), a database that links crime information, including First Information Reports, across 14,000 police stations in India.
    • As of 2019, NATGRID is headed by an Indian Police Service (IPS) officer Ashish Gupta.

    Its establishment

    • The 26/11 terrorist siege in Mumbai back in 2008 exposed the deficiency that security agencies had no mechanism to look for vital information on a real-time basis.

    Access to NATGRID

    • Prominent federal agencies of the country have been authorized to access the NATGRID database.
    • They are the:
    1. Central Bureau of Investigation
    2. Directorate of Revenue Intelligence,
    3. Enforcement Directorate
    4. Central Board of Indirect Taxes and Customs
    5. Central Board of Direct Taxes (for the Income Tax Department)
    6. Cabinet Secretariat
    7. Intelligence Bureau
    8. Directorate General of GST Intelligence
    9. Narcotics Control Bureau
    10. Financial Intelligence Unit, and
    11. National Investigation Agency

    Future prospects

    • According to the first phase plan, 10 user agencies and 21 service providers will be connected with the NATGRID, while in later phases, about 950 additional organizations will be brought on board.
    • In the following years, more than 1,000 organizations will be further integrated into the NATGRID.
    • These data sources include records related to immigration entry and exit, banking and financial transactions, and telecommunications.

     

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  • Thailand becomes first Asian country to legalize Marijuana

    Thailand has officially legalized the growing and consumption of marijuana in food and drinks, becoming the first Asian country to do so.

    Films like ‘Udta Punjab’ have graphically portrayed the crisis faced by the society and its youth with regard to the drug menace.

    What is Marijuana?

    • Cannabis, also known as marijuana among other names, is a psychoactive drug from the Cannabis plant used primarily for medical or recreational purposes.
    • The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, including cannabidiol (CBD).
    • It is used by smoking, vaporizing, within the food, or as an extract.

    Prospects of legalizing Marijuana

    (1) Health benefits

    • The cannabinoids found in Cannabis is a great healer and has found mention in the Ayurveda.
    • It can be used to treat a number of medical conditions like multiple sclerosis, arthritis, epilepsy, insomnia, HIV/AIDS treatment, cancer.

    (2) Ecological benefits

    • The cannabis plant and seeds apart from being labeled a ‘super-foods’ as per studies is also a super-industrial carbon negative raw material.
    • Each part of the plant can be used for some industry. Hemp currently is also being used to make bio-fuel, bio-plastics and even construction material in certain countries. The cosmetic industry has also embraced Hemp seeds.

     (3) Marijuana is addiction-free

    • An epidemiological study showed that only 9%  of those who use marijuana end up being clinically dependent on it.
    • The ‘comparable rates’ for tobacco, alcohol and cocaine stood at 32%, 15% and 16% respectively.

    (4) Good source of Revenue

    • By legalizing and taxing marijuana, the government will stand to earn huge amounts of revenue that will otherwise go to the Italian and Israeli drug cartels.
    • In an open letter to US President George Bush, around 500 economists, led by Nobel Prize winner Milton Friedman, called for marijuana to be “legal but taxed and regulated like other goods”.

    (5) A potential cash crop

    • The cannabis plant is something natural to India, especially the northern hilly regions. It has the potential of becoming a cash crop for poor marginal farmers.
    • If proper research is done and the cultivation of marijuana encouraged at an official level, it can gradually become a source of income for poor people with small landholdings.

    (6) Prohibition was ineffective

    • In India, the consumption of synthetic drugs like cocaine has increased since marijuana was banned, while it has decreased in the US since it was legalized in certain states.
    • Moreover, these days, it is pretty easy to buy marijuana in India and its consumption is widespread among the youth. So it is fair to say that prohibition has failed to curb the ‘problem’.

     (7) Marijuana is less harmful

    • Marijuana consumption was never regarded as a socially deviant behaviour any more than drinking alcohol was. In fact, keeping it legal was considered as an ‘enlightened view’.
    • It is now medically proven that marijuana is less harmful than alcohol.

    Risks of Legalizing Cannabis

    (1) Health risks continue to persist

    • There are many misconceptions about cannabis. First, it is not accurate that cannabis is harmless.
    • Its immediate effects include impairments in memory and in mental processes, including ones that are critical for driving.
    • Long-term use of cannabis may lead to the development of addiction of the substance, persistent cognitive deficits, and of mental health problems like schizophrenia, depression and anxiety.
    • Exposure to cannabis in adolescence can alter brain development.

    (2) A new ‘tobacco’ under casualization

    • A second myth is that if cannabis is legalized and regulated, its harms can be minimized.
    • With legalization comes commercialization. Cannabis is often incorrectly advertised as being “natural” and “healthier than alcohol and tobacco”.
    • Tobacco, too, was initially touted as a natural and harmless plant that had been “safely” used in religious ceremonies for centuries.

    (3) Unconvincing Advocacy

    • Advocates for legalization rarely make a convincing case. To hear some supporters tell it, the drug cures all diseases while promoting creativity, open-mindedness, moral progression.
    • Too much trivialization of Cannabis use could lead to its mass cultivation and a silent economy wreaking havoc through a new culture of substance abuse in India.

    Way forward

    • For Cannabis/ Marijuana, it’s important to make a distinction between legalization, decriminalization and commercialization.
    • We must ensure that there are enough protections for children, the young, and those with severe mental illnesses, who are most vulnerable to its effects.
    • Hence, laws should be made to suit people so that they do not break the law to maintain their lifestyle.
    • Laws should weave around an existing lifestyle, not obstruct it. Or else laws will be broken.

    Conclusion

    • The debate on the legalization of marijuana in India has been consistent on social media and other noted platforms.
    • As with alcohol and tobacco products, the use of cannabis needs to be regulated, taxed and monitored.

     

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  • The Jal Jeevan and Swachh Bharat Missions are improving people’s well-being

    Context

    The performance of the Jal Jeevan and Swachh Bharat Missions highlights the importance of convergence as an operating principle of the government.

     Jal Jeevan Mission: Progress made so far

    • Jal Jeevan Mission (JJM) is a flagship programme of the Government of India, launched by Hon’ble Prime Minister on 15th August 2019.
    • Jal Jeevan Mission, is envisioned to provide safe and adequate drinking water through individual household tap connections by 2024 to all households in rural India.
    • Community approach: The Jal Jeevan Mission is based on a community approach to water and will include extensive Information, Education and communication as a key component of the mission.
    • Over 9.6 crore rural households get tap water supply; notably, more than 6.36 crore households have been provided tap water connections since the programme was announced in August 2019.

    Achievements of Swachh Bharat Mission

    • Universal sanitation coverage: To accelerate the efforts to achieve universal sanitation coverage and to put the focus on sanitation, the Prime Minister of India had launched the Swachh Bharat Mission on 2nd October 2014.
    • Under the mission, all villages, Gram Panchayats, Districts, States and Union Territories in India declared themselves “open-defecation free” (ODF) by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi.
    • To ensure that the open defecation free behaviours are sustained, no one is left behind, and that solid and liquid waste management facilities are accessible, the Mission is moving towards the next Phase II of SBMG i.e ODF-Plus.
    • Swachh Bharat Mission Phase-2: The government has launched Swachh Bharat Mission Phase 2 with a focus on plastic waste management, biodegradable solid waste management, grey water management and faecal sludge management.
    •  Under Swachh Bharat Mission Phase-2, arrangements for solid and liquid waste management have been made in 41,450 villages; nearly 4 lakh villages have minimal stagnant water.
    • ODF Plus: Nearly 22,000 villages have been named “model village” under the ODF Plus scheme, and another 51,000 villages are on their way to achieving this tag.
    • Sludge treatment and plastic waste management: Before the government embarked on Swachh Bharat Mission, nearly 1,20,000 tonnes of faecal sludge was left untreated as two-thirds of all toilets were not connected to the main sewer lines
    • The scale of India’s plastic waste pollution is staggering.
    • Both these problems find themselves on the agenda of Swachh Bharat Mission’s Phase 2.
    • In a short time, 3.5 lakh villages have become plastic dump free and nearly 4.23 lakh villages have minimal litter.
    • Nearly 178 faecal sludge treatment plants and nearly 90,000 km of drains have been constructed.

    How convergence between SBM and JJM enabled each other

    • Principle of convergence: The late Arun Jaitley introduced convergence as one of the primary operating principles of the government in his first budget speech.
    • One enabling the other: The best exhibition of this can be found in the ways in which the Jal Jeevan Mission and Swachh Bharat Mission work in tandem, one enabling the other.
    • More than 10 crore toilets were built under SBM but this accomplishment could have been difficult had the government not had the foresight to build the toilets on a twin-pit design that has in-situ treatment of faecal sludge.
    • Now, providing tap water connections through the Jal Jeevan Mission is among the government’s top priorities.
    • Managing grey water discharge: The Jal Jeevan Mission faces a challenge similar to that faced by the Swachh Bharat Mission — managing grey water discharge.
    • Holistic sanitation: When household tap connections were provided, the Jal Jeevan Mission converged with the Swachh Bharat Mission to achieve holistic sanitation in which the treatment of grey water became a vital component.
    • Focus on women: The Jal Jeevan mission intends to relieve women of the drudgery of travelling long distances to fetch water.
    • The Swachh Bharat Mission too is centred around the dignity of women.
    • A joint study by the Bill and Melinda Gates Foundation and UNICEF revealed that an overwhelming number (80 per cent) of the respondents stated that safety and security were the main drivers of their decision to construct toilets.
    • The Jal Jeevan Mission is catalysing change at the grass roots level by reserving 50 per cent seats for women in village and water sanitation committees.
    • In every village, at least five women have been entrusted with water quality surveillance and many of them have been trained as plumbers, mechanics and pump operators.

    Impact on growth and economy

    •  In 2006, a joint study by WSP, Asian Development Bank and UKAID revealed that inadequate sanitation cost India Rs 2.4 trillion — 6 per cent of India’s GDP at that time.
    • The Swachh Bharat Mission, apart from preventing GDP loss, provides annual benefits worth Rs 53,000 per household.

    Conclusion

    The success of Jal Jeevan Mission and Swachh Bharat Mission is a good example of convergence, one of the primary operating principles of the government.

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  • [pib] Children in Street Situations (CiSS) Application

    The National Commission for the Protection of Child Rights (NCPCR) has launched a “CiSS application” under the Baal Swaraj portal to help in the rehabilitation process of Children in Street Situations (CiSS).

    CiSS Application

    • The CiSS application is used for receiving data of children in street situations from all the states and union territories, tracking their rescue and rehabilitation process.
    • The initiative is taken under the direction of the Supreme Court of India.
    • The program embodies Article 51 (A) of the Constitution of India, as it provides a platform to the public and organizations catering to the welfare of the children to report any child in need of assistance.
    • The platform serves to collect data and report to the District Child Protection Officer (DCPO) for them to take necessary action.
    • It also provides a platform for professionals and organizations to provide any help that they can to children in need.
    • Help can be provided in the form of open shelters, counselling services, medical services, sponsorships, de-addiction services, education services, legal/paralegal services, volunteering etc.

    Its working framework

    • It categorizes any child under ‘Children in Street Situation’ if the child is living on the streets alone, living on the streets during the day, or living on the streets with the family.
    • The root cause of this phenomenon is the migration of families from rural to urban areas in search of a better standard of living.

    How does it work?

    It follows six stages framework for the rehabilitation of children.

    1. Collection of the child’s details, which is accomplished through the portal.
    2. Social Investigating Report (SIR)e. investigating the child’s background. This is done under the supervision of the District Child Protection Unit (DCPU) by the District Child Protection Officer (DCPO) by conversing and counselling the child.
    3. Formulating an Individual Care Plan (ICP) for the child.
    4. Child Welfare Committee (CWC) based on the SIR submitted to the CWC.
    5. Allocating the schemes and benefits that the beneficiary can avail of.
    6. A checklist is made for the evaluation of the progress i.e. (Follow Ups).

     

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  • Healthcare in India is ailing. Here is how to fix it

    Context

    The lesson emerging from the pandemic experience is that if India does not want a repeat of the immeasurable suffering and the social and economic loss, we need to make public health a central focus.

    Need for institutional reforms in the health sector

    • The importance of public health has been known for decades with every expert committee underscoring it.
    • Ideas ranged from instituting a central public health management cadre like the IAS to adopting an institutionalised approach to diverse public health concerns — from healthy cities, enforcing road safety to immunising newborns, treating infectious diseases and promoting wellness.
    • Covid has shifted the policy dialogue from health budgets and medical colleges towards much-needed institutional reform.

    About National Health Mission (NHM)

    • The National Health Mission (NHM) seeks to provide universal access to equitable, affordable and quality health care which is accountable, at the same time responsive, to the needs of the people, reduction of child and maternal deaths as well as population stabilization, gender and demographic balance.
    • The Framework for Implementation of NUHM has been approved by the Cabinet on May 1, 2013.
    • NHM encompasses two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
    • The National Rural Health Mission (NRHM) was launched in 2005 with a view to bringing about dramatic improvement in the health system and the health status of the people, especially those who live in the rural areas of the country.

    Learning from the failure of National Health Mission (NHM)

    • The National Health Mission (NHM) has been in existence for about 15 years now and the health budget has trebled— though not as a proportion of the GDP.
    • Despite this less than 10 per cent of the health facilities below the district level can attain the grossly minimal Indian public health standards.
    • Clearly, the three-tier model of subcentres with paramedics, primary health centres with MBBS doctors and community health centres (CHC) with four to six specialists has failed.
    • Lack of accountability framework: The model’s weakness is the absence of an accountability framework.
    • The facilities are designed to be passive — treating those seeking care.

    Suggestions

    • 1] FHT: Instead of passive design of NHM, we need Family Health Teams (FHT) like in Brazil, accountable for the health and wellbeing of a dedicated population, say 2,000 families.
    • The FHTs must consist of a doctor with a diploma in family medicine and a dozen trained personnel to reflect the skill base required for the 12 guaranteed services under the Ayushman Bharat scheme.
    • A baseline survey of these families will provide information about those needing attention.
    • Family as a unit: The team ensures a continuum of care by taking the family as a unit and ensuring its well-being over a period.
    •  Nudging these families to adopt lifestyle changes, following up on referrals for medical interventions and post-operative care through home visits for nursing and physiotherapy services would be their mandate.
    • 2] Health cadre: The implication of and central to the success of such a reset lies in creating appropriate cadres.
    • 3] Clarity to nomenclatures: There is also a need to declutter policy dialogue and provide clarity to the nomenclatures.
    • Currently, public health, family medicine and public health management are used interchangeably.
    • While the family doctor cures one who is sick, the public health expert prevents one from falling sick.
    • The public health management specialist holds specialisation in health economics, procurement systems, inventory control, electronic data analysis and monitoring, motivational skills and team-building capabilities, public communication and time management, besides, coordinating with the various stakeholders in the field.
    • 4] Move beyond doctor-led systems: India needs to move beyond the doctor-led system and paramedicalise several functions.
    • Instead of wasting gynaecologists in CHCs midwives (nurses with a BSc degree and two years of training in midwifery) can provide equally good services except surgical, and can be positioned in all CHCs and PHCs.
    • This will help reduce C Sections, maternal and infant mortality and out of pocket expenses.
    • 5] Counsellors and physiotherapists at PHC: Lay counsellors for mental health, physiotherapists and public health nurses are critically required for addressing the multiple needs of primary health care at the family and community levels.
    • 6] Review of existing system: Bringing such a transformative health system will require a comprehensive review of the existing training institutions, standardising curricula and the qualifying criteria.
    • Increase spending on training: Spending on pre-service and in-service training needs to increase from the current level of about 1 per cent.
    • 7] Redefining of functions: A comprehensive redefinition of functions of all personnel is required to weed out redundancies and redeploy the rewired ones.

    Conclusion

    Resetting the system to current day realities requires strong political leadership to go beyond the inertia of the techno-administrative status quoist structures. We can.

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  • The problem with putting the civil services on a pedestal

    Context

    Recently, two IAS officers were the subject of widespread public derision for misuse of power. A week later, the media and the public feted those who had successfully cracked the UPSC examination in order to become bureaucrats of the future.

    About Indian Administrative Service

    • Civil Services refer to the career civil servants who are the permanent executive branch of the Republic of India.
    • The modern Indian Administrative Service was created under Article 312(2) in part XIV of the Constitution of India, and the All-India Services Act, 1951.
    • It is the backbone of the administrative machinery of the country.
    • As India is a parliamentary democracy, the ultimate responsibility for running the administration rests with the people’s elected representatives.
    • The elected executive decides the policy and it is civil servants, who serve at the pleasure of the President of India, implement it.
    • Article 311 of the Constitution protects Civil Servants from politically motivated vindictive action.

    What makes civil services favourable in India

    • Most countries in the world have a cadre of professional civil servants but nowhere are new entrants to the system of government celebrated like in India.
    • Colonial legacy: The fact is that, 75 years after independence and 30 years after liberalisation, there is still an overhang of the all-powerful, all-pervasive state.
    • There are good reasons for a favourable view of the civil services.
    • Merit based selection: For one, candidates are selected on merit based on an open examination and interview.
    • Job security: Then there is the job security that comes with gaining entry.
    • Unless a civil servant does an extraordinary wrong, she has a job for life, and steady, time-bound promotions which ensure that everyone retires at the top irrespective of performance.

    Issues with public perception

    • However, in the perceived strengths of the civil services lie its weaknesses.
    • Single exam: The single UPSC examination is treated as gospel. 
    • But merit and competence cannot be judged by a single exam.
    • Permanence is a problem: The permanence of the job is a problem too.
    • Punishment for over-reach or misuse of power is a transfer, either from a weightier ministry to a lighter one or from high-profile capitals to geographically remote ones.
    • A system of limited accountability: The result is that all civil servants, never mind their ability or competence, operate in a system of limited accountability with few incentives to perform and plenty of opportunities to use and abuse their powers.

    Way forward

    • Placing civil servant at par with other professions: The civil services system needs to be brought down from its pedestal and placed at par with every other profession like elsewhere in the world.
    • This will not happen via political diktat. It requires the weight of public opinion.
    • Broaden the selection criteria: The system must be manned by capable, competent individuals. This cannot be decided on the basis of one exam.
    • Remove the job permanency: The underperforming officers need to be separated which cannot happen when the job is for life.
    • It may sound radical for India’s civil services but that is the way the rest of India and the world function, including the UK from where we inherited the structure.

    Conclusion

    If we can make these changes in the civil services, India will get the government it needs for the 21st century.

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  • ASHA Program

    Context

    India’s one million Accredited Social Health Activists (ASHA) volunteers have received World Health Organization’s Global Health Leaders Awards 2022.

    Background of the ASHA program

    • In 1975, a WHO monograph titled ‘Health by the people’ and then in 1978, an international conference on primary health care in Alma Ata (in the then USSR and now in Kazakhstan), gave emphasis for countries recruiting community health workers to strengthen primary health-care services that were participatory and people centric.
    • Soon after, many countries launched community health worker programmes under different names.
    • India launched the ASHA programme in 2005-06 as part of the National Rural Health Mission.
    • The biggest inspiration for designing the ASHA programme came from the Mitanin (meaning ‘a female friend’ in Chhattisgarhi) initiative of Chhattisgarh, which had started in May 2002.
    • The core of the ASHA programme has been an intention to build the capacity of community members in taking care of their own health and being partners in health services.
    • Each of these women-only volunteers work with a population of nearly 1,000 people in rural and 2,000 people in urban areas, with flexibility for local adjustments.

    A well thought through and deliberated program

    • The ASHA programme was well thought through and deliberated with public health specialists and community-based organisations from the beginning.
    • 1] Key village stakeholders selected: The ASHA selection involved key village stakeholders to ensure community ownership for the initiatives and forge a partnership.
    • 2] Ensure familiarity: ASHAs coming from the same village where they worked had an aim to ensure familiarity, better community connect and acceptance.
    • 3] Community’s representative: The idea of having activists in their name was to reflect that they were/are the community’s representative in the health system, and not the lowest-rung government functionary in the community.
    • 4] Avoiding the slow process of government recruitment: Calling them volunteers was partly to avoid a painfully slow process for government recruitment and to allow an opportunity to implement performance-based incentives in the hope that this approach would bring about some accountability.

    Contribution of ASHA

    • It is important to note that even before the COVID-19 pandemic, ASHAs have made extraordinary contributions towards enabling increased access to primary health-care services; i.e. maternal and child health including immunisation and treatment for hypertension, diabetes and tuberculosis, etc., for both rural and urban populations, with special focus on difficult-to-reach habitations.
    • Over the years, ASHAs have played an outstanding role in making India polio free, increasing routine immunisation coverage; reducing maternal mortality; improving new-born survival and in greater access to treatment for common illnesses.

    Challenges

    • Linkages with AWW and ANM: When newly-appointed ASHAs struggled to find their way and coordinate things within villages and with the health system, their linkage with two existing health and nutrition system functionaries — Anganwadi workers (AWW) and Auxiliary Nurse Midwife (ANM) as well as with panchayat representatives and influential community members at the village level — was facilitated.
    •  This resulted in an all-women partnership, or A-A-A: ASHA, AWW and ANM, of three frontline functionaries at the village level, that worked together to facilitate health and nutrition service delivery to the community.
    • No fixed salary to ASHAs: Among the A-A-A, ASHAs are the only ones who do not have a fixed salary; they do not have opportunity for career progression.
    • These issues have resulted in dissatisfaction, regular agitations and protests by ASHAs in many States of India.

    Way forward

    • The global recognition for ASHAs should be used as an opportunity to review the programme afresh, from a solution perspective.
    • 1] Higher remuneration: Indian States need to develop mechanisms for higher remuneration for ASHAs.
    • 2] Avenues for career progression: It is time that in-built institutional mechanisms are created for capacity-building and avenues for career progression for ASHAs to move to other cadres such as ANM, public health nurse and community health officers are opened.
    • 3] Extend the benefits of social sector services: Extending the benefits of social sector services including health insurance (for ASHAs and their families) should be considered.
    • 4] Independent and external review: While the ASHA programme has benefitted from many internal and regular reviews by the Government, an independent and external review of the programme needs to be given urgent and priority consideration.
    • 5] Regularisation of temporary posts: There are arguments for the regularisation of many temporary posts in the National Health Mission and making ASHAs permanent government employees.

    Conclusion

    The WHO award for ASHA volunteers is a proud moment and also a recognition of every health functionary working for the poor and the underserved in India.  It is a reminder and an opportunity to further strengthen the ASHA programme for a stronger and community-oriented primary health-care system.

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  • Malnutrition in India is a worry in a modern scenario

    Context

    The country’s response to its burden of malnutrition and growing anaemia has to be practical and innovative.

    What is malnutrition?

    • Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
    • The term malnutrition covers 2 broad groups of conditions.
    • One is ‘undernutrition’—which 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).
    • The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).

    What are the root causes of malnutrition in India?

    The following three deficits are the root cause of malnutrition in India.

    1) Dietary deficit

    • There is a large dietary deficit among at least 40 per cent of our population of all age groups, shown in— the National Nutrition Monitoring Bureau’s Third Repeat Survey (2012), NFHS 4, 2015-16, the NNMB Technical Report Number 27, 2017.
    • Our current interventions are not being able to bridge this protein-calorie-micronutrient deficit.
    • The NHHS-4 and NFHS-5 surveys reveal an acute dietary deficit among infants below two years, and considerable stunting and wasting of infants below six months.
    • Unless this maternal/infant dietary deficit is addressed, we will not see rapid improvement in our nutritional indicators.

    2) Information deficit at household level

    • We do not have a national IEC (information, education and communication) programme that reaches targeted households to bring about the required behavioural change regarding some basic but critical facts.
    • For example, IEC tells about the importance of balanced diets in low-income household budgets, proper maternal, child and adolescent nutrition and healthcare.

    3) Inequitable market conditions

    • The largest deficit, which is a major cause of dietary deficiency and India’s chronic malnutrition, pertains to inequitable market conditions.
    • Such market conditions deny affordable and energy-fortified food to children, adolescents and adults in lower-income families.
    • The market has stacks of expensive fortified energy food and beverages for higher income groups, but nothing affordable for low-income groups.

    The vicious cycle of malnutrition

    • Link with mother: A child’s nutritional status is directly linked to their mother.
    • Poor nutrition among pregnant women affects the nutritional status of the child and has a greater chance to affect future generations.
    • Impact on studies: Undernourished children are at risk of under-performing in studies and have limited job prospects.
    • Impact on development of the country: This vicious cycle restrains the development of the country, whose workforce, affected mentally and physically, has reduced work capacity.

    Marginal improvement on Stunting and Wasting

    • The National Family Health Survey (NFHS-5) has shown marginal improvement in different nutrition indicators, indicating that the pace of progress is slow.
    • This is despite declining rates of poverty, increased self-sufficiency in food production, and the implementation of a range of government programmes.
    • Children in several States are more undernourished now than they were five years ago.
    • Increased stunting in some states: Stunting is defined as low height-for-age.
    • While there was some reduction in stunting rates (35.5% from 38.4% in NFHS-4) 13 States or Union Territories have seen an increase in stunted children since NFHS-4.
    • This includes Gujarat, Maharashtra, West Bengal and Kerala.
    • Wasting remains stagnant: Wasting is defined as low weight-for-height.
    • Malnutrition trends across NFHS surveys show that wasting, the most visible and life-threatening form of malnutrition, has either risen or has remained stagnant over the years.

    Prevalence of anaemia in India

    • What is it? Anaemia is defined as the condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.
    • Consequences: Anaemia has major consequences in terms of human health and development.
    • It reduces the work capacity of individuals, in turn impacting the economy and overall national growth.
    • Developing countries lose up to 4.05% in GDP per annum due to iron deficiency anaemia; India loses up to 1.18% of GDP annually.
    • The NFHS-5 survey indicates that more than 57% of women (15-49 years) and over 67% children (six-59 months) suffer from anaemia.

    Way forward

    1] Increase investment:

    • There is a greater need now to increase investment in women and children’s health and nutrition to ensure their sustainable development and improved quality of life.
    • Saksham Anganwadi and the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) 2.0 programme have seen only a marginal increase in budgetary allocation this year (₹20,263 crore from ₹20,105 crore in 2021-22).
    • Additionally, 32% of funds released under POSHAN Abhiyaan to States and Union Territories have not been utilised.

    2] Adopt outcome oriented approach on the nutrition programme

    • India must adopt an outcome-oriented approach on nutrition programmes.
    • It is crucial that parliamentarians begin monitoring needs and interventions in their constituencies and raise awareness on the issues, impact, and solutions to address the challenges at the local level.
    • Direct engagement: There has to be direct engagement with nutritionally vulnerable groups and ensuring last-mile delivery of key nutrition services and interventions.
    • This will ensure greater awareness and proper planning and implementation of programmes.
    • This can then be replicated at the district and national levels.

    3] Increase awareness and mother’s education

    • With basic education and general awareness, every individual is informed, takes initiatives at the personal level and can become an agent of change.
    •  Various studies highlight a strong link between mothers’ education and improved access and compliance with nutrition interventions among children.

    4] Monitoring

    • There should be a process to monitor and evaluate programmes and address systemic and on the ground challenges.
    • A new or existing committee or the relevant standing committees meet and deliberate over effective policy decisions, monitor the implementation of schemes, and review nutritional status across States.

    Conclusion

    We must ensure our young population has a competitive advantage; nutrition and health are foundational to that outcome.

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  • Accessible India Campaign

    With its deadline of June 2022 almost up, the status of targets under the Accessible India Campaign (AIC) is likely to be discussed during a meeting of the Central Advisory Board on Disability.

    What is Accessible India Campaign?

    • Accessible India Campaign or Sugamya Bharat Abhiyan is a program that is launched to serve the differently-able community of the country.
    • The flagship program has been launched on 3 December 2015, the International Day of People with Disabilities.
    • The program comes with an index to measure the design of disabled-friendly buildings and human resource policies.
    • The initiative also in line with Article 9 of the (UN Convention on the Rights of Persons with Disabilities) which India is a signatory since 2007.
    • The scheme also comes under the Persons with Disabilities Act, 1995 for equal Opportunities and protection of rights which provides non-discrimination in Transport to Persons with Disabilities.

    Recent developments

    • The Central Public Works Department (CPWD) released the Harmonised Guidelines and Standards for Universal Accessibility in India 2021.
    • Drafted by a team of the IIT-Roorkee and the National Institute of Urban Affairs of the MoHUA, the revised guidelines aim to give a holistic approach.
    • Earlier, the guidelines were for creating a barrier-free environment, but now they are focusing on universal accessibility.

    Key highlights

    • Ramps: The guidelines provide the gradient and length of ramps — for example, for a length of six metres, the gradient should be 1:12. The minimum clear width of a ramp should be 1,200 mm.
    • Beyond PwDs: While making public buildings and transport fully accessible for wheelchair users is covered in the guidelines, other users who may experience temporary problems have also been considered. For instance, a parent pushing a child’s pram while carrying groceries or other bags, and women wearing saris.
    • Women friendly: Built environment needs for accessibility for women should consider diverse age groups, diverse cultural contexts and diverse life situations in which women operate. Diverse forms of clothing (saris, salwar-kameez, etc.) and footwear (heels, kolhapuri chappals, etc.) require a certain orientations.
    • Accessibility symbols: The guidelines call for accessibility symbols for PwD, family-friendly facilities and transgender to be inclusively incorporated among the symbols for other user groups.
    • Targeted authorities: The guidelines are meant for State governments, government departments and the private sector, as well as for reference by architecture and planning institutes.

    Policy measures for PwDs

    • India is a signatory to the UN Convention the Right of Persons with Disabilities, which came into force in 2007.
    • The Union Minister for Social justice and Empowerment has also launched the “Sugamya Bharat App” to complain for ease accessibility for PwDs.
    • India has its dedicated the Rights of Persons with Disabilities Act, 2016, which is the principal and comprehensive legislation concerning persons with disabilities.

     

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