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Subject: Governance

Important aspects of Society

  • Smart Policing

    Context

    On March 11, speaking at the NCRB Foundation Day, the Union Home Minister remarked that the second phase of the Inter-operable Criminal Justice System (ICJS) is set to be completed by 2026.

    Increasing use of technology for policing

    • the Inter-operable Criminal Justice System (ICJS), a Rs 3,500 crore project, is set to be completed by 2026 with increased use of artificial intelligence, fingerprint systems and other tools of predictive policing.
    • One crore fingerprints had already been uploaded and if these were available to all police stations as part of the Crime and Criminal Tracking Network System (CCTNS), there would no longer be any need to pursue criminals.
    • The existing systems of ICJS and CCTNS empower the state to cross-reference data between different pillars of the criminal justice system.
    • Recently, the Indore Police Commissioner unveiled a “fingerprint-based criminal record data fetching system” in which a small thumb impression machine can be added to a phone.
    • If the fingerprint recorded matches with the police database, all information about a person’s criminal record will be pulled up.

    Issues with the use of technologies

    • Privacy concerns: The enthusiasm for generating and cross-referencing data to make policing more efficient ignores privacy concerns and structural faults of policing.
    • The Supreme Court in K.S Puttaswamy declared a fundamental right to informational privacy as paramount and noted that any measure that sought to collect information or surveil must be legal, necessary, and proportionate.
    • Fear of mass surveillance: Integrating “fingerprint-based criminal record data fetching system” to the list of predictive policing practices will give birth to mass surveillance, particularly of certain oppressed caste communities, based on little evidence.
    • Nomadic and semi-nomadic tribes were ascribed “criminality by birth” and considered as “hereditary criminals addicted to systematic commission of non-bailable offences” under the colonial Criminal Tribes Act, 1871.
    • It has been replaced with the murky Habitual Offenders (HO) provisions, which have acted as a tool for police to continue to attribute criminality to Vimukta communities, by mandating their surveillance through regular check-ins at police stations.
    • Mere suspicion or FIRs filed against an individual are sufficient to trigger the discretionary powers of the police.

    Consider the question “Use of technology in policing can make it better at the same time run the risk of making it more dangerous.” Critically examine.

    Conclusion

    With the increasing adoption of technology in policing, we must pay attention to the risks involved and the issue of misuse.

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  • Vacancies in the Indian Administrative Service (IAS)

    Minister of State for Personnel, Public Grievances and Pensions told  the Lok Sabha that as on January 1, 2021, there were 5,231 IAS officers in the country — 1,515 (22.45 per cent) fewer than the sanctioned strength of 6,746.

    About IAS

    • The Indian Administrative Service (IAS) is the administrative arm of the All India Services of Government of India.
    • Considered the premier central civil service of India, the IAS is one of the three arms of the All India Services along with the Indian Police Service and the Indian Forest Service.
    • Members of these three services serve the Government of India as well as the individual states.
    • IAS officers may also be deployed to various public sector undertakings and international organizations.

    Functions of the IAS

    • Upon confirmation of service, an IAS officer serves a probationary period as a sub-divisional magistrate.
    • Completion of this probation is followed by an executive administrative role in a district as a district magistrate and collector which lasts several years.
    • After this tenure, an officer may be promoted to head a whole state administrative division, as a divisional commissioner.

    How are officers recruited in the IAS?

    • Direct recruits are selected through the Civil Service Examination (CSE) every year; the number of recruits is decided by a committee that takes several factors into account.
    • Since 2012, 180 IAS officers have been recruited every year through the CSE.
    • A committee has been constituted to arrive at a suitable formula to determine the intake of IAS officers every year from CSE-2022 to 2030.
    • Some officers are promoted from the State Civil Services (SCS), and a limited number are promoted from among non-SCS officers.
    • Filling of vacancies through induction from State Services is a continuous process.
    • The Union Public Service Commission (UPSC) holds Selection Committee meetings with state governments.

    Is the shortage a new trend?

    • The shortage has been a constant feature ever since — it was the least in 2001 (0.79 per cent), and the most in 2012 (28.87 per cent), as per available data.

    How is the sanctioned strength decided?

    • There is a provision for quinquennial cadre reviews for every cadre of the All India Services under the relevant Cadre Rules.
    • The Cadre Review Committee (CRC) is headed by the Cabinet Secretary with the Secretary DoPT, Secretary Expenditure, Secretary Administrative Ministry, and the senior-most member of the service/cadre in question as its members.
    • Cadre review is an ongoing process, and some states are taken up by rotation every year for review — in 2020-21.
    • For example, it was decided to revise the strength and composition of the IAS in UP and Bihar, and of the IPS in Manipur.
    • The sanctioned strength, therefore, keeps changing.

    What impact can a shortage of IAS officers have?

    • IAS officers are given a wide range of high-level responsibilities.
    • In states, their work relates to the collection of revenue, maintenance of law and order, and supervision of policies of the central and state governments.
    • They function as executive magistrates in revenue matters, and as development commissioners.
    • They supervise the spending of public funds and, at a senior level, contribute to policy formulation and decision-making in consultation with Ministers.
    • They serve the central government under deputation.

    Other issues

    • State governments have sometimes refused to send IAS/IPS/Indian Forest Service officers to the Centre saying they are short of officers.
    • The Centre has recently proposed amendments to the IAS (Cadre) Rules in order to exercise greater control in central deputation of IAS officers.

    Why can’t we have more IAS officers?

    • The B S Baswan Committee, said in its report submitted in 2016 that “any number above 180 would
    1. Compromise quality
    2. Exceed the LBNSAA’s (Lal Bahadur Shastri National Academy of Administration’s) capacity and
    3. Lead to a distortion in the career pyramid of IAS officers, particularly for senior posts in the Government of India
    • The Committee recommended that “vacant posts in the Centre and states can be filled by deputation where the number of deputationists would be less than the present.”

    Issues with shortage of Officers

    • Bureaucracy deficit is, perhaps, compelling states to take recourse to such means as appointing non-cadre officers to cadre posts.
    • States allow them to continue in such posts beyond the permissible time limit besides giving multiple charges to serving officers.
    • Such measures compromise the efficiency of administration.

    Way ahead

    • The DoPT should increase the annual intake of IAS officers significantly keeping in view the evolving needs of Indian administration.

     

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  • Fighting TB with lessons learnt during Covid pandemic

    Context

    On World TB day, we need to ask how best we can leverage the lessons learnt from Covid-19 to help gain a new momentum in TB control.

    Comparing the impact of Covid-19 and TB

    • In the first year of the Covid-19 pandemic, 1.8 million people were reported to have succumbed to the virus.
    • In the decade between 2010-20, 1.5-2 million individuals died every year because of tuberculosis.
    • The difference in responses to the two pandemics can only be explained by the differences in the profiles of those who get infected.
    • TB disproportionately affects people in low-income nations, the poor and the vulnerable.
    • The increased burden on healthcare to manage Covid has led to a serious setback in TB control.

    Using lessons from Covid-19 for TB control

    • To leverage the lessons learnt from Covid-19 to control TB, we need to focus on the epidemiological triad: Agent, host and the environment.
    • Test, treat and track has been a strategy successfully employed for Covid.
    • Scaling up testing: We need to aggressively scale up testing with innovative strategies such as active surveillance, bidirectional screening for respiratory tract infections using the most sensitive molecular diagnostics, and contact tracing.
    • Vaccine: The biggest victory against Covid has been the speed with which vaccines were developed, scaled up and deployed.
    • We need to replicate the same for tuberculosis, lobbying for funding from governments and industry to develop a successful vaccine for TB.
    • Social security programs for the prevention of risk: Malnutrition, poverty and immuno-compromising conditions such as diabetes are some of the factors strongly associated with TB.
    • Social security programmes that work towards prevention of modifiable risk factors would possibly pay richer dividends than an exclusive focus on “medicalising” the disease.
    • Environmental factors: Environmental factors which have been neglected include ventilation of indoor spaces, educating individuals to avoid crowds when possible, and to encourage voluntary masking, especially in ill-ventilated and closed spaces.
    • Investment and actions: Covid has been a stellar example of how investments and actions can be swift, and public education can transform behaviour.
    • Similar aspirations for TB can help turn this crisis into an opportunity to re-imagine our overburdened and underfunded systems.
    • Involvement of private sector: We need to actively engage the private sector, build bridges and partnerships as we did in the case of Covid.

    Way forward

    • The country needs to invest in state-of-the-art technologies, build capacity, expand its health workforce and strengthen its primary care facilities.
    • It also needs to consider telemedicine and remote support as important aspects of health services.
    • We need to build an open and collaborative forum where all stakeholders, especially affected communities and independent experts, take a lead role.

    Conclusion

    We have ignored TB for too long. It’s time we acknowledge the magnitude of the disease, and work harder at offering individuals equitable healthcare access and resources that the disease warrants.

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  • Mid day Meal Scheme

    A parliamentarian has recently asked the government to re-start the mid-day meals in reopening schools and to ensure that the meals provided are cooked and nutritious.

    What is the Mid-Day Meal Scheme?

    • The Midday Meal Scheme is a school meal program designed to better the nutritional standing of school-age children nationwide.
    • It was launched in the year 1995.
    • It supplies free lunches on working days for children in primary and upper primary classes in:
    1. Government, government aided, local body schools
    2. Education Guarantee Scheme, and alternate innovative education centres,
    3. Madarsa and Maqtabs supported under Sarva Shiksha Abhiyan, and
    4. National Child Labour Project schools run by the ministry of labour
    • The Scheme has a legal backing under the National Food Security Act, 2013.

    Objective: To enhance the enrolment, retention and attendance and simultaneously improve nutritional levels among school going children studying in Classes I to VIII

    History of the scheme

    • In 1925, a Mid Day Meal Programme was introduced for disadvantaged children in Madras Municipal Corporation.
    • By the mid-1980s three States viz. Gujarat, Kerala and Tamil Nadu and the UT of Pondicherry had universalized a same scheme with their own resources for children studying at the primary stage.
    • In 2001, the Supreme Court asked all state governments to begin this programme in their schools within 6 months.

    Features: Calorie approach

    • Primary (1-5) and upper primary (6-8) schoolchildren are currently entitled to 100 grams and 150 grams of food grains per working day each.
    • It also include adequate quantities of micronutrients like iron, folic acid, Vitamin-A, etc.
    • The calorific value of a mid-day meal at various stages has been fixed at a minimum:
    Calories Intake Primary Upper Primary
    Energy 450 calories 700 calories
    Protein 12 grams 20 grams

     

    Why in news?

    • The flagship report of The State of Food Security and Nutrition in the World 2020 estimated that as of April 2020 369 million children globally were losing out on school meals, a bulk of whom were in India.
    • As many as 116 million children — actually, 116 million hungry children — is the number of children impacted due to indefinite school closure during the pandemic.

    Why discuss it now?

    • The recent Global Hunger Index (GHI) report for 2020 ranks India at 94 out of 107 countries and in the category ‘serious’, behind our neighbours Pakistan, Bangladesh and Nepal.
    • The index is a combination of indicators of undernutrition in the population and wasting (low weight for height), stunting (low height for age), and mortality in children below five years of age.

    What measures were resorted to counter this?

    • In March and April 2020 the GoI had announced that the usual hot-cooked mid-day meal or an equivalent food security allowance/dry ration would be provided to all eligible school-going children even during vacation.
    • Nearly three months into this decision, States were still struggling to implement this.

    What lies ahead?

    • Across the country and the world, innovative learning methods are being adopted to ensure children’s education outcomes.
    • The GHI report calls for effective delivery of social protection programmes.
    • With continuing uncertainty regarding the reopening of schools, innovation is similarly required to ensure that not just food, but nutrition is delivered regularly to millions of children.
    • For many of them, that one hot-cooked meal was probably the best meal of the day.

     

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  • SC backs Centre’s OROP scheme

    The Supreme Court has upheld the Centre’s one rank, one pension (OROP) scheme for the armed forces.

    What is the news?

    • The Supreme Court has ruled that there was “no constitutional infirmity” in the way the government had introduced ‘one rank, one pension’ (OROP) among ex-service personnel.
    • The scheme, notified by the Defence Ministry on November 7, 2015, was challenged by Indian Ex-Service Movement, an association of retired defence personnel.

    What is OROP Scheme?

    • OROP means that any two military personnel retiring at the same rank, with the same years of service, must get an equal pension.
    • While this might appear almost obvious, there are several reasons why two military personnel who may have retired at the same rank with the same years of service, may get different pensions.

    Need for the scheme

    Military personnel across the three services fall under two categories, the officers and the other ranks.

    • Early age of retirement: The other ranks, which are soldiers, usually retire at age 35.
    • No benefits from pay commissions: Unlike government employees who retire close to 60, soldiers can thus miss out on the benefits from subsequent pay commissions.
    • Salary based pension: And since pensions are based on the last drawn salary, pensions too are impacted adversely.
    • Ranks based discrimination: The age when officers in the military retire depends upon their ranks. The lower the rank, the earlier they superannuate.
    • Liability against the sacrifice: It was argued that early retirement should not become an adverse element for what a soldier earns as pension, compared with those who retire later.

    Earlier pension mechanism

    • From 1950 to 1973, there was a concept known as the Standard Rate of Pension, which was similar to OROP.
    • In 1974, when the 3rd Pay Commission came into force, certain changes were effected in terms of weightage, additional years of notion service, etc., with regard to pensions.
    • In 1986, the 4th Pay Commission’s report brought further changes.
    • What ultimately happened was that the benefits of the successive pay commissions were not passed to servicemen who had retired earlier.
    • Pensions differed for those who had retired at the same rank, with the same years of service, but years apart.

    Demand for OROP

    • Ex-servicemen demanded OROP to correct the discrepancy.
    • Over the decades, several committees looked into it.
    • The Brig K P Singh Deo committee in 1983 recommended a system similar to Standard Rate of Pension, as did Parliament’s standing committees on defence.
    • The Narendra Modi government notified the current OROP scheme in November 2015, and it was made applicable from July 1, 2014.

    Issues with OROP

    • During the OROP protests of 2013-15, it was argued repeatedly that meeting the demand would be financially unsustainable.
    • Because soldiers retire early and remain eligible for pension for much longer than other employees, the Defence Ministry’s pension budget is very large, impacting capital expenditure.
    • The total defence pensioners are 32.9 lakh, but that includes 6.14 lakh defence civilian pensioners.
    • The actual expenditure of the Defence Ministry on pensions was Rs 1.18 lakh crore in 2019-2020.
    • The Defence Ministry’s pension-to-budget ratio is the highest among all ministries, and pensions are more than one-fifth of the total defence budget.
    • When the late Manohar Parrikar was Defence Minister, it was estimated that a one-time payout of Rs 83,000 crore would be needed to clear all past issues.

    Challenge to OROP

    • The petitioners contended that the principle of OROP had been replaced by ‘one rank multiple pensions’ for persons with the same length of service.
    • They submitted that the government had altered the initial definition of OROP and, instead of an automatic revision of the rates of pension.
    • Under this, any future raising of pension rates would be passed on to past pensioners — the revision would now take place at periodic intervals.
    • According to the petitioners, this was arbitrary and unconstitutional under Articles 14 and 21.

    What has the SC ruled now?

    • The court did not agree with the argument that the government’s 2015 policy communication contradicted the original decision to implement OROP.
    • It said that “while a decision to implement OROP was taken in principle, the modalities for implementation were yet to be chalked out.
    • The court also said that while the Koshyari Committee report furnishes the historical background of the demand, and its own view on it, it cannot be construed as embodying a statement of governmental policy.
    • It held that the OROP policy “may only be challenged on the ground that it is manifestly arbitrary or capricious”.

     

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  • What is POSH Act?

    The Kerala High Court has asked organizations associated with the film industry to take steps to constitute a joint committee to deal with cases of sexual harassment of women, in line with the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act of 2013.

    Why in news?

    • During the #MeToo movement, a number of women in India called out influential men — actors, standup comics, senior journalists — for alleged sexual harassment.
    • Hence the HC underlined that film production units must comply with the law against sexual harassment, commonly known as the prevention of sexual harassment at workplace (SHW) or POSH Act.

    What is the POSH Act?

    • The Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act was passed in 2013.
    • It defined sexual harassment, lay down the procedures for a complaint and inquiry, and the action to be taken.
    • It broadened the Vishaka Guidelines, which were already in place.

    What are Vishakha Guidelines?

    • The Vishakha guidelines were laid down by the Supreme Court in a judgment in 1997. This was in a case filed by women’s rights groups, one of which was Vishakha.
    • In 1992, she had prevented the marriage of a one-year-old girl, leading to the alleged gangrape in an act of revenge.

    Guidelines and the law

    • The Vishakha guidelines, which were legally binding, defined sexual harassment and imposed three key obligations on institutions :
    1. Prohibition
    2. Prevention
    3. Redress
    • The Supreme Court directed that they should establish a Complaints Committee, which would look into matters of sexual harassment of women at the workplace.

    The POSH Act broadened these guidelines:

    • It mandated that every employer must constitute an Internal Complaints Committee (ICC) at each office or branch with 10 or more employees.
    • It lay down procedures and defined various aspects of sexual harassment, including the aggrieved victim, who could be a woman “of any age whether employed or not”, who “alleges to have been subjected to any act of sexual harassment”.
    • This meant that the rights of all women working or visiting any workplace, in any capacity, were protected under the Act.

    Definition of Sexual Harassment

    Under the 2013 law, sexual harassment includes “any one or more” of the following “unwelcome acts or behaviour” committed directly or by implication:

    • Physical contact and advances
    • A demand or request for sexual favours
    • Sexually coloured remarks
    • Showing pornography
    • Any other unwelcome physical, verbal or non-verbal conduct of sexual nature.

    The Ministry of Women & Child Development has published a Handbook on Sexual Harassment of Women at Workplace with more detailed instances of behaviour that constitutes sexual harassment at the workplace. These include, broadly:

    • Sexually suggestive remarks or innuendos; serious or repeated offensive remarks; inappropriate questions or remarks about a person’s sex life
    • Display of sexist or offensive pictures, posters, MMS, SMS, WhatsApp, or emails
    • Intimidation, threats, blackmail around sexual favours; also, threats, intimidation or retaliation against an employee who speaks up about these
    • Unwelcome social invitations with sexual overtones, commonly seen as flirting
    • Unwelcome sexual advances.

    Unwelcome behavior

    • The Handbook says “unwelcome behaviour” is experienced when the victim feels bad or powerless; it causes anger/sadness or negative self-esteem.
    • It adds unwelcome behaviour is one which is “illegal, demeaning, invading, one-sided and power based”.

    Circumstance amounting to SHW

    The Act mentions five circumstances that amount to sexual harassment implied or explicit:

    1. Promise of preferential treatment in her employment
    2. Threat of detrimental treatment
    3. Threat about her present or future employment status
    4. Interference with her work or creating an offensive or hostile work environment
    5. Humiliating treatment likely to affect her health or safety

    Procedure for complaint

    • Technically, it is not compulsory for the aggrieved victim to file a complaint for the ICC to act.
    • The Act says that she “may” do so — OR any member of the ICC “shall” render “all reasonable assistance” to her to complain in writing.
    • If the woman cannot complain because of “physical or mental incapacity or death or otherwise”, her legal heir may do so.
    • Under the Act, the complaint must be made “within three months from the date of the incident”.
    • However, the ICC can “extend the time limit” if “it is satisfied that the circumstances were such which prevented the woman from filing a complaint within the said period”.
    • It provides that “no monetary settlement shall be made as a basis of conciliation”.
    • The ICC may either forward the victim’s complaint to the police, or it can start an inquiry that has to be completed within 90 days.
    • The identity of the woman, respondent, witness, any information on the inquiry, recommendation and action taken, the Act states, should not be made public.

    After the ICC report

    • If the allegations of sexual harassment are proved, the ICC recommends that the employer take action “in accordance with the provisions of the service rules” of the company.
    • These may vary from company to company.
    • It also recommends that the company deduct from the salary of the person found guilty, “as it may consider appropriate”.

    Compensation is determined based on five aspects:

    1. Suffering and emotional distress caused to the woman;
    2. Loss in career opportunity;
    3. Her medical expenses;
    4. Income and financial status of the respondent;
    5. Feasibility of such payment.

    Appeal in Court

    • After the recommendations, the aggrieved woman or the respondent can appeal in court within 90 days
    • Section 14 of the Act deals with punishment for false or malicious complaint and false evidence.
    • In such a case, the ICC “may recommend” to the employer that it take action against the woman, or the person who has made the complaint, in “accordance with the provisions of the service rules”.
    • The Act, however, makes it clear that action cannot be taken for “mere inability” to “substantiate the complaint or provide adequate proof”.

     

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  • 13% reduction in air pollution deaths due to UJJAWALA Scheme

    Greater penetration and usage of LPG as a cooking fuel is estimated to have prevented at least 1.5 lakh pollution-related premature deaths in the year 2019 alone, according to the first independent impact assessment of the government’s flagship Ujjwala program.

    About the PM Ujjwala Yojana

    • Pradhan Mantri Ujjwala Yojana (PMUY) was launched in 2016, with the aim to provide Liquefied petroleum gas (LPG) connections to five crore women members of below poverty line (BPL) households in the first phase.
    • he scheme was expanded in April 2018 to include women beneficiaries from seven more categories (SC/ST, PMAY, AAY, Most backward classes, tea garden, forest dwellers, Islands).
    • In the second phase the target was expanded to eight crore LPG connections.

    Why was this scheme launched?

    • Indoor air pollution is also responsible for a significant number of acute respiratory illnesses in young children.
    • Providing LPG connections to BPL households will ensure universal coverage of cooking gas in the country.
    • This measure has empowered women and protected their health. It reduced drudgery and the time spent on cooking.
    • It will also provide employment for rural youth in the supply chain of cooking gas.

    Ujjwala 2.0

    • Under Ujjwala 2.0 migrant workers would no longer have to struggle to get address proof documents to get the gas connections.
    • Now migrant workers would only be required to submit a self-declaration of their residential address to get the gas connection.
    • Along with a deposit-free LPG connection, Ujjwala 2.0 will provide the first refill and a hotplate free of cost to the beneficiaries.

    Significance of Ujjwala 2.0

    • LPG infrastructure has expanded manifold in the country due to the Ujjwala scheme.
    • In the last six years, more than 11,000 new LPG distribution centres have opened across the country.
    • The LPG coverage in India is now very close to becoming 100 per cent.

     

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  • Caste-based NREGS Wages Payment System

    Parliament’s Standing Committee on Rural Development and Panchayati Raj has asked the government to roll back the system of caste-based wages, under which NREGS workers are paid based on whether they belong to a Scheduled Caste, Scheduled Tribe, or Others.

    Back in news: MGNREGA

    What is the caste-based payment system?

    • Last year, the Rural Development Ministry sent an advisory to states asking them to take necessary action for payment of wages to NREGS workers according to their categories — SC, ST, and Others.
    • Under the new system, if 20 individuals (say, six SCs, four STs and 10 others) work together at a site under MG-NREGA, a single muster roll would be issued.
    • But payment would be done by issuing three separate Fund Transfer Orders (FTOs), one for each of the three categories.
    • Due to this, some beneficiaries started complaining that despite working at the same site and registering on the same muster roll, they were getting their wages at different times depending on their categories.
    • Beneficiaries in the ‘Others’ category, which includes the ‘General’ and Other Backward Classes (OBC) categories, especially complained of delays.

    What was the earlier system of payment?

    • The Rural Development Ministry notifies wage rates for states and Union Territories under Section 6(1) of The Mahatma Gandhi National Rural Employment Guarantee Act, 2005.
    • Until 2020-21, the wages were being paid to NREGS beneficiaries through a single funds transfer order.
    • In other words, if 20 beneficiaries, including SCs, STs and Others work at a site under MGNREGA, all received their wages at the same time, through a single muster roll and a single funds transfer order.

    Why was the system of caste-based wage payment introduced?

    • According to the Ministry, the system of category-wise payment of wages was introduced to “accurately reflect on the ground flow of funds to various population groups”.
    • Last year, a process of “streamlining” of the new system was taken up.

     

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  • TB’s steep socio-economic cost to women

    Context

    As India steadily steers its way through the pandemic to safer shores, we must foreground a disease which has been impacting our country for years, and disproportionately affecting women –  tuberculosis.

    Toll of TB

    • In India, the TB case fatality ratio increased from 17 per cent in 2019 to 20 per cent in 2020.
    • According to a joint report (2010-13) of the Registrar General of India and the Centre for Global Health Research, TB was the fifth-leading cause of death among women in the country, accounting for nearly 5 per cent of fatalities in women aged 30–69.

    How TB affects women more than men

    • Much steeper socio-economic price: While both men and women suffer the consequences of this debilitating disease, women patients pay a much steeper socio-economic price.
    • Beyond clinical metrics: From social ostracisation and lack of family support to the negative impact on marital prospects, women absorb the repercussions of TB beyond the clinical metrics.
    • Stigma also acts as a strong deterrent when it comes to health-seeking behaviour.
    • Fewer women, therefore, get included in the available cascade of care for TB.

    Measures by government

    • In 2019, the Health Ministry-Central TB Division developed a national framework for a gender-responsive approach to TB in India.
    • The document takes cognisance of the challenges faced by women in accessing treatment and offers actionable solutions.
    • Gender-responsive policy interventions: In December 2021, a parliamentary conference on ‘Women Winning Against TB’ was organised by the Ministry of Women and Child Development where gender-responsive policy interventions were discussed.
    • The Vice-President of India urged states to take proactive steps such as ensuring nutritional support to women and children and the doorstep delivery of TB services, especially for women from socio-economically weaker backgrounds.

    Suggestions

    1] Highlight the issue at the relevant forum

    • One, as elected representatives, we need to come together more to highlight the issue at all relevant forums and spaces.
    • These meetings see increased participation of women leaders from all walks of life in the community going forward.

    2] Strengthen counselling network

    • We need to strengthen counselling networks for women patients and their families.
    • Irrespective of where the patient seeks care – public or private sector – build the capacity of healthcare workers to educate the patient’s family about the importance of providing her a supportive environment during the course of her treatment.

    3] Nutritional needs

    • We need to ensure that the nutritional needs of women are being met.
    • Undernutrition is a serious risk factor for TB and research indicates such risks are higher for women.
    • It is commendable that the government, through Nikshay Poshan Yojana, has effectively provided a monthly benefit of Rs 500 to enable a nutritious diet for TB patients in the last few years.
    • For the 2020 cohort, the total amount paid under NPY via DBT has been over  Rs 200 crore.
    • Additionally, we can look to further strengthen inter-departmental coordination, wherein the Public Distribution System can explore appropriate linkages with relevant departments of the MoHFW and even include a protein-rich diet for TB patients.

    4] Amplify accurate TB messaging

    • At a community level, we must amplify accurate TB messaging and showcase how gender plays a role in determining the course of action on the ground.

    Conclusion

    These are universal problems that must transcend gender binaries. Only when equitable solutions are offered to vulnerable sections of society will we be able to realise the dream of TB-Mukt Bharat.

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  • Maternal Mortality in India

    Kerala has yet again emerged on top when it comes to maternal and child health, with the State recording the lowest Maternal Mortality Ratio (MMR) of 30 (per one lakh live births) in the country.

    What is Maternal Mortality?

    • Maternal mortality refers to deaths due to complications from pregnancy or childbirth.
    • The maternal mortality ratio (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period.
    • It depicts the risk of maternal death relative to the number of live births and essentially captures the risk of death in a single pregnancy or a single live birth.

    Trends in India

    • India’s maternal mortality ratio (MMR) has improved to 103 in 2017-19, from 113 in 2016-18.
    • Seven Indian states have very high maternal mortality. These are Rajasthan, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Bihar, Odisha and Assam.
    • The MMR is ‘high’ in Punjab, Uttarakhand and West Bengal. This means 100-130 maternal deaths per 100,000 live births.
    • It is ‘low’ in Haryana and Karnataka.
    • The states of Uttar Pradesh, Rajasthan and Bihar have seen the most drop in MMR.
    • West Bengal, Haryana, Uttarakhand and Chhattisgarh have recorded an increase in MMR over the last survey.

    Various determinants of maternal health in India

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