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Subject: Governance

Important aspects of Society

  • Policy implementation in India : Issues

    Policy implementation matters as much as the policy itself. The article highlights the importance of monitoring system to track the implementation of the policies.

    Implementing policy

    • It is taken for granted that a government policy or social-development program, is meant to be perfectly executed.
    • Implementation is the key and ends up with sub-par results and uncompleted projects.
    • India has had mixed experiences post-Independence, the consolidated development chart will appear rather skewed.
    • Millions continue to live in abject poverty, deprived of basic amenities.

    Dealing with implementation deficit

    • India needs to work on the implementation and reforms processes in a wider manner, with the primary aim of attaining fast-paced development and effective delivery of the intended public benefits.
    • The first requirement would be a capable implementing machine — or what has been called the “perfect administration”, driven by passionate team leaders.
    • The guiding urge should be to complete the task before schedule.
    • Other critical determinants include:
    • Unambiguous demarcation of responsibilities.
    • Frequent brainstorming sessions to anticipate and take formal note of likely challenges and agreeing upon solutions.
    • Ensuring and authorizing a largely freehand with matching resources, and the ability to make on-the-spot decisions.
    • The evergreen strategy to make the implementation of a near-perfect process is to build in a vigilant monitoring and evaluation mechanism.
    • A dynamic monitoring mechanism makes use of technology, which today is being built into various flagship programs initiated by the present government.

    Achieving implementation

    • In the interest of achieving wholesome implementation, it would be desirable to set up an autonomous “Monitoring Trust”.
    • The trust will act as an integral part of all important public policies and programs.
    • The proposed Trust can comprise core technical, administrative, and legal members, along with stakeholders and social activists.
    • Engaging stakeholders and implementers, through various methodologies, is fast emerging as an effective strategy.
    • Sharing information and progress through dashboards and other technology tools, inviting suggestions through IT portals like MyGov democratize and enrich both policy formulation and execution.
    • The institutions and methodologies developed in Deen Dayal Upadhyaya Gram Jyoti Yojana present an exemplary fusion between human ingenuity and the miracles of customized technology.

    Conclusion

    The political leadership both at the national and the state level is the most crucial force behind the success of the implementation machinery. An endeavor’s effective implementation alone can provide the converge with good governance, bold innovation, rewarding delivery, and the transformation of marginalized human lives.

  • Dominance of Private healthcare in India & Related issues

    • Lack of resources such as 1:1,700, doctor: citizen ratio, well below the minimum ratio of 1:1,000 stipulated by WHO.

    • Rural areas and smaller towns of India are the worst sufferers, where even basic health services remain inaccessible, many cases were reported where ward boys and alone found running the primary healthcare center.

    • Inadequate government spending on healthcare and lack of access to health insurance to a large section of society.

    • The quality of public health services in India continues to remain below expectations which hamper the economic growth of the country.

    • Government’s inability to build sufficient capacity and infrastructure, difficulty in reaching out to poor and vulnerable groups.

    • An undersized skilled workforce and the absence of upgraded technology is a major challenge in the health sector.

  • Custodial torture in India

    Installation of cameras would help in curbing the custodial torture to some extent but ending the menace requires comprehensive reforms.

    Installation of CCTV cameras to curb custodial torture

    • The Supreme Court recently mandated that CCTV cameras be installed in police stations and offices of other investigative agencies.
    • However, previous decisions with similar recommendations have been poorly implemented.
    • The present decision shows a marked difference from the earlier ones in its approach.
    • It shows more care by listing out areas of police stations where cameras must be installed to ensure that there are no blind spots.
    • It asks for oversight committees to be set up to monitor the functioning of the cameras.
    • It also specifies that the cameras must be equipped with night vision and be able to record audio and visual footage.
    • The recordings will have to be preserved for at least 12 months.

    Issues with installing CCTV cameras

    • Alteration of a video to conceal an object, an event, or change the meaning conveyed by the video is a well-documented reality in the United States.
    • Indian courts have also expressed their apprehension of police tampering with CCTV footage.
    • The judgment does not assuage these concerns.
    •  Cameras in police stations will not foreclose the possibility of torture in other locations.
    • Multiple works on torture in India suggest that torture is often not inflicted in police stations, but in isolated areas or police vehicles.
    • Victims are illegally detained and tortured in undisclosed locations before officially arrested and brought to the police station.

    Challenges in fixing criminal responsibility

    • Since torture is not recognized as an offense per se under Indian law, the judgment refers to the use of force resulting in “serious injuries and/or custodial deaths” unwittingly creates a high threshold for what amounts to torture.
    • It fails to acknowledge the existence of forms of physical and psychological torture that leave behind no marks on the body.
    • Requiring prior sanction from the government operates as the foremost hurdle in initiating criminal complaints.
    • The absence of statutory guidelines mandating independent investigation results in police officers from the same police station investigating the crime and suppressing evidence.
    • Between 2005-2018, with respect to 1,200 deaths in police custody, 593 cases were registered, 186 police personnel were charge-sheeted, and only seven were convicted (National Crime Records Bureau).
    •  Evidentiary concerns frequently arise since often the only witnesses are the victims themselves.
    • The Supreme Court (1995) has noted that police officials remain silent to protect their colleagues as they are “bound by brotherhood” and held that courts should not insist on direct or ocular evidence in these cases.
    • This position is rarely applied and many cases result in acquittal for want of evidence.

    Conclusion

    Monitoring the police through CCTVs is an important step towards combating torture but its effectiveness is contingent on broader reforms. The Supreme Court needs to ensure a robust implementation of its order and simultaneously plug the gaps so that incidents of torture are curtailed.

  • West Bengal IPS Controversy

    Police personnel should not be made instruments of a political battle

    Tug of war between political parties in West Bengal

    • The appointment of three IPS officers of the West Bengal cadre to various posts by the Union Home Ministry on Thursday has escalated the confrontation between the State and the Centre.
    • Chief Minister Mamata Banerjee has termed the deputation order despite the State’s objection “a colourable exercise of power and blatant misuse of emergency provision of IPS Cadre Rule 1954”.
    • The constant hostility between the State and Central governments is now taking a turn for the worse ahead of the 2021 Assembly election.
    • The tug of war began after a convoy of BJP President J.P. Nadda came under stone pelting in the State on December 10. The BJP apparently holds the IPS officers accountable for the incident.
    • After an initial move to recall these officials was resisted by the State, the Centre has invoked Section 6(1) of the Indian Police Service (Cadre) Rules, which says that “in case of any disagreement, the matter shall be decided by the Central Government….”

    Administrative instruments Vs. Political battles

    • The CM’s style of managing the police force has gained attention for the wrong reasons in the past.
    • Senior officials are seen as allied with the ruling govt and the oppositions determined drive to capture power in the State is multi-pronged.
    • The Supreme Court restrained West Bengal from taking any “coercive action” against several opposition leaders in criminal cases registered against them by the State Police.
    • The opposition continues to knock on the doors of the Court and the Election Commission of India to bring pressure on the State government.
    • By enforcing its writ on IPS officers, the Centre is sending a signal to all officers that their conduct will now be under scrutiny.

    Never-ending issues between the state and the centre

    • The central schemes, Ayushman Bharat and PM Kisan Samman Nidhi are also a bone of contention.
    • The Bengal government has refused to implement them, demanding that the funds be routed through the State.
    • The CM has also complained of insufficient central assistance to manage the COVID-19 pandemic and cyclone Amphan.
    • The Centre’s earlier demand that the Chief Secretary and DGP attend a meeting in New Delhi on the State’s law-and-order situation increased tensions.
    • The partisan use of the personnel and instruments of the state by parties in power as is happening in this tussle is a disturbing signal for democracy and federalism.

    Practice Question: The partisan use of the personnel and instruments of the state by parties in power is a disturbing signal for democracy and federalism. Elaborate.

  • [pib] PM Special Scholarship Scheme (PMSSS)

    The Prime Minister’s Special Scholarship Scheme (PMSSS) instalment has been released to support J&K and Ladakh students.

    Tap to read more about: Reorganization of J&K

    About PMSSS

    • The PMSSS aims to build the capacities of the youths of J&K and Ladakh by educating, enabling and empowering them to compete in the normal course.
    • Under the Scheme, the youths of J&K and Ladakh are supported by way of scholarship in two parts namely the academic fee & maintenance allowance.
    • The academic fee is paid to the institution where the student is provided admission after on-line counselling process conducted by the AICTE (All India Council for Technical Education).
    • The academic fee covers tuition fee and other components as per the ceiling fixed for various professional, medical and other under-graduate courses.
    • In order to meet the expenditure towards hostel accommodation, mess expenses, books & stationery etc., a fixed amount of Rs.1.00 Lakh is provided to the beneficiary and is paid in instalments of Rs. 10,000/- pm directly into students account.

  • PM -WANI : As Game changer

    The PM-WANI project seems to fit within the framework of an evolving decentralized concept to bridge the e-divide.

    Practice Question:

    With the PM-WANI, the state is expanding the reach of digital transformation to those who have been excluded till now. It is a game-changer because it has the potential to move Digital India to Digital Bharat. Discuss.

    PM WANI – the ‘game-changer’

    • The term ‘game-changer’ can be seen as an accurate reflection of the capability of an initiative to change the status quo for Prime Minister’s Wi-Fi Access Network Interface, or PM WANI.
    • It provides for “Public Wi-Fi Networks by Public Data Office Aggregators (PDOAs) to provide public Wi-Fi service spread across the length and breadth of the country to accelerate the proliferation of Broadband Internet services through Public Wi-Fi network in the country”.

    What the data shows

    • The initiative can help to bridge the increasing digital divide in India. Recently, the NITI Aayog CEO had said that India can create $1 trillion of economic value using digital technology by 2025.
    • As per the latest Telecom Regulatory Authority of India (TRAI) data, about 54% of India’s population has access to the Internet.
    • The 75th round of the National Statistical Organization survey shows that only 20% of the population has the ability to use the Internet.
    • The India Internet 2019 report shows that rural India has half the Internet penetration as urban, and twice as many users who access the Internet less than once a week.

    Digital poverty

    • Umang App (Unified Mobile Application for New-age Governance) allows access to 2,084 services, across 194 government departments, across themes such as education, health, finance, social security, etc.
    • The ability to access and utilize the app enhances an individual’s capabilities to benefit from services that they are entitled to.
    • With each move towards digitization, we are threatening to leave behind a large part of our population to suffer in digital poverty.
    • What the government is trying to achieve with PM-WANI is anyone living in their house, a paan shop owner or a tea seller can all provide public Wi-Fi hot posts, and anyone within range can access it.
    • This will also help to reduce the pressure on the mobile Internet in India. Going back to the India Internet report, it shows that 99% of all users in India access the Internet on mobile, and about 88% are connected on the 4G network.
    • This leads to a situation where everyone is connected to a limited network, which is getting overloaded and resulting in bad speed and quality of Internet access.

    Key links

    • There are three important actors here.
    1. First is the Public Data Office (PDO). The PDO can be anyone, and it is clear that along with Internet infrastructure, the government also sees this as a way to generate revenue for individuals and small shopkeepers. It is important to note that PDOs will not require registration of any kind, thus easing the regulatory burden on them.
    2. Second is the PDOA, who is basically the aggregator who will buy bandwidth from the Internet service provider (ISPs) and telecom companies and sell it to PDOs, while also accounting for data used by all PDOs.
    3. The third is the app provider, who will create an app through which users can access and discover the Wi-Fi access points.
    • Two pillars have been given as a baseline for public Wi-Fi.
    1. Interoperability – where the user will be required to login only once and stay connected across access points.
    2. Multiple payment options – allowing the user to pay both online and offline.
    • The products should start from low denominations, starting with â‚č2. It is suggested in the report that the requirement of authentication through stored e-know your customer (KYC) is encouraged, which inevitably means a linking with Aadhaar.

    Aiding rural connectivity

    • The PM-WANI has the potential to change the fortunes of Bharat Net as well. Bharat Net envisions broadband connectivity in all villages in India.
    • The project has missed multiple deadlines, and even where the infrastructure has been created, usage data is not enough to incentivize ISPs to use Bharat Net infra to provide services.
    • One of the reasons for the lack of demand is the deficit in digital literacy in India and the lack of last-mile availability of the Internet.
    • The term digital literacy must be seen as an evolving decentralized concept, which depends on how people interact with technology in other aspects of their life and is influenced by local social and cultural factors.
    • The PM-WANI seems to fit within this framework, simply because it seeks to make accessing the Internet as easy as having tea at a chai shop. This is not a substitute for the abysmal digital literacy efforts of the government, but will definitely help.

    Security, privacy issues

    • There are some concerns, mainly with respect to security and privacy. A large-scale study conducted at public Wi-Fi spots in 15 airports across the United States, Germany, Australia, and India discovered that two thirds of users leak private information whilst accessing the Internet.
    • Further, the TRAI report recommends that ‘community interest’ data be stored locally, raising questions about data protection in a scenario where the country currently does not have a data protection law in place.
    • These are, however, problems of regulation, state capacity and awareness and do not directly affect the framework for this scheme.

  • [pib] Vision 2035: Public Health Surveillance in India

    NITI Aayog today released a white paper: Vision 2035: Public Health Surveillance (PHS) in India.

    Q.Discuss the role of Public Health Surveillance in the success of Ayushman Bharat Abhiyan.

    Vision 2035 for PHS

    • It is a continuation of the work on health systems strengthening.
    • It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.
    • Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

    Let’s have a look at the executive summary of the vision document:

    PHS in India

    • Surveillance is an important Public Health function.
    • It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

    Why need PHS?

    • Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance.
    • India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated.
    • India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.
    • These successes are a result of effective community-based, facility-based, and health system-based surveillance.
    • The COVID19 pandemic has further challenged the country. India rapidly ramped up its diagnostic capabilities and aligned its digital technology expertise.
    • This ensured that there was a comprehensive tracking of the pandemic.

    Highlights of the vision document

    • It builds on initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program.
    • It aligns with the citizen-centricity highlighted in the National Health Policy 2017 and the National Digital Health Blueprint.
    • It encourages the use of mobile and digital platforms and point of care devices and diagnostics for amalgamation of data capture and analyses.
    • It highlights the importance of capitalizing on initiatives such as the Clinical Establishments Act to enhance private sector involvement in surveillance.
    • It points out the importance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the ICMR, and others.

    Gap areas in India’s PHS that could be addressed

    • India can create a skilled and strong health workforce dedicated to surveillance activities.
    • Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
    • Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
    • An amalgamation of plant, animal, and environmental surveillance in a One-Health approach.
    • PHS could be integrated within India’s three-tiered health system.
    • Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
    • To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

    Moving ahead

    • Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
    • Identify broad disease categories that will be included under PHS.
    • Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
    • Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
    • Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
    • Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action.
    • Encourage innovations at every step-in surveillance activity.

  • Standards must not be lowered to certify Ayurveda postgraduates surgeons

    This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.

    Practice Question: There is a need to rethink on the recent notification of AYUSH Ministry allowing Ayurveda postgraduates to conduct surgeries keeping the safety of the patient at the centre. Discuss.

    The current clash

    • The clash between the allopathic and AYUSH fraternities is about the AYUSH practitioners’ “right” to conduct surgeries.
    • The Ayurvedic fraternity maintains postgraduates in Shalya and Shalakya (two surgical streams among 14 post-graduate courses) are taught procedures listed in the curriculum.
    • The oldest-known surgical specialist was, in fact, an Ayurvedic surgeon/sage Sushrut (600 BC) who wrote the Sushrut Samhita — a profound exposition on conducting human surgery which continues to receive worldwide acclaim.
    • Surgery was practised by Ayurvedic surgeons long before the advent of western medicine.
    • Allopaths question the logic of Sushrut’s millennia-old pre-eminence bestowing the right to practise modern surgery. Ayurvedic surgeons may not know the hidden risks of every surgical procedure and how to surmount sudden mishaps.
    • The Ministry of AYUSH justifies its notification on the ground that not all vaidyas but only postgraduates qualifying from two surgical streams have been authorized to perform selected surgeries.

    The contentious issue

    • The moot point is about who decides whether Ayurvedic surgeons possess sufficient proficiency to conduct these surgeries safely and by what standard their skills are judged.
    • Surgical proficiency cannot be judged by different standards in one country — particularly when less-educated patients would rather save money than question a surgeon’s qualifications.
    • The statutory regulatory body for AYUSH education is the Central Council of Indian Medicine (CCIM). CCIM has only promoted what private college managements demand, propelled, in turn, by students’ need to earn a stable income as medical professionals.
    • In this misplaced zeal to give better earnings to the Ayurvedic vaidyas, CCIM has sidelined many skills that Ayurveda could have included, which are relevant even today.
    • This has subjugated the curriculum to nurture more and more replicas of doctors of modern medicine.
    • This has killed the knowledge, purity and goodness of classical Ayurveda, which ironically is the Ayurveda in high demand in Europe, Russia and America.

    Nothing can replace practise and training to perform surgery

    • When it comes to surgery, it is not knowledge but rigorous training and continuous practice which makes for perfection. Both require clinical material and most Ayurvedic hospitals do not have a fraction of the surgical patients found in allopathic general hospitals.
    • Allopathic students of surgery learn first by watching and then performing scores of surgeries under supervision.
    • Surgical skills are by no means impossible to learn but they become difficult to master without continuous training and supervision.
    • Due to the paucity of patients, limited scope for training and access to gaining hands-on practice, it is hazardous to allow all Shalya and Shalakya postgraduates to undertake surgical procedures.
    • In the last three decades, specialization has excluded general surgeons from performing what was once considered routine. For example, only an ENT surgeon can perform a tonsillectomy.
    • Therefore, to notify that Ayurvedic postgraduates in surgery can perform omnibus operations runs counter to the norm in India and in other countries.

    Way forward

    • In performing surgery, the only benchmark should be the duration of hands-on training received — counted by surgeries under supervision, and being judged through external evaluation.
    • Every surgeon’s skills and competence must be tested by applying exactly the same standards before she/he can operate.
    • This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.

  • India needs to rethink its nutrition agenda

    Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

    Nutrition-related data released by NFHS-5

    • The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
    • The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

    Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

    Worrying findings

    • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
    • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
    • Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
    • There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
    • Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
    • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
    • Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

    Economic growth vs health indicators

    • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
    • This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
    • The World Health Organization calls stunting “a marker of inequalities in human development”.
    • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
    • Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
    • The situation has become even worse due to the pandemic and lockdown-induced economic distress.
    • Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
    • All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

    Social protection schemes and their impact on nutrition indicators

    • Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
    • However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
    • Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
    • There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

    A piecemeal approach

    • The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
    • Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
    • Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
    • The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

    Conclusion

    • The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
    • An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
    • There have been many indications in our country that business as usual is not sustainable anymore.
    • It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.

  • National Family Health Survey- 5 Part: I

    • Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable to all.
    • The data in NFHS-5 gives requisite input for strengthening existing programmes and evolving new strategies for policy intervention, therefore government and authorities should take steps to further improve the condition of women in India.

    The first phase of the fifth National Family Health Survey (NFHS-5) has been released.

    Do you think that India is still the sick man of Asia?

    What is the National Family Health Survey?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, etc.
    • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

    Part I of the Survey

    • The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five UTs (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic.
    • Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.

    Highlights of the NHFS-5

    • The NFHS-5 contains detailed information on population, health, and nutrition for India and its States and Union Territories.
    • This is a globally important data source as it is comparable to Demographic Health Surveys (DHS) Programme of 90 other countries on several key indicators.
    • It can be used for cross country comparisons and development indices.

    Good news

    • Several of the 22 states and UTs, for which findings have been released, showed an increase in childhood immunisation.
    • There has been a drop in neonatal mortality in 15 states, a decline in infant mortality rates in 18 states and an increase in the female population (per 1,000 males) in 17 states.
    • Fertility rate decline and increase in contraceptive use were registered in almost all the states surveyed showing trends of population stabilization.

    Some bad news

    • There has been an increase in stunting and wasting among children in several states, a rise in obesity in women and children, and an increase in spousal violence.
    • In several other development indicators, the needle has hardly moved since the last NFHS-4.

    (1) Hunger Alarm

    • The proportion of stunted children has risen in several of the 17 states and five UTs surveyed, putting India at risk of reversing previous gains in child nutrition made over previous decades.
    • Worryingly, that includes richer states like Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh.
    • The share of underweight and wasted children has also gone up in the majority of the states.

    (2) Fertility Rate

    The total fertility rate (TFR) is defined as the average number of children that would be born to a woman by the time she ends childbearing.

    • The TFR across most Indian states declined in the past half-a-decade, more so among urban women, according to the latest NFHS-5.
    • Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.
    • In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.
    • India’s population is stabilizing, as the total fertility rate (TFR) has decreased across majority of the states.

    (3) Under-5 and infant mortality rate (IMR)

    • The Under 5 and infant mortality rate (IMR) has come down but in parallel recorded an increase in underweight and severely wasted under 5 children among 22 states that were surveyed.
    • These states are Goa, Gujarat, Himachal Pradesh, Kerala, Maharashtra, Meghalaya, Mizoram, Nagaland, Telangana, Tripura, West Bengal, Lakshadweep and Dadra & Nagar Haveli and Daman and Diu.

    For the first time: Gaps in internet use

    • In 2019, for the first time, the NFHS-5, which collects data on key indicators on population health, family planning and nutrition, sought details on two specific indicators: Percentage of women and men who have ever used the Internet.
    • On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet, according to the survey.
    1. First, only an average of 42.6 per cent of women ever used the Internet as against an average of 62.16 per cent among the men.
    2. Second, in urban India, average 56.81 per cent women ever used the Internet compared to an average of 73.76 per cent among the men.
    3. Third, dismal 33.94 per cent women in rural India ever used the Internet as against 55.6 per cent among men.
    • In urban India, 10 states and three union territories reported more than 50 per cent women who had ever used the Internet: Goa (78.1%), Himachal Pradesh (78.9%), Kerala (64.9%), and Maharashtra (54.3%).
    • The five states reporting the lowest percentage of women, whoever used the Internet in urban India were Andhra Pradesh (33.9%), Bihar (38.4%), Tripura (36.6%), Telangana (43.9%) and Gujarat (48.9%).