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Subject: Governance

Important aspects of Society

  • The next mission

    Context

    After the success of the SBM, government is looking for the next mission in the form of Jal Jeevan Mission.

    Investment in Sanitation

    • Investment of over 1 lakh crore: The central and state governments have invested in excess of one lakh crore on sanitation over the past five years.
    • Where the fund was used? A majority of these funds have gone towards-
      • Incentivising the poor and marginalised households to construct and use household toilets.
      • Bringing about behaviour change, and-
      • Building capacities of field functionaries.
    • The success of the mission: Over 10 crore toilets have been built in rural India and nearly 55 crore people have stopped defecating in the open, all in just five years.
      • This has contributed in bringing down global open defecation by more than half.
    • Return on the investment in sanitation: The returns on these investments have been manifold, and their effects on the broader economy, markets and employment have been significant.
      • 400 % return: The UNICEF recently estimated that investments in sanitation in India are yielding a 400 per cent return with each rural household in an open-defecation-free village saving Rs 50,000 on account of avoided medical costs and time savings.
    • Future prospects for the sanitation infrastructure: The Toilet Board Coalition has estimated that the sanitation infrastructure and services market in India will be worth over $60 billion by 2021.
      • Many new jobs, even in the most rural areas of the country, apart from reducing health and environmental costs and generating savings for households.
    • Growth in the sanitation-related business: The business of manufacturing toilet-related hardware accessories have reported huge growth in sales during the SBM period.
      • They project a continued uptrend through retrofitting and upgrades.
      • This has been corroborated by another recent study by UNICEF in which they have estimated that SBM has resulted in creating over 75 lakh full-time equivalent jobs over the past five years, giving the rural economy a major boost.

    A milestone, not a finish-line

    • Sustaining the success: The government is committed to ensuring that this success is sustained.
    • On October 2, 2019, the prime minister said that we must all ensure that people continue to use toilets and that no one is left behind.
    • Allocation of 10,000 crores in the Budget: This has been backed up by the finance minister in the budget for 2020-21.
      • In the budget, she announced about Rs 10,000 crore for rural sanitation to focus on-
      • ODF sustainability.
      • Bio-degradable waste management.
      • Greywater management.
      • Sludge management and-
      • Plastic waste management for all villages by 2024.

    Next Mission- Piped Water Supply

    • Jal Jeevan Mission: The next critical basic service, is piped water supply. On Independence day this year, the prime minister announced the Jal Jeevan Mission (JJM).
      • With the goal of ensuring piped water supply for all households of India by 2024 and with a commitment of Rs 3.6 lakh crore of central and state funds for the scheme.
      • The budgetary allocation of 12,000 crores: In the Union budget for 2020-2021, the government has already allocated Rs 11,500 crore for JJM, with an additional Rs 12,000 crore being made available through extra-budgetary resources.
    • Earmarking 50% grants for drinking water and sanitation: In addition, a huge impetus to the rural water supply and sanitation sector is the earmarking of 50 per cent of the Rs 60,750 crore grant for rural local bodies provided under the Fifteenth Finance Commission for drinking water and sanitation.
      • Making local bodies more responsible: This will ensure that the gram panchayats and local communities are responsible for the upkeep of their water and sanitation infrastructure, providing a boost to the sustainability of service delivery to people.
      • Making sanitation and water supply everyone’s business: This approach will ensure that just like sanitation, provision of water supply and its upkeep will also become everyone’s business.

    Conclusion

    It is fairly clear now that investment in sanitation is actually a facilitator for broader economic, health and social gains. The government should ensure the sustainability of SBM and replicate its success in implementing the JJM.

     

  • Worldwide Educating for the Future Index (WEFFI) 2019

     

     

    India has jumped five ranks in the Worldwide Educating for the Future Index (WEFFI) 2019.

    About WEFFI

    • The report is published by The Economist Intelligence Unit. The report and index were commissioned by the Yidan Prize Foundation.
    • The index ranks countries based on their abilities to equip students with skill-based education.
    • The report analyses the education system from the perspective of skill-based education “in areas such as critical thinking, problem-solving, leadership, collaboration, creativity and entrepreneurship, as well as digital and technical skills.”

    Global scenario

    • Among the world’s largest economies, the US, UK, France and Russia all fell back in the index, while China, India and Indonesia took steps forward.
    • Finland was at the apex of the index, with strengths across each category followed by Sweden.

    India’s performance

    • India ranked 35th on the overall index in 2019 with a total score of 53, based on three categories – policy environment, teaching environment and overall socio-economic environment.
    • India scored 56.3 in policy environment falling from a 61.5 score in 2018.
    • India’s score of 52.2 in the teaching environment category and 50.1 in the socio-economic environment category increased significantly from 32.2 and 33.3 in 2018 respectively.
    • Earlier, India ranked 40th with an overall score of 41.2 across categories in 2018.

    What made India progress?

    • The report attributed India’s growth to the new education policy introduced by the government.
    • India’s Finance Minister Nirmala Sitharaman, in the Union Budget 2020, had highlighted a
    • The New Education Policy announced in this year budget under ‘Aspirational India’ will focus on “greater inflow of finance to attract talented teachers, innovate and build better labs.
    • The policy will focus further on skill-based education.

    Various shortcomings highlighted

    • The 2018 WEFFI report had highlighted the shortcomings in India’s education system emphasizing upon its inability to utilise the opportunity of internationalizing its higher education system.
    • A decentralized education system is another shortcoming of India’s education policy according to the 2019 report.
    • Well-intentioned policy goals relating to future skills development often do not get filtered downward, a hazard in economies such as the US and India that have large, decentralized education systems, the report said.

  • Gearing up to fight the next big viral outbreak

    Context

    India is ill-prepared to deal with the new strain of coronavirus (SARS-CoV-2) that is causing worldwide panic. Policymakers must take forceful action to prevent the spread of the new virus and heed the urgent warnings of global public health professionals about new pathogens.

    No country is adequately prepared

    • Finding of the Global Health Security Index: The World Health Organization (WHO)’s Global Health Security Index finds that no country is adequately prepared.
    • It assesses 195 countries across six categories–
      • Prevention
      • Early detection.
      • Rapid response.
      • Health system quality.
      • Standards.
      • Risk environment.
    • India’s dismal rank: India is ranked 57th.
      • That the country scores around the global average is no comfort, because the global average is a low 40.2 out of 100, and India’s score is 46.5. (For the record, the U.S. is ranked first and China 51st).

    Four-point health agenda

    • The prospect of new outbreaks puts four items on the health agenda in the spotlight that require both immediate and longer-term action:
      • Early detection and prevention.
      • Better collaboration across health service providers.
      • More investment in health systems; outcomes, and education; and-
      • Better care of the environment and biodiversity, which directly affects people’s health safety.

    Thailand’s outstanding example

    • Sixth rank on Health Security Index: That Thailand is ranked sixth in the Health Security Index- the highest ranking for an Asian country.
      • The rank says a great deal about the country’s track record in disease prevention, early detection, and rapid response linked to investments in its public health system.
      • When the deadly Middle East Respiratory Syndrome (MERS), also caused by a coronavirus, broke out in 2015, Thailand quickly notified the WHO of its first confirmed case and acted transparently to arrest the spread.
      • This is in stark contrast to delayed notification by China’s officials of the recent outbreak.

    India’s record in past outbreaks

    • Underscoring inadequacies: The influenza A (H1N1) outbreaks since 2009 in Rajasthan, Maharashtra, Tamil Nadu and other States have acutely underscored the need for better detection, awareness of symptoms and quarantining.
    • Protocols for surveillance: Clearer protocols for all three types of surveillance are needed in all States.
      • And these protocols need to be communicated to health professionals at all levels and the public in local languages.

    Conducting stress tests on health system

    • Countries need to do the stress tests for their preparedness to deal with health emergencies.
    • Exposing the crucial gap: Each State in India should do this to expose crucial gaps in areas such as-
      • Adequacy and supply of diagnostic equipment.
      • Health facilities.
      • Hygienic practices, and-
      • Prevention and treatment protocols.
    • Ensuring strong supply chains: Queues of desperate shoppers trying to buy hand sanitizer, face masks and other protective products in Hong Kong and China highlight the need for strong supply chains for products that people need during health emergencies.

    The partnership between countries and with the private sector

    • Partnership to ensure supply chains: Partnerships between private and public sectors, and between countries– that can sustain supply chains and bolster the medical capacity of countries struggling to cope.
      • Collaborative approach in Asia: In Asia, collaborative approaches exist, for example, for combating tuberculosis, AIDS and malaria.
    • Need to do more: More is needed to tackle health emergencies on the scale of recent outbreak, particularly on funding.
      • Emergency loan option: There could be an emergency loan facility, with a “deferred drawdown option” as the World Bank uses for disasters, natural or health.
      • The loan option can help augment own resources in times of a public health catastrophe.
    • Investment is the best defence: But the best defence of all is to invest more, and more efficiently, in health and education to prepare populations and strengthen health services.
      • Low health expenditure: Health expenditure by the government in India is less than 5% of Gross Domestic Product, which is low for a middle-income country.
      • Spending at that level limits, among other things, the availability of health professionals during crises.
      • According to WHO, India has only 80 doctors per 1,00,000 people.

    Investment in health, education

    • Kerala’s experience: Kerala’s experience in 2018 with the deadly Nipah virus showed the value of investing in education and health over the long term.
    • What measures were taken in Kerala? The availability of equipment for-
      • Quick diagnosis.
      • Measures to prevent diseases from spreading and-
      • Public information campaigns- all helped to keep the mortality rate from the Nipah virus relatively low.
      • Having capable public health professionals helped in the information exchange with WHO and other international bodies.

    The relation between environmental degradation and health

    • A new dimension of new pathogens: One of the many dimensions of new pathogens that is getting increased attention is the link with environmental degradation.
    • The relation between pollution and viral respiratory infection: The interaction between particulate matter from pollution and viral respiratory tract infections, especially in the young and the elderly, as well as the malnourished, has been increasingly noted in epidemiological studies.
      • Many of the highest air pollution readings are being recorded in Indian cities.
    • Most vulnerable country: An HSBC study of 67 countries ranks India as the most climate-vulnerable one because of the impact of severe temperature increases and declines in rainfalls.
      • Reasons for vulnerability: The effects of such occurrences are magnified by the high density of the country’s population, the sheer number of people in harm’s way, and the high incidence of poverty.
      • Research is increasingly connecting global warming to vector-borne viruses.

    Conclusion

    The dangerous trend for disease spillovers from animals to humans can be traced to increased human encroachment on wildlife territory; land-use changes that increase the rate of human-wildlife and wildlife-livestock interactions; and climate change. Protecting the precious biodiversity should be a priority.

     

     

     

     

     

     

     

  • Assisted Reproductive Technology Regulation Bill, 2020

     

    The Union Cabinet has approved the Assisted Reproductive Technology Regulation Bill, 2020 to monitor medical procedures used to assist people to achieve pregnancy.

    What is ART?

    • Assisted reproductive technology (ART) is used to treat infertility.
    • Assisted reproductive technology includes medical procedures used primarily to address infertility.
    • This subject involves procedures such as in vitro fertilization, intracytoplasmic sperm injection, cryopreservation of gametes or embryos, and/or the use of fertility medication.

    Highlights of the bill

    • National Board: The Bill provides for a national Board which will lay down a code of conduct to be observed by those operating clinics.
    • Standardization: It will also formulate minimum standards for laboratory and diagnostic equipment and practices to be followed by human resources employed by clinics and banks.
    • National registry: Under the proposed law, a national registry and registration authority will maintain a database to assist the national Board to perform its functions.
    • Confidentiality clause: The Bill will also ensure confidentiality of intending couples and protect the rights of the child.

    Strict punishment:

    • India has one of the highest growths in the number of ART centres and ART cycles performed every year.
    • India has become one of the major centres of this global fertility industry, with reproductive medical tourism becoming a significant activity.
    • This has also introduced a plethora of legal, ethical and social issues; yet, there is no standardisation of protocols and reporting is still very inadequate.
    • The Bill thus proposes stringent punishment for those who practise sex selection; indulge in sale of human embryos or gametes and those who operate rackets.

    Other such Bills

    Taken together, theses proposed legislations create an environment of safeguards for women’s reproductive rights, addressing changing social contexts and technological advances.

    Surrogacy Regulation Bill 2020

    • The Surrogacy (Regulation) Bill, 2020 proposes to regulate surrogacy in India by establishing National Board at the central level and State Boards and Appropriate Authorities in the States and Union Territories.
    • The major benefit of the Act would be that it will regulate the surrogacy services in the country.
    • While commercial surrogacy will be prohibited including sale and purchase of human embryos and gametes, ethical surrogacy to the Indian Married couple, Indian Origin Married Couple and Indian Single Woman (only widow or Divorcee) will be allowed on fulfillment of certain conditions.
    • As such, it will control the unethical practices in surrogacy, prevent commercialization of surrogacy and will prohibit potential exploitation of surrogate mothers and children born through surrogacy.

    Medical Termination Pregnancy Amendment Bill 2020

    • The Medical Termination of Pregnancy Act, 1971 (34 of 1971) was enacted to provide for the termination of certain pregnancies by registered medical practitioners and for matters connected therewith or incidental thereto.
    • The said Act recognised the importance of safe, affordable, accessible abortion services to women who need to terminate pregnancy under certain specified conditions.
    • Besides this, several Writ Petitions have been filed before the Supreme Court and various High Courts seeking permission for aborting pregnancies at gestational age beyond the present permissible limit on the grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.

  • Powering the health-care engine with innovation

    Context

    India needs to tap the potential of the health-care start-ups in India and make the necessary provision to deal with the problems in the adoption of innovations in health-care.

    Expanding the supply side

    • Need to increase the hospital empanelled: As the scale of this scheme grows, a key area of focus is-
      • To expand the secondary and tertiary hospitals empanelled under PM-JAY and
      • To ensure their quality and capacity while keeping the costs down.
    • The ratio of doctors and beds: At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
    • 3% hospitalisation under the scheme: In the coming years, considering 3% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
      • This means physical and human infrastructure capacity would need to be augmented vastly.
    • Need for more beds: Conservative estimates suggest that we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
    • Long-term strategy: While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.
    • Mainstreaming innovation: A strong, yet under-tapped lever for accelerating health system efficiency and bridging these gaps is mainstreaming innovation in the Indian health system.

    Transformative solutions

    • India’s burgeoning entrepreneurial spirit combined with a systematic push for the development of a start-up ecosystem has led to a plethora of innovations in health care.
    • It is estimated that there are more than 4,000 health-care technology start-ups in India.
    • How do start-ups help? Today, start-ups are working to bring-
      • Innovative technologies and business models that leapfrog infrastructure.
      • Human resources.
      • Cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
    • How other innovations could help?
      • Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings.
      • Tele-ICU platforms to bridge the gap in high-skilled critical care personnel.
      • Centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably are all no longer just theoretical ideas.
    • Time to implement transformative solutions: It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.

    Challenges in mainstreaming healthcare innovations

    • Lack of uniform regulatory standards: One challenge is non-uniform regulatory and validation standards.
      • Regulations evolving in India: Regulatory requirements, specifically for biomedical start-ups, are still evolving in India.
      • As a result, hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
      • Government to overhaul standards: The government is now pushing ahead to overhaul Indian med-tech regulatory standards and product standards which will help bridge this trust-deficit.
    • Difficulty in the promotion of start-ups: Another problem in promoting start-ups is the operational liquidity crunch due to a long gestation period.
      • Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned.
      • Long gestation period: The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
    • Lack of framework to adopt innovation: Another hurdle is the lack of incentives and adequate frameworks to grade and adopt innovations.
      • Health-care providers and clinicians, given limited bandwidth, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations.
      • This leads to limited traction for start-ups promoting innovative solutions.
    • Procurement challenges: Start-ups also face procurement challenges in both public and private procurement.
      • They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.
      • Private procurement is complicated by the presence of a fragmented customer base and limited systematic channels for distribution.

    Way forward

    • Identify promising market-ready products: To accelerate the process of mainstreaming innovations within the hospital system in India-
      • We need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
    • Facilitate standard operational validation studies: There is a need to-
      • Facilitate standardised operational validation studies that are required for market adoption.
      • To help ease out the start-up procurement process such that these solutions can be adopted with confidence.
      • This, in effect, will serve the entire ecosystem of health-care innovators by opening up health-care markets for all.
    • Need to develop an interface between hospital and start-ups: A strong theme in mature health-care systems in other parts of the world is a vibrant and seamless interface between hospitals and health-care start-ups.
      • Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where-
      • Hospitals actively engage with health-care start-ups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
      • Start-ups as collaborators: Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals.

    Conclusion

    The dream of an accessible, affordable and high-quality health-care system for all, will be achieved when we work in alignment to complement each other and jointly undertake the mission of creating an Ayushman Bharat.

  • Battling the bug

    Context

    With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected. This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.

    Cause of worry turned into a reality

    • Public health experts have worried most about an animal virus-
      • That gets into humans.
      • Causes human-to-human transmission.
      • Has high infectivity and a range of clinical severity.
      • With no human immunity, no diagnostic tests, drugs or vaccines.
    • An emerging virus, called the 2019 novel coronavirus (2019-nCoV), appears to be just that.
    • With the World Health Organisation declaring it a Public Health Emergency of International Concern (PHEIC), this outbreak is now a pandemic.

    What is coronavirus

    • Group of animal virus: Coronaviruses are a group of animal viruses identified by their crown-like (corona) appearance under a microscope.
    • SAARS connection: The 2019-nCoV belongs to this group of viruses, six of which, including the 2003 Severe Acute Respiratory Syndrome (SARS) and the 2012 Middle East Respiratory Syndrome (MERS) viruses, were earlier known to cause disease in humans.
      • Genetic similarity with other viruses: Genetic sequencing of the virus from five patients showed it to be 5 per cent identical to the SARS virus.
    • Bats as hosts: Since the SARS outbreak in 2003, scientists have discovered a large number of SARS-related coronaviruses from their natural hosts-bats.
      • Previous studies have shown some of these bat coronaviruses to have the potential to infect humans.
      • Genetic sequencing showed it to human coronavirus to be over 96 per cent identical to a bat coronavirus.
      • Thus, 2019-nCoV clearly originated from bats, jumped into humans either directly or through an intermediate host, and adapted itself to human-to-human transmission.
      • Bats are a particularly rich reservoir for viruses with the potential to infect humans.
      • Examples of these include viruses such as Hanta, Rabies, Nipah, Ebola and Marburg viruses, and others that have caused high levels of mortality and morbidity in humans.
      • India has 117 species and 100 sub-species of bats, but we know little about the viruses they harbour and their disease potential.

    India’s response

    • India’s response includes-
      • Surveillance of arriving passengers at airports.
      • Awareness drives in the border states.
      • Designation of hospitals with isolation wards and the availability of protective gear (e.g. masks) to health workers.
      • SOP: There are clear operating procedures for sample collection and its transport to the National Institute of Virology, Pune, which is the nodal testing centre.
      • A self-declaration mechanism is in place and a 24×7 telephone helpline has been set up.
    • Two areas of concern
      • 1. Promotion of untested medicines: There is mixed messaging promoting AYUSH products that are untested and of questionable efficacy.
      • 2. India- a hot zone of zoonotic pathogens: India has been a “hot zone” for the emergence of new zoonotic (animal-derived) pathogens for over a decade.
      • But we continue to lack the capacity to quickly identify, isolate and characterise a novel pathogen.
      • Example of China: China is a good example of how investments in research and public health will allow it to take a lead on developing diagnostic tests, vaccines and drugs for this new virus. We must do the same and prepare for the future.
    • Disruption in global supply chains and concerns for India
      • With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected.
      • This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.
      • Disruption in medicine supply: The Indian pharmaceuticals industry imports about 85 per cent of its active pharmaceutical ingredients from China.
      • Any disruption in this supply chain would adversely affect the availability of medicines in India, which would be required in an outbreak situation.
      • Need to support local pharma. industry: India must, therefore, take steps to correct this imbalance and support the local pharmaceuticals industry in reducing its dependence on China

    Possible scenarios

    • Public health experts estimate that the epidemic will peak in three months.
    • From here on, there are a few possible scenarios, but which of these would play out is hard to guess.
    • 1st possibility: There could be very large numbers of cases and global spread of the virus with a low CFR of 0.1-0.5 per cent, like the bad flu. Or the same with increased CFR, which would lead to significant mortality.
    • 2nd possibility: It is also possible that the outbreak spiralled in China due to a combination of factors not present elsewhere, such as population density, food habits and the Chinese New Year, which sees large population movements.
      • It is also possible that the pandemic may not sustain outside China and die out like the 2003 SARS outbreak.
    • Whatever be the case, surveillance and sensible public health measures will be needed over the next few months.

    Conclusion

    India escaped the 2003 SARS and 2012 MERS outbreaks largely unscathed. This may still be the case with 2019-nCoV, but the laws of probability are likely to catch up soon. It would help to invest, build capacity and be ready.

     

     

     

     

  • In news: Two-child Norm

    A Rajya Sabha MP has introduced a Private Member’s Bill on two-child norms.

    Key propositions of the Bill

    • Essentially, the Bill aims to amend the Constitution in order to incentivise limiting families to two children by offering tax concessions, priority in social benefit schemes and school admissions, among other things.
    • It proposes incentives in taxation, education and employment for people who limit their family size to two children.

    Article 47A

    • The Bill has sought the incorporation of a new provision, Article 47A in Part IV of the Constitution, to withdraw all concessions from people who fail to adhere to the “small-family” norm.
    • Article 47A says the following:

     “47A. The State shall promote small family norms by offering incentives in taxes, employment, education etc. to its people who keep their family limited to two children and shall withdraw every concession from and deprive such incentives to those not adhering to small family norm, to keep the growing population under control.”

    Note: Article 47 of the Indian Constitution is one of the DPSP  which directs the State to raise the level of nutrition and the standard of living and to improve public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of intoxicating drinks and drugs which are injurious to health.

    Why such Bill?

    • The Bill’s Statement of Object and Reasons states that the fact that India’s population has already crossed 125 crore is “really frightening”.
    • It goes on to say that India’s population has doubled in the last 40 years and that it is expected to unseat China as the world’s most populous nation in the next couple of decades.
    • Despite the fact that we have framed a National Population Control Policy, we are the second most populous country in the world.
    • Further, the population explosion will cause “many problems” for our future generations.
    • The Bill also makes a reference to “overburdened” natural resources that are overexploited because of overpopulation.

    Statewide policies relating to two-child norms

    Assam Cabinet has recently decided that those with more than two children will be ineligible for government jobs from 2021. Other states with similar norms:

    Rajasthan: For government jobs, candidates who have more than two children are not eligible for appointment.

    Madhya Pradesh: The state follows the two-child norm since 2001. Under Madhya Pradesh Civil Services (General Condition of Services) Rules, if the third child was born on or after January 26, 2001, one becomes ineligible for government service. The rule also applies to higher judicial services.

    Telangana: Under Section 19 (3) read with Sections 156 (2) and 184 (2) of Telangana Panchayat Raj Act, 1994, a person with more than two children shall be disqualified from contesting election. However, if a person had more than two children before May 30, 1994, he or she will not be disqualified.  The same sections in the Andhra Pradesh: AP Panchayat Raj Act, 1994, apply to Andhra Pradesh, where a person having more than two children shall be disqualified from contesting election.

    Gujarat: In 2005, the government amended the Gujarat Local Authorities Act. The amendment disqualifies anyone with more than two children from contesting elections for bodies of local self-governance — panchayats, municipalities and municipal corporations.

    Maharashtra: The Maharashtra Zilla Parishads And Panchayat Samitis Act disqualifies people who have more than two children from contesting local body elections (gram panchayats to municipal corporations). The Maharashtra Civil Services Rules, 2005 states that a person having more than two children is disqualified from holding a post in the state government. Women with more than two children are also not allowed to benefit from the Public Distribution System.

    Karnataka: The Karnataka (Gram Swaraj and Panchayat Raj) Act, 1993 does not bar individuals with more than two children from contesting elections to local bodies like the gram panchayat. The law, however, says that a person is ineligible to contest “if he does not have a sanitary latrine for the use of the members of his family”.

    Odisha: The Odisha Zilla Parishad Act bars those individuals with more than two children from contesting.

  • Riding on data for mobility

    Context

    Data-based governance can assist in reducing traffic congestion, as illustrated by a pilot study in Hyderabad.

    How the Digital revolution is transforming lives

    • Seamless and efficient interaction: The digital revolution has made interactions between humans and machines, and among citizens, governments and businesses, seamless and efficient.
    • Helping efficient delivery of services: Today, e-governance enables and empowers citizens to directly engage with the state, thereby eliminating barriers in the delivery of public services.
    • The next wave of transformation: The next wave of transformation in digital governance is at the intersection of data and the public good.
      • Data as a strategic asset: The key to this transformation lies in incorporating data as a strategic asset in all aspects of-
      • Policy.
      • Planning.
      • Service delivery and-
      • Operations of the government.

    Transportation system improvement by leveraging Digital revolution

    • Loss caused by the congestion
      • Congestion caused an estimated $24 billion to the four metro cities in India in 2018.
      • Given the limited land resources available, the key to solving congestion lies in improving the efficiency of existing transportation systems.
    • How can Digital revolution help tackle the problem?
      • An efficient transportation system would help ease congestion, reduce travel time and cost, and provide greater convenience.
      • How it will work? Data from multiple sources such as-
      • CCTV cameras.
      • Automatic traffic 
      • Map services and-
      • Transportation service providers could be used.
    • Results of the previous studies
      • London example: A study by Transport for London estimates that its open data initiative on sharing of real-time transit data has helped add ÂŁ130 million a year to London’s economy by improving productivity and efficiency.
      • Results from China: In China, an artificial intelligence-based traffic management platform developed by Alibaba has helped improve average speeds by 15%.

    Hyderabad Open Transit Data portal

    • Hyderabad Open Transit Data, launched by Open Data Telangana, is the country’s first data portal.
      • What does it do? It publishes datasets on bus stops, bus routes, metro routes, metro stations, schedules, fares, and frequency of public transit services.
    • The objective of the portal: The objective is to empower start-ups and developers to create useful mobility applications.
      • The datasets were built after an intensive exercise carried out by the Open Data Team and Telangana State Road Transport Corporation to collect, verify and digitise the data.
    • Collaboration with the private sector: Hyderabad has also begun collaborating with the private sector to improve traffic infrastructure.
      • MoU with Ola Mobility Institute: One such partnership followed a Memorandum of Understanding signed between the Telangana government and Ola Mobility Institute.
      • Monitoring the quality of roads in the city: Under this collaboration, Ola has developed a tool, Ola City Sense, to provide data-based insights that can monitor the quality of Hyderabad’s roads and identify bad quality patches.
      • Other areas in which the data is used: The information thus given is useful not only for carrying out road repairs, it also helps officials take initiatives to improve road safety, monitor quality of construction, and study the role of bad roads in causing congestion.
    • A pilot project to prioritisation of repairs: A pilot was implemented in a municipal zone to gauge the efficacy of the data in supporting road monitoring and prioritisation of repairs.
      • The early results of this pilot project were encouraging. The dashboard helped city officials plan the pre-monsoon repair work and budget for repairs last year.

    Conclusion

    • The willingness of the government to apply data-based insights: The Hyderabad project and the pilot demonstrated the willingness of government departments to apply data-based insights for better decision making.
      • This could also serve as a model for other cities to emulate.
    • Making the departments data-centric: The Hyderabad example also shows that governments can make their departments data-centric by-
      • Institutionalising data collection.
      • Building technology platforms.
      • And helping the departments develop the capacity to handle the insights generated from the data.
      • Smart cities as a starting point: Command and control centres under the ‘smart cities’ initiative can be an ideal starting point.
      • Data security and privacy: Such interventions, however, also need to address genuine concerns around data security and privacy.

     

     

  • Nutrition and the Budget’s fine print

    Context

    There are well-equipped schemes to address the malnutrition, plugging the policy gaps is the problem.

    Nutrition and hunger in India

    • Global Hunger Index rank 102: A few months ago, the Global Hunger Index, reported that India suffers from “serious” hunger, ranked 102 out of 117 countries.
    • Only one-tenth of children getting proper diet: Just a tenth of children between six to 23 months are fed a minimum acceptable diet.
    • Urgency reflected in the budget: The urgency around nutrition was reflected in the Union Finance Minister’s Budget speech, as she referred to the “unprecedented” scale of developments under the scheme for Holistic Nutrition, or POSHAN Abhiyaan, the National Nutrition Mission with efforts to track the status of 10 crore households.
    • The Economic Survey notes that “Food is not just an end in itself but also an essential ingredient in the growth of human capital and therefore important for national wealth creation”.
    • How malnutrition affects? Malnutrition affects cognitive ability, workforce days and health, impacting as much as 16% of GDP (World Food Programme and World Bank).

    Addressing Nutrition through Agriculture

    • Multiple dimension of malnutrition: There are multiple dimensions of malnutrition that include-
      • Calorific deficiency.
      • Protein hunger.
      • Micronutrient deficiency.
    • Addressing the issue through Agriculture: An important approach to address nutrition is through agriculture.
      • The Bharatiya Poshan Krishi Kosh which was launched in 2019 is a recent attempt to bridge this gap.
      • The krishi kosh was launched by Ministry of Women and Child Development along with Bill & Melinda Gates Foundation (BMGF).
      • Existing schemes can well address India’s malnutrition dilemma. Following is the analysis of budgetary allocation and expenditure in the previous year.

    First- Calorific deficiency

    • The Integrated Child Development Services (ICDS) scheme provides a package of services including-
      • Supplementary nutrition.
      • Nutrition and health education.
      • Health check-ups and
      • Referral services addressing children, pregnant and lactating mothers and adolescent girls, key groups to address community malnutrition, and which also tackle calorific deficiency and beyond.
      • Underutilisation of funds: For 2019-20, the allotment was â‚č27,584.37 crore but revised estimates are â‚č24,954.50 crore, which points to an underutilisation of resources.
      • Which area needs the emphasis: The allocation this year is marginally higher, but clearly, the emphasis needs to be on implementation.
    • Mid-Day Meal Scheme: Another pathway to address hunger is the Mid-Day Meal Scheme, to enhance the nutrition of schoolchildren.
      • Here too, the issue is not with allocation but with expenditure.
      • The 2019-20 Budget allocation was â‚č11,000 crore and revised estimates are only â‚č9,912 crores.

    Second-Protein Hunger

    • Contribution of pulses: Pulses are a major contributor to address protein hunger.
      • Underutilisation of funds: A scheme for State and Union Territories aims to reach pulses into welfare schemes (Mid-Day Meal, Public Distribution System, ICDS) has revised estimates standing at just â‚č370 crores against â‚č800 crore allocation in the 2019-20 Budget.

    Third-micronutrient deficiency

    • Horticulture Mission: The Horticulture Mission can be one of the ways to address micronutrient deficiency effectively, but here too implementation is low.
      • Revised estimates for 2019-20 stand at â‚č1,583.50 crores against an allocation of â‚č2,225 crores.
    • National Millet Mission: In 2018-19, the Government of India launched a national millet mission which included renaming millets as “nutri-cereals” also launching a Year of Millets in 2018-19 to promote nutritious cereals in a campaign mode across the country.
      • This could have been further emphasised in the Budget as well as in the National Food Security Mission (NFSM) which includes millets.
      • Under-utilisation of funds: The NFSM strains to implement the allocation of â‚č2,000 crores during 2019-20, as revised expenditures stand at â‚č1,776.90 crore.
      • Need to sustain the momentum: As millets have the potential to address micronutrient deficiencies, the momentum given to these cereals needs to be sustained.

    POSHAN Abhiyan and issues involved

    • 72% expenditure on technology: The National Nutrition Mission which is a major initiative to address malnutrition, had 72% of total expenditure going into “Information and Communication Technology.
      • Misplaced focus: The focus of the bulk of the funding has been on technology, whereas, actually, it is a convergence that is crucial to address nutrition.
      • Under-utilisation of funds: Only 34% of funds released by the Government of India were spent from FY 2017-18 to FY 2019-20 till November 30, 2019.
      • Limiting the possibility of an increase in the allocation: With underspending, allocations for subsequent years will also be affected, limiting the possibility of increasing budgets and the focus on nutrition schemes.

    Agriculture-nutrition link

    • The agriculture-nutrition link is another piece of the puzzle.
    • Link not explicitly mentioned: While agriculture dominated the initial Budget speech, the link between agriculture and nutrition was not explicit.
      • Why the link is important: The link is important because about three-fifths of rural households are agricultural in India (National Sample Survey Office, 70th round)
      • The malnutrition rates, particularly in rural areas are high (National Family Health Survey-4).
      • Need for greater emphasis: Agriculture-nutrition linkage schemes have the potential for greater impact and need greater emphasis.

    Way forward

    • Focus: Focus on nutrition-related interventions, beyond digitisation.
    • Bring all departments in one place: Intensify the convergence component of POSHAN Abhiyaan, using the platform to bring all departments in one place to address nutrition.
    • Nutrition based activities by farmer-producer: Direct the announcement to form 10,000 farmer producer organisations with an allocation of â‚č500 crores to nutrition-based activities.
    • Youth schemes: Promotion of youth schemes to be directed to nutrition-agriculture link activities in rural areas.
    • Emphasis on fund allocation: Give explicit emphasis and fund allocation to agriculture-nutrition linked schemes.
    • Early disbursement and utilisation of funds: Ensure early disbursement of funds and optimum utilisation of schemes linked to nutrition.

    Conclusion

    Nutrition goes beyond just food, with economic, health, water sanitation, gender perspectives and social norms contributing to better nutrition. This is why the implementation of multiple schemes can contribute to better nutrition.

     

  • Medical Devices (Amendment) Rules, 2020

    The Ministry of Health and Family Welfare has notified changes in the Medical Devices Rules, 2017 to regulate medical devices on the same lines as drugs under the Drugs and Cosmetics Act, 1940.

    Medical Devices (Amendment) Rules, 2020

    • These rules are applicable to devices intended for internal or external use in the diagnosis, treatment, mitigation or prevention of disease or disorder in human beings or animals” (as notified by the ministry).
    • It requires online registration of these devices “with the Central Licensing Authority through an identified online portal established by the Central Drugs Standard Control Organisation for this purpose.
    • Among the information that the manufacturer has to upload are “name & address of the company or firm or any other entity manufacturing the medical device along with name and address of manufacturing site.
    • It also need to upload certificate of compliance with respect to ISO 13485 standard accredited by National Accreditation Board for Certification Bodies or International Accreditation Forum.
    • This would mean that every medical device, either manufactured in India or imported, will have to have quality assurance before they can be sold anywhere in the country.
    • After furnishing of the above information a registration number will be generated. Manufacturer shall mention the registration number on the label of the medical device.

    What are the items covered under the new Rules?

    • A large number of commonly used items including hypodermic syringes and needles, cardiac stents, perfusion sets, catheters, orthopaedic implants, bone cements, lenses, sutures, internal prosthetic replacements etc are covered under the new rules.
    • For some items such as sphygmomanometers (used to monitor blood pressure), glucometers (to check blood sugar), thermometers, CT scan and MRI equipment, dialysis and X-ray machines, implants etc, different deadlines for compliance have been set.
    • For example for the first three, it is January 2021, for the others it is April next year. For ultrasound equipment, it is November 2020.

    Is this a sudden move?

    • This has been in the offing for some time now.
    • In October last year, the ministry had circulated copies of the then proposed notification for public comments following recommendations of the Drugs Technical Advisory Board (DTAB), which is the highest technical body for these decisions and has experts among its members.
    • In April last year, the DTAB had recommended that all medical devices should be notified as “drugs” under the drug regulation law to ensure they maintain safety and quality standards.
    • The notification makes it clear that the government has issued it in consultation with the DTAB.

    Why was the move required?

    • For much of the last one year, the health sector has been at the centre of attention following revelations about faulty hip implants marketed by pharma major Johnson & Johnson.
    • This has caused major embarrassment to the government, too, as it exposed the lack of regulatory teeth when it came to medical devices.
    • The matter dragged on, exposing the regulatory loopholes until finally the company agreed in court to pay Rs 25 lakh each to the 67 people who had had to undergo revision surgeries because the implants were defective.
    • That is really where the discussion started about regulation of medical devices.

    What are the penal provisions under Indian law?

    • There are various penal provisions under the Drugs and Cosmetics Act, 1940 for various kinds of offences. Manufacture or sale of substandard items is punishable with imprisonment of at least 10 years, which may extend to imprisonment for life.
    • There is also a provision for fine that will “not be less than Rs 10 lakh rupees or three times value of the confiscated items”.