💥Join UPSC 2027,2028 Mentorship (July Batch) + XFactor Notes & Microthemes PDF

Subject: Health

  • Why is the centre revising the NFSA 

    Why in the News?

    The Union Food and Public Distribution Department has published a draft amendment to the National Food Security Act (NFSA), 2013 converting the Antyodaya Anna Yojana (AAY) entitlement from a household-based to a per-capita formula. Tamil Nadu and Kerala have objected, arguing the change will cut monthly foodgrain allocations for smaller households even though it is framed as an equity correction. The dispute revives a food-politics fault line between the Centre and these two States that traces back to the NFSA’s 2013 enactment.

    What has the Centre proposed, and what does it claim to fix?

    1. Current rule: Every Antyodaya Anna Yojana (AAY) household receives 35 kg of foodgrains per month, regardless of household size.
    2. Proposed rule: Each person in an AAY household is entitled to 7 kg per month, subject to a ceiling of 35 kg per household.
    3. Legal provision amended: The first provision to Section 3(1) of the NFSA, which governs the right to subsidised foodgrains for eligible households.
    4. Stated rationale: The F&PD Department says the household-based system causes intra-category inequity. Smaller households get a higher per-capita share. Larger households get a lower per-capita share that can fall below what priority households receive.
    5. Stated objective: The amendment aims to make allocation more rational and align entitlements with nutritional norms.
    6. Consultation window: Public comments were invited till July 13, 2026.
    7. Gap in the amendment: The draft does not address inclusion of ineligible persons as beneficiaries. This problem remains a State-level issue.

    Why have Tamil Nadu and Kerala historically treated food policy as high-stakes politics?

    1. Kerala’s PDS legacy: Kerala traces informal food distribution mechanisms to the erstwhile princely State of Travancore and launched a formal Public Distribution System (PDS) in 1962, three years before the Food Corporation of India (FCI) was established.
    2. Tamil Nadu’s political precedent: Incumbent governments lost power in 1952 and 1967 over failure to manage rice shortages, making rice policy a lasting political sensitivity.
    3. Kerala’s resistance to the 2013 NFSA: The Congress-led UDF government, despite the Congress-led UPA pushing the law at the Centre, resisted implementation. It argued the law would drop a large number of poor families and impose a heavy financial burden on the State.
    4. Delayed Kerala rollout: Chief Minister Oommen Chandy committed to enforcing the NFSA, but the formal decision was taken only under his successor, Pinarayi Vijayan.
    5. Tamil Nadu’s universal rice policy: Chief Minister Jayalalithaa opposed the NFSA after her government began distributing free rice to all ration cardholders in 2011, regardless of economic status.
    6. Concession extracted in 2013: Tamil Nadu secured a Central guarantee that its then-existing allocation levels would be legally protected under the NFSA.
    7. Delayed adoption: Both southern States joined the rest of the country in implementing the NFSA only in November 2016.

    Why does a per-capita formula built on a household ceiling disadvantage southern States?

    1. Mechanical effect of the formula: A household with fewer than five members receives less than 35 kg under the per-capita rule, since 7 kg multiplied by fewer than five persons falls short of the existing ceiling.
    2. Kerala’s structural exposure: Kerala’s Food Minister has argued that States characterised by nuclear families will lose out, since Kerala took the position in 2013 that AAY cardholders deserved “special consideration,” a stance it maintains.
    3. Tamil Nadu’s quantified loss: The State’s monthly allocation is projected to fall from 65,261 tonnes to 42,040 tonnes under the new formula.
    4. Scale of exposure in Tamil Nadu: Of 18.64 lakh AAY households, 15.75 lakh have fewer than five members, covering 58.51 lakh of the State’s 69.27 lakh AAY beneficiaries.
    5. Non-substitutability argument: Rice is a staple across all three daily meals for AAY cardholders and cannot be replaced with market purchases without significant out-of-pocket cost.
    6. North-South divide argument: Right to Food Campaign functionary Anuradha Talwar has argued that northern States, with larger average family sizes, will receive higher allocations under the new formula while southern States lose out.
    7. South’s collective stake: The five southern States and Puducherry together hold 52.51 lakh of India’s 250 lakh AAY household ceiling, about one-fifth of the national total, making the region’s exposure to the formula change substantial in absolute terms.

    What is the way forward, and does it resolve the underlying tension?

    1. Process concern: A change of this scale should have been subjected to wider public scrutiny before a consensus was sought, according to food policy commentary cited in the report.
    2. Middle-path proposal: Tamil Nadu Progressive Consumer Centre president T. Sadagopan has suggested a flat allocation of 30 kg per household, irrespective of family size, as a compromise.
    3. Fiscal rationale for the middle path: A flat 30 kg allocation would still let the Union government reduce its overall subsidy bill compared to the current 35 kg ceiling.
    4. Implementation context: Current off-take and distribution data for the financial year up to May 2026 show uneven utilisation across southern States relative to their allocations, indicating that formula design alone will not resolve execution gaps in the PDS chain.
    5. Unresolved gap: Neither the Centre’s draft nor the proposed middle path addresses the separate, State-level problem of ineligible persons remaining on beneficiary lists.

    Conclusion

    The NFSA amendment corrects a genuine per-capita inequity within the AAY category, but the household ceiling built into the new formula shifts the burden onto smaller-household southern States, reviving a federal food-politics conflict rooted in each State’s distinct PDS history. The amendment leaves the parallel problem of ineligible beneficiaries at the State level untouched, meaning one inequity is corrected while another persists. A flat per-household allocation remains a proposed middle path, but the Centre has not formally responded to it.

    PYQ Relevance

    [UPSC 2013] What are the salient features of the National Food Security Act, 2013? How has the Food Security Bill helped in eliminating hunger and malnutrition in India?

    Linkage: The PYQ examines the provisions and effectiveness of the NFSA as a rights-based framework for ensuring food and nutritional security. The proposed shift from a fixed 35 kg entitlement per AAY household to 7 kg per person, capped at 35 kg, enables a critical assessment of whether rationalising foodgrain allocation may weaken existing NFSA entitlements and affect vulnerable households unevenly.

  • Poshan Tracker

    Why in News?

    The Ministry of Women and Child Development (MoWCD) highlighted the achievements of the Poshan Tracker, India’s real time nutrition monitoring platform under Mission Poshan 2.0.

    What is Poshan Tracker?

    • Mobile based application launched in March 2021.
    • Developed by MoWCD with the National e-Governance Division (NeGD).
    • Digital backbone of POSHAN Abhiyaan.
    • Enables real time monitoring of nutrition, beneficiaries, and Anganwadi services.

    About POSHAN Abhiyaan

    • Launched on 8 March 2018.
    • India’s flagship National Nutrition Mission.
    • In 2021, merged with Anganwadi Services and Scheme for Adolescent Girls under Mission Saksham Anganwadi and Poshan 2.0.

    Key Features

    • Aadhaar based beneficiary authentication.
    • Facial Recognition System (FRS) for service verification.
    • Digital home visit scheduler.
    • Poshan Calculator based on WHO Child Growth Standards.
    • Tracks stunting, wasting, underweight, SAM, MAM, and obesity.
    • Provides ECCE learning content and Poshan Helpline (1515).

    Achievements (May 2026)

    • Covers 28 States and 8 UTs.
    • 8.93 crore beneficiaries registered.
    • 7.7 crore children tracked through Aadhaar authenticated database.
    • 6.3 crore children (0 to 5 years) monitored for growth (about 94% coverage).
    • 5.5 crore beneficiaries received Supplementary Nutrition for at least 15 days.

    Significance

    • Enables evidence based nutrition governance.
    • Reduces leakages and duplicate beneficiaries.
    • Strengthens Anganwadi service delivery.
    • Supports Digital India and Viksit Bharat.

    Prelims Facts

    • POSHAN Abhiyaan: 2018.
    • Poshan Tracker: March 2021.
    • Nodal Ministry: Ministry of Women and Child Development.
    • Uses WHO Child Growth Standards.
    • Operates under Mission Saksham Anganwadi and Poshan 2.0.

    [2023] Consider the following statements in the context of interventions being undertaken under Anaemia Mukt Bharat Strategy:
    1. It provides prophylactic calcium supplementation for pre-school children, adolescents and pregnant women.
    2. It runs a campaign for delayed cord clamping at the time of child- birth.
    3. It provides for periodic deworming to children and adolescents.
    4. It addresses non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis.
    How many of the statements given above are correct?

    [A] Only one

    [B] Only two

    [C] Only three

    [D] All four

  • Anaemia Mukt Bharat Abhiyaan (Revised Guidelines)

    Why in News?

    The Union Health Ministry has launched the revised operational guidelines for Anaemia Mukt Bharat (AMB), upgrading it to Anaemia Mukt Bharat Abhiyaan with a strengthened 7×7×7 framework, digital monitoring and expanded beneficiary coverage.

    What is Anaemia Mukt Bharat (AMB)?

    • Launched in 2018 under the National Health Mission (NHM).
    • Aims to reduce anaemia through a life-cycle approach.
    • Supports the POSHAN Abhiyaan and Anemia Reduction Strategy.

    Key Changes

    • 7×7×7 Strategy (Earlier 6×6×6): Added Low Birth Weight (LBW) babies (0 to 6 months) as the 7th beneficiary group.
    • New Intervention: Introduces “Eating Right” to promote: Iron-rich diets, Dietary diversity, and Nutrition counselling
    • Digital Monitoring: New institutional mechanism for digital tracking and programme monitoring.
    • T4 Strategy (Earlier T3): Test, Treat, Talk, and Track (new addition)
    • Better Clinical Management: Severe anaemia in pregnant/lactating women: Ferric Carboxymaltose and Iron Sucrose (IV therapy)
    • Integrated Digital Ecosystem:
      • JANANI Portal: Pregnant women
      • RBSK Portal: Children
      • U-WIN Portal: Child health records
      • Integrated into a unified AMB Abhiyaan Portal

    Causes of Anaemia

    • Iron deficiency, Folate deficiency, Vitamin B12 deficiency, Worm infestations, Infections, Inherited blood disorders, and Poor dietary diversity

    NFHS-5 Highlights

    • Children (6 to 59 months): 67.1%
    • Women (15 to 49 years): 57%
    • Pregnant women: 52.2%
    • Adolescent girls (15 to 19 years): 59.1%

    Significance

    • Early intervention for vulnerable infants.
    • Improved diagnosis and follow-up.
    • Promotes nutrition-sensitive interventions.
    • Strengthens digital health governance.
    • Supports reduction in maternal and child morbidity.

    [2023] Consider the following statements in the context of interventions being undertaken under Anaemia Mukt Bharat Strategy:
    1. It provides prophylactic calcium supplementation for pre-school children, adolescents and pregnant women.
    2. It runs a campaign for delayed cord clamping at the time of child- birth.
    3. It provides for periodic deworming to children and adolescents.
    4. It addresses non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis.
    How many of the statements given above are correct?

    [A] Only one

    [B] Only two

    [C] Only three

    [D] All four

  • Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All ‘ in India. Explain.

    The goal of ‘Health for All’, as envisioned in the Alma-Ata Declaration (1978) and reinforced through National Health Policy 2017, emphasizes universal, equitable, and accessible healthcare.

    Importance of Local Community-Level Healthcare Interventions

    Accessibility and Inclusivity – Brings primary healthcare closer to grassroot and reduces dependency on overburdened tertiary hospitals. Eg- Ayushman Bharat – Health and Wellness Centres (HWCs)

    Preventive and Promotive Health – Community health workers (e.g., ASHA, Anganwadi, ANM) enable early detection, immunization, maternal and child care.

    Local interventions are more trust-based, improving adoption of health services. Eg- ASHA workers act as a bridge between local communities and formal healthcare systems

    Cost-Effectiveness – Community-based preventive healthcare reduces out-of-pocket expenditure (OOPE). (Presently at 40%)

    Empowering Local Governance – Panchayati Raj Institutions (PRIs) and Village Health Sanitation and Nutrition Committees (VHSNCs) ensure decentralized planning and monitoring.

    Integration of Traditional and Modern Systems – Incorporates AYUSH practices alongside allopathy to widen reach and enhance preventive health.

    Empowering Women and Local Workforce – ASHAs and Anganwadi workers-over 10 lakh women-act as frontline caregivers.

    Community health networks enable rapid disease surveillance and emergency response. Eg- ASHAs and PRIs played a critical role in contact tracing during COVID-19

    Continuous community engagement increases awareness of disease prevention, hygiene, family planning, and nutrition.

    Key Challenges

    Shortage of trained manpower and high attrition among ASHA and ANM workers.

    Inadequate infrastructure at Sub-Centres and PHCs.

    Weak inter-sectoral convergence (between health, sanitation, and nutrition departments).

    Limited community participation due to lack of awareness and ownership.

    Way Forward

    Strengthen Primary Health Infrastructure: Upgrade all 1.5 lakh HWCs with telemedicine and diagnostics.

    Capacity Building: Continuous training and performance-based incentives for ASHA and ANM workers.

    Community Ownership: Empower Panchayats and SHGs in planning and monitoring local health outcomes.

    Technology Integration: Use eSanjeevani, digital health IDs, and mobile-based health tracking.

    Social Determinants Approach: Integrate health with nutrition, sanitation (Swachh Bharat), and clean energy (Ujjwala Yojana).

    Achieving Universal Health Coverage (UHC) by strengthening local healthcare will help realize the vision of “Swasth Bharat – Samriddh Bharat.”

  • In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss.

    ​​Social development rests on improving human well-being, equity, and inclusivity. Health care is a key determinant of human capital formation and social progress.

    Importance of Geriatric Care

    India’s elderly (60+ years) population is projected to reach 19.5% by 2050 (UNFPA).

    A larger elderly population implies growing dependency ratios and burden on families and social welfare

    Healthy and active elderly contribute to knowledge transfer, social cohesion, and community engagement.

    Reduces healthcare expenditure through preventive and primary care, enhancing productivity of caregivers.

    Healthy ageing aligns with the SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

    Key Interventions

    National Programme for Health Care of the Elderly (NPHCE) – dedicated geriatric units in district hospitals.

    Atal Vayo Abhyuday Yojana (AVYAY) – integrated senior citizen welfare.

    Ayushman Bharat – provides insurance for elderly with chronic diseases.

    Importance of Maternal Healthcare

    Foundation of Human Development – Maternal health directly influences infant mortality, child nutrition, and family welfare.

    Promotes inter-generational well-being, preventing malnutrition and anaemia cycles.

    Economic Impact – Reduces healthcare costs, improves labour participation of women,

    Healthier mothers mean healthier children and better learning outcomes, strengthening the human capital base.

    Key Interventions

    Janani Suraksha Yojana (JSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY) – incentives for institutional deliveries and nutrition.

    POSHAN 2.0 – integration of health and nutrition for pregnant and lactating women.

    LaQshya and SUMAN – focus on quality maternal and newborn care.

    Challenges in Maternal and Geriatric Healthcare

    Shortage of geriatric specialists, gynaecologists, and ASHA workers in rural areas.

    Regional Disparities – Maternal mortality in Assam (195) vs. Kerala (19).

    Out-of-pocket expenditure (OOPE) remains 40%, pushing poor households into poverty.

    Focus remains on curative rather than preventive health.

    Social and Cultural Barriers

    Patriarchal norms restrict women’s access to healthcare and nutrition.

    Elderly often face neglect, isolation, and financial insecurity.

    Way Forward

    Increase Public Health Expenditure to 2.5% of GDP as per National Health Policy 2017.

    Strengthen Home-Based Care Models and palliative services for the elderly.

    Decentralize Planning and Monitoring via Panchayati Raj Institutions. (Kerala Model)

    Strengthen ASHAs, ANMs, and geriatric caregivers at village level.

    Use of telemedicine (eSanjeevani) and digital records for continuum of care.

    A life-cycle approach to health is essential to achieve equitable and sustainable development and achieve Viksit Bharat @2047.

  • “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.(150 words)

    The Directive Principles of State Policy (Articles 38, 39, 42, and 47) mandate the State to ensure the health and well-being of all citizens.

    Moral Imperative of the Welfare State

    Right to Health forms part of Article 21 (Right to Life)

    Ensuring accessible, affordable, and equitable healthcare upholds social justice and human dignity.

    Primary healthcare represents state accountability towards vulnerable groups, fulfilling the ethos of “Sabka Saath, Sabka Vikas.”

    Reduces out of pocket expenditure and vicious cycle of poverty

    Primary Health as a Precondition for Sustainable Development

    SDG-3 emphasizes ensuring healthy lives and well-being for all.

    Social Development – Reduces disease burden, enhances productivity, and improves quality of life. Eg- Reduction in IMR (24) and MMR (97)

    Economic Development – World Bank (2023):

    Strong primary healthcare ensures better productivity, improved livelihoods, and universal healthcare access.

    Institutional Sustainability – Strengthens local governance and community participation in health planning. Eg- ASHA workers

    Supported by the Astana Declaration and National Health Policy 2017, which envisions comprehensive and affordable healthcare.

    Key Challenges

    India spends only 1.9% of GDP on healthcare (Economic Survey 2024), far below the WHO’s recommendation of 2.5%.

    Overemphasis on tertiary care- only 15% of public funds go to primary care

    Human resource shortage: Shortfall of 76% doctors at PHCs (RHS 2023).

    Urban-Rural Disparities (Spatial Inequity) – only 33% of doctors and 25% of hospital beds in rural areas.

    Way Forward

    Increase Public Health Expenditure to 2.5% of GDP as per National Health Policy 2017.

    Decentralize Planning and Monitoring via Panchayati Raj Institutions. (Kerala Model)

    Strengthen ASHAs, ANMs, and geriatric caregivers at village level.

    Use of telemedicine (eSanjeevani) and digital records for continuum of care.

    Strong primary and preventive healthcare is essential to achieve equitable and sustainable development and achieve Viksit Bharat @2047.

  • In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.

    The Directive Principles of State Policy (Articles 38, 39, 42, and 47) mandate the State to ensure the health and well-being of all citizens. However, increasing marketisation of healthcare has led to inequality and exclusion, necessitating proactive state intervention.

    Adverse Impacts of Marketisation

    High OOPE: Nearly 47% of health expenditure in India is borne out-of-pocket (NHA 2023).

    Around 75% of private hospitals are located in urban areas, creating rural-urban disparities

    Profit Orientation: Commercial motives undermine equity and quality.

    Violation of Right to Health under Article 21 (Olga Tellis Case)

    Neglect of Preventive and Primary Care – Private sector prioritises curative and high-profit specialities

    Erosion of Equity and Ethics: Healthcare becomes a commodity

    Weak Regulation and Accountability leads to price inflation, quackery, and malpractice.

    Brain Drain from Public Sector due to better pay and infrastructure in private sector

    Role of the State

    As per Article 38 and 47, the State must promote public health and ensure equitable access.

    Ensuring Universal Health Coverage (UHC): State intervention is key to fulfilling SDG-3 (Good Health and Well-being) and ensuring healthcare equity.

    Correcting Market Failures: Government must act as a regulator and service provider, ensuring affordability, quality, and inclusivity.

    Measures to Enhance Reach of Public Healthcare at the Grassroots Level

    Upgrade Sub-Centres, PHCs, and CHCs under the Ayushman Bharat. Ensure diagnostic labs, maternity wards, and telemedicine facilities at PHC level.

    Raise public health spending to 2.5% of GDP (National Health Policy 2017). Prioritise spending on rural and preventive healthcare.

    Recruit and train ASHA, ANM, and community health officers with proper incentives and infrastructure.

    Implement transparent PPPs for tertiary healthcare in district hospitals (NITI Aayog)

    Expand Pradhan Mantri Jan Aushadhi Kendras for affordable drugs. Mandate prescription of generic medicines.

    Decentralised Health Governance – Empower Panchayati Raj Institutions and urban local bodies for health planning, awareness, and monitoring. (Kerala Model)

    Preventive Health – Strengthen immunisation, sanitation, and nutrition programmes (e.g., POSHAN Abhiyaan, Swachh Bharat).

    Promote health literacy through ASHA-led campaigns.

    Expand telemedicine (eSanjeevani) to connect rural PHCs with urban specialists.

    Integrate AYUSH systems with allopathic care at PHC level for holistic wellness.

    By strengthening primary care, the State can transform healthcare into a rights-based, inclusive, and sustainable system, achieving the goal of “Swastha Bharat, Samriddh Bharat.”

    Issues Related to Poverty and Hunger