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Subject: Indian Society

  • A green signal for India to assert its health leadership

    Why in the News?

    Recently, the Budget has acknowledged health care as a cornerstone of national growth and development.

    What are India’s steps towards healthcare transformation in Budget 2025-26?

    • Increased Healthcare Spending: The budget includes a substantial allocation of â‚č99,859 crore to the healthcare sector, marking a 9.8% increase from the previous fiscal year.
    • Expansion of Medical Education: The budget allocates resources to add 10,000 new seats in medical colleges across India in FY26, with plans to add 75,000 seats over the next five years. This expansion aims to address the rising demand for skilled healthcare professionals.
    • Strengthening Healthcare Infrastructure: There is an increase of â‚č1,000 crore allocation under the PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), which aims to strengthen health infrastructure at all levels.
    • Digital Health Focus: The budget emphasizes the expansion of digital health portfolios, including telemedicine and AI-driven diagnostic solutions, to bridge care gaps and offer efficient healthcare solutions to underserved regions.
    • Promoting Medical Tourism: With the launch of the ‘Heal in India’ initiative, the budget aims to position India as a top medical tourism destination by introducing on-arrival visas for international patients and streamlining visa norms.
    • Healthcare Coverage for Gig Workers: The budget extends Ayushman Bharat coverage to one crore gig workers, recognizing their contribution to the new-age services economy.
    • Support for AI in Healthcare: The budget announces the establishment of India’s Centre of Excellence for AI, and the expansion of the Atal Tinkering Labs (ATL) initiative, will further propel research within the Indian healthcare sector.

    What would be the implications of Customs duty exemptions?

    • Cost Reduction: The budget includes a full exemption of customs duty on 36 life-saving drugs used to treat cancer, rare diseases, and other severe chronic conditions. This measure will significantly reduce the cost of these essential medications, making them more accessible to patients, especially those from economically disadvantaged backgrounds.
    • Improved Access to Medications: The exemption extends to specific drugs under Patient Assistance Programs run by pharmaceutical companies, along with adding 37 new medicines and 13 new patient assistance programs by next year. This will improve access to critical medications for patients, particularly those with chronic conditions.

    What are the objectives of synergy – ‘Heal in India’?

    • Promote Medical Tourism: The ‘Heal in India’ initiative aims to promote medical tourism by simplifying visa procedures for international patients.
    • Establish India as a Global Healthcare Destination: By enhancing hospital infrastructure and streamlining visa processes, India is poised to become the preferred medical destination for international patients.

    What are the challenges in India? 

    • Inadequate Infrastructure: India faces a shortage of healthcare infrastructure, particularly in rural areas, leading to unequal access to services.
      • For example, India has only 0.9 beds per 1000 population, with only 30% of these beds located in rural areas. This is significantly lower than the WHO’s suggested norm of 3.5 beds per 1000 population.
      • The underdeveloped state of roads and railways, along with erratic power supply, further complicates the establishment of rural health facilities.
    • Financial Barriers: A significant portion of the population faces affordability issues, with many households bearing healthcare expenses out-of-pocket.
      • For instance, a large proportion of the Indian population lacks health insurance coverage, exacerbating the financial burden and limiting access to necessary healthcare services.
      • High costs of intensive care units (ICUs), averaging â‚č60,000-90,000 per day, are beyond the reach of most Indians.
    • Shortage of Healthcare Professionals: There is a shortage of trained healthcare professionals, including doctors, nurses, and specialists.
      • For example, shortages of surgeons, obstetricians and gynaecologists, general physicians, and paediatricians range from 74.2% to 81.6% of the required strength in Community Health Centers (CHCs). The doctor-patient ratio is significantly low, especially in rural areas.

    Way forward: 

    • Strengthen Rural Healthcare Infrastructure – Increase investments in rural hospitals, improve transport and power infrastructure, and incentivize private sector participation to bridge accessibility gaps.
    • Expand Medical Workforce & Insurance Coverage – Enhance training programs for doctors and nurses, increase medical seats, and extend affordable health insurance schemes to reduce out-of-pocket expenses for low-income groups.

    Mains PYQ:

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • Eliminating elitism in mental health

    Why in the News?

    The Ministry of Labour and Employment’s 2024 report indicates that all States and Union Territories must complete harmonization and pre-publication of draft rules for new Labour Codes by March 31, 2025, allowing for mental health provisions.

    How does social inequality impact mental health access and outcomes?

    • Disparity in Access to Care: Social inequality leads to significant disparities in access to mental health care services. Individuals from lower socio-economic backgrounds, particularly blue-collar workers, often face barriers such as lack of awareness, stigma, and inadequate healthcare infrastructure, resulting in a treatment gap of 70% to 92% for mental disorders in India.
    • Workplace Conditions: Blue-collar workers frequently endure demanding jobs with poor working conditions, job insecurity, and inadequate pay, which can exacerbate mental health issues. These conditions contribute to higher rates of stress and mental disorders among this demographic compared to their white-collar counterparts.
    • Limited Legislative Protections: The existing labor laws primarily focus on physical safety and do not adequately address mental health concerns. This legislative gap perpetuates the marginalization of blue-collar workers in accessing mental health resources and support.

    What legislative and policy changes are necessary to promote inclusivity in mental health care?

    • Rights-Based Framework: Establishing a rights and duty-based legislative framework that mandates employers to ensure both physical and mental well-being is crucial. This framework should include clear definitions of occupational diseases that encompass mental health issues arising from work conditions.
    • Inclusion of Mental Health in Labor Codes: The upcoming labor codes should explicitly incorporate provisions for mental health, creating a liability-based framework for employers to prioritize the mental well-being of their employees. This includes recognizing stress-related conditions as occupational hazards eligible for compensation.
    • Awareness and Accessibility Initiatives: Legislative measures should mandate employers to promote awareness of available mental health resources, such as helplines and support programs like Tele Manas, ensuring that blue-collar workers are informed and encouraged to seek help without stigma.

    What are the steps taken by the government? 

    • Implementation of National Mental Health Policies: The Indian government has implemented policies such as the National Mental Health Policy (2014), which emphasizes the integration of mental health services into primary healthcare.
    • Launch of Mental Health Initiatives and Helplines: Initiatives like Tele Manas, a government-run mental health support service, have been introduced to provide confidential telephonic counselling for individuals.
    • Increased Mental Health Awareness through Education and Campaigns: Programs like the “Mental Health Awareness Campaign” and partnerships with organizations like WHO have aimed to educate the public about mental health.

    How can societal attitudes towards mental health be transformed to reduce stigma? (Way forward)

    • Education and Awareness Campaigns: Raising awareness through national and local campaigns can help normalize mental health discussions. For example, the “It’s Okay to Not Be Okay” campaign in India aimed at addressing mental health issues in the workplace.
    • Media Representation and Positive Portrayal: The media plays a significant role in shaping public attitudes. Portraying individuals with mental health issues as strong, resilient, and capable of leading successful lives can help shift negative perceptions. For instance, Bollywood movies like “Dear Zindagi”.
    • Involvement of Influential Figures: Public figures such as celebrities, politicians, and community leaders can be instrumental in reducing stigma by sharing their personal mental health stories. When Virat Kohli, an Indian cricketer, spoke openly about struggling with mental health issues, it made a powerful impact and encouraged others.

    Mains PYQ:

    Q  ”Economic growth in the recent past has been led by increase in labour productivity.” Explain this statement. Suggest the growth pattern that will lead to creation of more jobs without compromising labour productivity. (UPSC IAS/2022)

  • Supreme Court (SC) bans Manual Scavenging in 6 cities in a writ petition

    Why in the News?

    Recently, the Supreme Court ordered a complete ban on manual scavenging and unsafe cleaning of sewers and septic tanks in major cities across India.

    What measures will be implemented to ensure compliance with the ban?

    • Affidavit Submission: The court has directed the Chief Executive Officers (CEOs) of the six metropolitan cities—Delhi, Mumbai, Chennai, Kolkata, Bengaluru, and Hyderabad to file detailed affidavits by February 13, 2025. 
      • These affidavits must outline how and when manual scavenging and sewer cleaning will cease in their respective cities.
    • Monitoring Progress: The court is actively monitoring compliance with its previous judgments, particularly the one from October 2023, which mandated actions to eliminate manual scavenging practices.
    • Implementation of Technology: The court noted that modern machinery and technology are available for sewer cleaning, suggesting that human involvement should no longer be necessary.

    Why is Manual scavenging banned in India? 

    • Severe Health Risks: Manual scavengers are exposed to hazardous conditions that pose significant health risks, including exposure to harmful pathogens and toxic gases. This can lead to a range of serious health issues, such as respiratory problems, gastrointestinal diseases, and skin infections.  
    • Social Stigma and Discrimination: Individuals engaged in manual scavenging often face severe social stigma and discrimination due to the nature of their work, which is viewed as “unclean” and tied to lower castes in the Indian caste system. 
      • This stigma affects not only the workers but also their families, perpetuating cycles of poverty and limiting access to education and better employment opportunities for their children.

    What consequences will officials face for failing to comply with the court’s order?

    • Judicial Displeasure: The court expressed frustration over past non-compliance with its orders, indicating that failure to adhere to this latest directive could lead to serious repercussions. The justices stated, “Either do it or face consequences,” emphasizing their determination to enforce compliance.
    • Potential Legal Action: While specific penalties were not outlined in this order, the strong language used by the court suggests that further legal action could be pursued against officials who fail to comply with the ban on manual scavenging and sewer cleaning.

    What are the significance of this action?

    • Human Rights Protection: This ruling is a critical step towards protecting the rights and dignity of marginalized communities who have historically been forced into manual scavenging. The court’s actions highlight the ongoing struggle against inhumane labour practices that violate basic human rights.
    • Public Health Improvement: By banning hazardous practices such as manual sewer cleaning, the court aims to reduce health risks associated with exposure to toxic gases and pathogens that affect workers in this field.
    • Legal Enforcement of Existing Laws: This action reinforces existing legislation aimed at prohibiting manual scavenging, including the Prohibition of Employment as Manual Scavengers and the Rehabilitation Act of 2013. It underscores the need for effective implementation of laws designed to protect vulnerable populations.

    Way forward: 

    • Strict Law Enforcement & Accountability: The government must establish a robust monitoring mechanism with regular audits, strict penalties for violations, and legal action against officials failing to comply with the Supreme Court’s order.
    • Technological Adoption & Worker Rehabilitation: Municipal bodies should prioritize mechanized cleaning solutions while ensuring alternative employment, skill training, and financial support for former manual scavengers to facilitate their reintegration into society.

  • [30th January 2025] The Hindu Op-ed: Bridge the milk divide for a nutritionally secure India

    PYQ Relevance:

    Q.) How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (CS Mains 2018)

     

    Mentor’s Comment: UPSC Mains has always focused on the main cause of hunger (2018) and poverty and hunger in India (2019).

    India’s White Revolution made it the world’s top milk producer, but now the focus should shift to ensuring milk reaches the most vulnerable. Milk is an important source of protein and calcium, especially for children. However, there are significant differences in milk consumption across income groups and regions. Addressing these gaps is crucial for better health outcomes.

    Today’s editorial discusses how milk should be accessible to everyone in India and highlights the differences in milk availability. It looks at how these issues are connected to topics in GS Paper 1, 2, and 3, such as social inequalities, health, and policy solutions. 

    _

    Let’s learn!

    Why in the News?

    The challenge is making sure that the most vulnerable people have fair access to milk, while also controlling how much milk is consumed by wealthier people.

    What is the disparity in milk consumption? 

    • Income-Based Disparities: Households in the top-income decile consume 3-4 times more milk per capita compared to those in the lowest-income decile. Despite increases in milk consumption among lower-income groups, the poorest 30% account for just 18% of India’s milk.
    • Urban vs. Rural and Regional Disparities: Urban households consume ~30% more milk per capita than rural households, despite rural areas being the main milk producers.
      • Additionally, northern states like Rajasthan, Punjab, and Haryana have higher consumption (333g-421g), while eastern states like Chhattisgarh, Odisha, and West Bengal have much lower consumption (75g-171g).
    • Social Group Disparities: Scheduled Tribe households consume 4 litres less milk per capita annually compared to general category households, highlighting social and economic inequalities in milk access.

    What are the nutritional implications of milk consumption in India?

    • Protein Source: Milk is a rich source of high-quality protein. In India, it contributes significantly to daily protein intake, especially for children and adults in rural areas. According to the National Family Health Survey (NFHS), over 70% of children in India consume milk, making it a key protein source.
    • Calcium and Bone Health: Milk provides essential calcium, which is vital for bone health. Around 67% of Indian households consume milk, helping to prevent calcium deficiency, particularly in growing children and elderly populations, which can lead to conditions like osteoporosis.
    • Micronutrients and Vitamin D: Milk is also a good source of vitamins such as B12 and D, essential for immune function and energy production. The National Institute of Nutrition (NIN) states that milk helps in reducing vitamin D deficiency, which is prevalent in India due to limited sunlight exposure.

    How can policy interventions address disparities in milk production and access?

    • Enhancing Milk Provision: Increase milk availability for vulnerable populations through government schemes like the Pradhan Mantri Poshan Shakti Nirman (POSHAN) and Integrated Child Development Services. States can collaborate with nutrition institutes to align milk products with local dietary preferences.
    • Financial Support: Boost financial allocations for existing schemes to ensure adequate milk provision, especially in states where such programs have been discontinued due to budget constraints.
    • Nutritional Awareness Campaigns: Conduct awareness campaigns focusing on the benefits of milk consumption, targeting women through various community channels. This can help improve dietary diversity within households.

    What strategies can be implemented to promote sustainable dairy practices?

    • Healthy Consumption Awareness: Develop partnerships with healthcare professionals and media to promote balanced diets and moderation in dairy consumption among affluent groups.
      • For example, Campaigns similar to the UK’s Change4Life initiative could serve as effective models for India.
    • Investing in Dairy Infrastructure: The government should continue investing in dairy infrastructure, including animal health care and fodder availability, to ensure sustainable production practices while improving yields.
    • Community Engagement: Engage local communities in sustainable practices through education and training programs aimed at improving animal husbandry practices and enhancing productivity without compromising environmental sustainability.

    What are the steps taken by the government? 

    • Rashtriya Gokul Mission: This initiative focuses on enhancing the genetic quality of bovine animals through the identification and use of high-quality bulls for breeding, in-vitro fertilization (IVF) technology, and genomic selection. It aims to improve milk production by covering millions of livestock and providing better healthcare services for animals.
    • National Dairy Plan (NDP): The NDP supports the establishment of dairy cooperatives and processing facilities to enhance milk marketing and value addition. It includes financial assistance for creating dairy processing infrastructure, thereby improving the overall efficiency and competitiveness of the dairy sector.
    • Kisan Credit Card (KCC) Facility: This scheme offers credit support to farmers for various agricultural activities, including dairy farming. By providing financial assistance, the KCC aims to empower smallholder farmers to invest in their livestock and improve milk production capabilities.

    Way forward: 

    • Increase Access for Vulnerable Groups: Expand milk distribution through government schemes (e.g., POSHAN and ICDS) and ensure adequate funding to cover vulnerable populations.
    • Regional and Social Equity: Implement targeted interventions to reduce regional, income, and social disparities in milk access, such as milk coupons or subsidies for underserved areas.

  • Substantive equality in child marriage laws

    Why in the News?

    Men are given more time than women to leave a child marriage. This means the age for marriage should be the same for both, at 18, not 21.

    What is the situation of child marriage in India? 

    • National Data: The National Family Health Survey-5 (NFHS-5), conducted between 2019 and 2021, reveals that 23.3% of women aged 20-24 were married before the age of 18. This shows a decline from 26.8% in NFHS-4 (2015-16), but child marriage remains a widespread issue.
    • State-wise Variation: The prevalence of child marriage varies significantly across states. For example: in Bihar: 40.8% of women aged 20-24 were married before 18, West Bengal: 41.6%, Rajasthan: 25.4% and Kerala: 6.3% (one of the lowest rates in India).
    • Gender Disparity: Although girls are more affected, boys also face child marriage. NFHS-5 reports that 17.7% of men aged 25-29 were married before the age of 21.

    How can existing laws be strengthened to effectively combat child marriage?

    • Uniform Age of Marriage: The legal age for marriage should be standardized at 18 for all genders, eliminating the current disparity that allows men to marry at 21 and women at 18. This would ensure equal rights and protections for both parties under the law.
    • Enhanced Enforcement Mechanisms: Strengthening the enforcement of existing laws, such as the Prohibition of Child Marriage Act (PCMA), is crucial. This includes more rigorous monitoring of marriages, especially in rural areas, and imposing stricter penalties on those who facilitate child marriages.
    • Stricter Penalties for Facilitators: Increase legal penalties for those facilitating child marriages, such as parents, religious leaders, and community officials, to act as a deterrent. Example: Nepal’s law penalizing facilitators of child marriage has reduced its occurrence by holding all involved parties accountable.
    • Awareness Campaigns and Education: Launch nationwide awareness campaigns to educate communities about the legal age of marriage and its harmful effects, empowering families to protect children. Example: In India, campaigns by organizations like “Plan India” have raised awareness and led to a decline in child marriage rates in targeted regions.

    What are the key judgements? 

    • Independent Thought v. Union of India (2017): The Supreme Court ruled that the exception to the prosecution of marital rape for husbands of girls below 18 years of age was unconstitutional. This judgment focused on the rights of girls under 18 in marriages, emphasizing their protection from sexual exploitation.
    • Gender Disparity in Nullity Petition: The Allahabad High Court emphasized that the gender-based difference in the minimum age of marriage (18 years for women and 21 for men) creates an unfair advantage for men, allowing them to annul marriages at a later age (up to 23), while women are restricted to 20. This interpretation contradicts the principle of gender equality.

    What are the societal and cultural factors contributing to the persistence of child marriage despite legal prohibitions?

    • Traditional Practices: In many communities, child marriage is deeply embedded in cultural and religious norms. These cultural beliefs place pressure on families to marry off daughters at a young age.
    • Poverty and Economic Factors: In regions with high poverty rates, families may view child marriage as a way to reduce financial burdens, sometimes even receiving dowry or financial assistance in return for the marriage.
    • Gender Inequality: Patriarchal views often limit girls’ opportunities for education and economic empowerment, which makes them more vulnerable to early marriage. Women may be seen as property to be married off, reinforcing the practice.
    • Lack of Education and Awareness: A lack of awareness about the legal age for marriage and the harmful effects of child marriage perpetuates this practice. Some families may not be fully aware of the legal consequences or the negative impacts on the health and development of girls.

    What role do community-driven approaches play in preventing child marriage?

    • Community Education and Awareness Programs: Empower local communities with knowledge about the dangers of child marriage in terms of legal, health and social consequences which can gradually change attitudes and reduce the incidence of child marriage.
    • Involving Local Leaders: Traditional community leaders, such as religious leaders and village elders, play a significant role in shaping opinions. Engaging them in awareness campaigns and encouraging them to take a stand against child marriage can influence public opinion and reduce the practice.
    • Strengthening Social Networks and Support Systems: Encouraging peer groups, women’s organizations, and NGOs to support girls at risk of child marriage can create an environment where they are less likely to fall victim to early marriage.
    • Monitoring and Reporting Mechanisms: Creating anonymous and accessible reporting mechanisms for communities to report child marriages can ensure prompt intervention. Encouraging local participation in safeguarding the rights of children helps address the issue at the community level.

    Way forward: 

    • Strengthening Legal and Institutional Frameworks: Ensure uniformity in the legal age of marriage for all genders and improve enforcement by establishing dedicated child marriage prevention units at local levels.
    • Community Empowerment and Education: Expand community-driven programs focusing on education, raising awareness about the harmful effects of child marriage, and providing support systems for vulnerable girls.

    Mains PYQ:

    Q The women’s questions arose in modern India as the part of 19th-century social reform movement. What are the major issues and debates concerning women in that period? (UPSC IAS/2017)

  • Is poverty being underestimated in India?

    Why in the News?

    The government recently published a factsheet on the 2023-24 Household Consumption Expenditure Survey (HCES), highlighting a reduction in poverty levels across both urban and rural areas.

    What are the key findings of the report? 

    • Average MPCE and Imputed Values: In 2023-24, the average Monthly Per Capita Expenditure (MPCE) was Rs. 4,122 in rural areas and Rs. 6,996 in urban areas, excluding the value of free items provided through social welfare schemes.
    • Growth in MPCE and Urban-Rural Gap: Compared to 2022-23, the MPCE in nominal terms grew by approximately 9% in rural areas and 8% in urban areas. The urban-rural MPCE gap narrowed from 84% in 2011-12 to 71% in 2022-23, further declining to 70% in 2023-24, indicating robust consumption growth in rural areas.
    • Consumption Trends by Population Segments: The highest increase in MPCE in 2023-24, compared to 2022-23, was observed among the bottom 5-10% of India’s population, for both rural and urban households.
    • Composition of Expenditure: Non-food items accounted for 53% of rural MPCE and 60% of urban MPCE in 2023-24. Within the food basket, beverages, refreshments, and processed foods dominated expenditure, while in the non-food category, conveyance, clothing, entertainment, and durable goods were significant contributors. Urban households also allocated about 7% of non-food expenditure to rent.
    • Decline in Consumption Inequality: The rural Gini coefficient dropped from 0.266 in 2022-23 to 0.237 in 2023-24, and the urban coefficient fell from 0.314 to 0.284 during the same period.
    Note: The Gini coefficient is a statistical measure used to quantify income or consumption inequality within a population, ranging from 0 (perfect equality) to 1 (maximum inequality).

    What are the concerns related to the HCES data?

    • Incomparability of Data Sets: The methodology used in the 2022-23 HCES differs significantly from previous surveys, making it difficult to compare results over time. The introduction of a “modified mixed reference period” complicates direct comparisons with earlier data collected under different methodologies.
    • Sampling Bias: There are concerns that the survey may not adequately represent extremely poor households, leading to an overestimation of average expenditures. This bias could arise from changes in sampling strategies that favor more affluent households.
    • Data Availability Issues: The absence of recent and reliable consumption data prior to the 2022-23 survey has led to a reliance on outdated estimates, which may not accurately reflect current poverty levels. The last comprehensive survey before this was conducted in 2011-12.

    What does the consumption pattern tell about poverty in rural and urban regions?

    • Divergent Poverty Levels: The average monthly per capita expenditure (MPCE) indicates significant disparities between rural and urban areas, with rural areas averaging Rs 4,122 and urban areas Rs 6,996 in 2023-24. This suggests that urban populations generally have higher consumption levels.
    • Survival on Minimal Incomes: Reports indicate that a substantial portion of India’s population survives on less than Rs 100 per day, highlighting persistent poverty despite claims of decline. This raises questions about the adequacy of the poverty line used for estimation.

    What are the criticisms faced by the Multidimensional Poverty Index?

    NITI Aayog, the policy think tank of the Government of India, adopted the Multidimensional Poverty Index (MPI) as a measure to evaluate poverty in India.

    • Methodological Concerns: Critics argue that the MPI’s reliance on equal weighting for health, education, and living standards may oversimplify the complexities of poverty. The selection of indicators can significantly influence outcomes, potentially leading to biased representations.
    • Dynamic Nature of Poverty: The MPI may not adequately capture the fluidity and changing nature of poverty over time, as it relies on static indicators that do not reflect immediate economic conditions or shocks such as those experienced during the COVID-19 pandemic.
    • Political Implications: Some economists suggest that using MPI as a primary measure for poverty could be politically motivated, aiming to present favourable statistics while ignoring deeper economic issues such as stagnant real wages and rising inequality.

    Way forward: 

    • Strengthen Data Collection: Conduct regular and comprehensive Household Consumption Expenditure Surveys (HCES) to ensure updated and accurate poverty assessments. This will bridge data gaps and provide a more reliable basis for policy decisions.
    • Refine Poverty Metrics: Combine the Multidimensional Poverty Index (MPI) with traditional consumption-based measures to capture a holistic and dynamic picture of poverty, accounting for region-specific and pandemic-induced challenges.

    Mains PYQ:

    Q “The incidence and intensity of poverty are more important in determining poverty based on income alone”. In this context analyse the latest United Nations Multidimensional Poverty Index Report. (UPSC IAS/2020)

  • Union cabinet extends National Health Mission for another 5 years

    Why in the News?

    The Union Cabinet has approved the extension of the National Health Mission (NHM) for an additional five years(2025 to 2030).

    What are the new Components of the NHM and initiatives launched?

    • Digital Health Initiatives: The U-WIN platform was launched in January 2023 to improve vaccination tracking for pregnant women, infants, and children, expanding to 65 districts across 36 states/UTs by the end of FY 2023-24.
    • Expanded Healthcare Programs: NHM has overseen the launch of initiatives such as the National Sickle Cell Anaemia Elimination Mission and the Measles-Rubella Elimination Campaign, enhancing disease control efforts.
    • Strengthening Human Resources: The NHM has focused on increasing healthcare personnel, engaging over 1.2 million additional healthcare workers across various roles since its last extension.

    What are the key achievements of the National Health Mission during its previous tenure?

    • Reduction in Maternal and Child Mortality:
      • Maternal Mortality Ratio (MMR): Declined from 130 per lakh live births in 2014-16 to 97 per lakh in 2018-20 (25% reduction).
      • Under-5 Mortality Rate: Decreased from 45 per 1,000 live births in 2014 to 32 in 2020 (75% decline).
      • Infant Mortality Rate (IMR): Reduced from 39 per 1,000 live births in 2014 to 28 in 2020. India is on track to achieve the SDG targets for maternal, child, and infant mortality before 2030.
    • Healthcare Workforce Expansion: The NHM facilitated the engagement of approximately 2.69 lakh additional healthcare workers in 2021-22 alone, contributing to improved healthcare delivery.
    • Disease Control Improvements: Enhanced surveillance and control measures for diseases like tuberculosis have led to a decrease in incidence rates, contributing to overall public health improvements.

    What are the financial implications and commitments associated with the NHM’s extension?

    • Budgetary Allocation and Funding Structure: The National Health Mission (NHM) continues based on recommendations from the Expenditure Finance Committee (EFC) and fixed spending limits. While the mission has been extended, its budget is reviewed regularly to ensure efficient use of resources.
      • For funding, most states share costs with the central government in a 60:40 ratio, while northeastern and hilly states follow a 90:10 pattern. This setup ensures states have enough funds to implement health programs effectively.
    • Performance-Based Funding: The NHM rewards states with additional funds for improving key health outcomes like maternal and child health. This encourages states to enhance their healthcare systems.
      • Local committees, such as Rogi Kalyan Samitis (RKS), also receive untied funds, giving them the flexibility to directly address patient needs and improve services.
    • Commitment to Health Targets: By 2025, the NHM aimed to achieve specific health goals, including reducing the Maternal Mortality Ratio (MMR) to 90, the Infant Mortality Rate (IMR) to 23, and the Under-5 Mortality Rate (U5MR) to 23. Achieving these targets will require consistent investment in health infrastructure, workforce training, and community programs.
      • The government is also focused on tackling broader factors affecting health, such as nutrition and disease prevention while improving access to healthcare for disadvantaged groups.

    What are the challenges? 

    • Infrastructure Deficiencies: Many Primary Health Centres (PHCs) lack essential diagnostic tools, medical equipment, and sanitation facilities. PHCs in remote areas of Bihar and Uttar Pradesh often face electricity and water supply shortages, limiting their ability to deliver quality care.
    • Shortage and Distribution of Healthcare Workforce: Despite adding 1.2 million healthcare workers, there remains a shortage of specialists such as gynaecologists, anaesthetists, and paediatricians in rural areas. Rajasthan and Madhya Pradesh struggle to staff CHCs with specialized doctors.
    • Financial Constraints and Inefficient Fund Utilization: Delays in fund disbursement and underutilization of allocated budgets hinder the implementation of key initiatives. Northeastern states like Nagaland and Manipur faced challenges in utilizing NHM funds due to inadequate financial planning and monitoring mechanisms.

    Way forward: 

    • Infrastructure and Workforce Enhancement: Strengthen PHC and CHC infrastructure with essential facilities and ensure equitable distribution of healthcare specialists through targeted incentives, training, and deployment programs in underserved areas.
    • Efficient Fund Utilization: Streamline fund disbursement processes, enhance financial planning, and implement robust monitoring mechanisms to ensure optimal use of allocated budgets, particularly in resource-constrained regions.

    Mains PYQ:

    Q “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC IAS/2021)

  • Is the government encouraging ‘crosspathy’?

    Why in the News?

    Recently, Maharashtra Food and Drugs Administration has allowed homeopathic doctors, who completed a course in modern medicine to prescribe allopathic medicines.

    What is the difference between Homeopathy and Allopathy?

    • Homeopathy uses natural substances in tiny doses to help the body heal, while allopathy uses medicines or treatments to directly fight or treat diseases based on science and evidence.

    What is crosspathy?

    • Crosspathy refers to practitioners from one medical system (e.g., homoeopathy) treating patients with medicines from another system (e.g., allopathy).

    Why did the Maharashtra FDA issue a directive allowing homoeopathic practitioners to prescribe allopathic medicines?

    • Addressing Doctor Shortage: The directive aimed to tackle the severe shortage of doctors, particularly in rural areas, where there is a lack of healthcare professionals, especially specialists.
    • Expanding Healthcare Access: By allowing certified homoeopathic practitioners to prescribe allopathic medicines, the Maharashtra FDA sought to expand healthcare services and make treatment more accessible to patients in underserved regions.
    • Promoting Integrative Medicine: The directive is part of a broader initiative to promote integrative or integrated medicine, where different medical systems, such as homoeopathy and allopathy, are used to complement each other in patient care.

    What is the Supreme Court’s stance on ‘crosspathy’?

    • The Supreme Court (SC) has consistently held that cross-system practice (practicing medicine from a system one is not qualified for) is a form of medical negligence.
    • Poonam Verma vs Ashwin Patel (1996) – A homoeopath was held liable for prescribing allopathic medicines that resulted in a patient’s death.
    • Crosspathy is only allowed where state governments have specifically authorized it through special orders.

    What are the challenges faced by govt?

    • Doctor Shortage: India faces a significant shortage of doctors, especially in rural areas, where the Health Dynamics of India 2022-23 report highlights an 80% deficit of specialists in community health centres. As of June 2022, there were 13.08 lakh allopathic doctors and 5.65 lakh AYUSH practitioners, indicating an insufficient number of qualified professionals to meet healthcare demands.
    • Integration of AYUSH Practitioners: While AYUSH practitioners could potentially fill healthcare gaps, there is no systematic approach to integrating them effectively, which could lead to poor outcomes.
    • Risk to Patients: Allowing unqualified practitioners to prescribe allopathic medicines could result in medical errors and negligence, raising concerns about patient safety.
    • Opposition from Professional Bodies: Organizations like the Indian Medical Association (IMA) strongly oppose crosspathy, questioning its legality and the risks posed to patients.
    • Regulatory Uncertainty: Lack of clarity on who has the authority to issue such directives and manage cross-system practice leads to legal and administrative challenges.

    Way forward: 

    • Clear Regulatory Framework: Establish clear guidelines and regulations for integrating different medical systems to ensure patient safety and effective healthcare delivery, with proper qualifications for practitioners.
    • Address Doctor Shortage Strategically: Focus on training and deploying more allopathic doctors, especially in rural areas, while ensuring AYUSH practitioners are properly integrated into the healthcare system through structured programs.

    Mains PYQ:

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • Why are fertility levels declining in India?

    Why in the News?

    The Global Burden of Diseases Study (GBD) 2021 shows that India’s fertility rate has dropped significantly, from 6.18 children per woman in the 1950s to 1.9 children per woman in 2021.

    Why are fertility levels declining in India?

    What has a GBD Report shown about the total fertility rate in India? 

    • Declining Fertility Rates: India’s TFR has dramatically decreased from 6.18 in the 1950s to 1.9 in 2021, which is below the replacement level of 2.1 necessary for population stability.
    • Future Projections: The report projects that India’s TFR could further decline to 1.04 by 2100, indicating a potential average of less than one child per woman.
    • Socio-Economic Concerns: This steep decline in fertility has raised alarms regarding political and socio-economic impacts, particularly in southern states, where there are fears of losing parliamentary representation due to demographic shifts post-delimitation in 2026.

    Why are fertility levels declining in India?

    • Early Adoption of Family Planning Policies: Southern states like Tamil Nadu and Andhra Pradesh rigorously implemented family planning policies introduced in the 1950s, leading to a significant decline in fertility rates. For example, Andhra Pradesh currently has a Total Fertility Rate (TFR) of 1.5, comparable to Nordic countries like Sweden.
    • Higher Female Literacy and Workforce Participation: Increased educational attainment among women has empowered them to delay marriage and childbirth. This is evident in Kerala, where high literacy rates have contributed to the state achieving replacement-level fertility as early as 1988.
    • Changing Societal Norms: Cultural shifts have led to late marriages and smaller families. For instance, women in southern states increasingly prioritize careers and financial independence over traditional roles, contributing to lower fertility rates.
    • Urbanization and Economic Pressures: Urban lifestyles and rising costs of living discourage larger families. States like Tamil Nadu and Karnataka have seen fertility rates drop to 1.4 and 1.6 respectively due to urbanization and modern aspirations.

    Why are the southern States worried?

    • Ageing Population: Southern states like Kerala, Tamil Nadu, and Andhra Pradesh have fertility rates that have fallen below the replacement level of 2.1 children per woman. This decline leads to an increasing proportion of elderly individuals in the population, which is projected to rise significantly.
      • For instance, Kerala’s population aged 60 and above is expected to increase from 13% in 2011 to 23% by 2036. This demographic shift results in a smaller working-age population, which can strain economic productivity and increase demands for pensions and healthcare services.
    • Political Representation: The upcoming delimitation of parliamentary constituencies, based on population figures from the 2031 Census, raises fears that southern states may lose parliamentary seats due to their slower population growth.
      • This potential reduction in representation could diminish their political influence at the national level, especially compared to more populous northern states like Uttar Pradesh and Bihar.
    • Economic Strain: With a declining workforce contributing less to the economy through taxes and social security, southern states face challenges similar to those observed in countries with ageing populations, such as Japan and China.
    • Migration Issues: As birth rates decline, southern states may increasingly rely on internal migration from northern states to fill labour shortages. However, this reliance could create further socio-economic disparities between regions.

    Way forward: 

    • Equitable Resource Distribution: Implement policies ensuring equitable representation and resource allocation in parliamentary seats post-delimitation to address regional disparities without penalizing states with successful population control measures.
    • Support for Ageing Populations: Develop robust social security systems, healthcare infrastructure, and incentives for elder care while promoting skill development and migration-friendly policies to mitigate workforce shortages in southern states.

    Mains PYQ:

    Q Discuss the main objectives of Population Education and point out the measures to achieve them in India in detail. (UPSC IAS/2021)

  • UNICEF’s ‘Global Outlook 2025: Strengthening the foundations of children’s futures

    Why in the News?

    Recently, UNICEF’s Global Outlook 2025 emphasizes the urgent need for resilient systems to protect children’s rights amid crises like conflict, climate change, and economic instability, ensuring equitable access to essential services globally.

    What are the primary challenges facing children in the current global landscape as per UNICEF’s Global Outlook 2025?

    • Conflict and Displacement: Over 473 million children, or about 19% globally, live in conflict-affected areas—a figure that has nearly doubled since the 1990s. This exposes children to severe risks, including displacement, starvation, disease, and psychological trauma.
    • Economic Instability: Nearly 400 million children live in countries in debt distress, where financial pressures are reducing investments in essential services such as education and healthcare, further deepening their vulnerabilities.
    • Climate Change: Around 1 billion children are at extremely high risk from climate impacts. Disruptions from extreme weather events affect their access to education and healthcare, while only 2.4% of global climate finance is directed toward child-focused initiatives.
    • Digital Inequality: The expansion of digital public infrastructure (DPI) offers opportunities to improve service delivery, but significant digital divides persist, disproportionately affecting children in low-income and marginalised communities.

    What are the steps taken by the Indian Government?

    • Beti Bachao Beti Padhao (BBBP): Launched in 2015, this flagship scheme aims to address the declining child sex ratio and promote the education and empowerment of girls.
    • Sukanya Samriddhi Yojana (SSY): This savings scheme encourages parents to save for their daughters’ education and marriage by offering attractive interest rates and tax benefits.
    • Integrated Child Development Services (ICDS): Established in 1975, ICDS focuses on improving the nutritional and health status of children under six years, pregnant women, and lactating mothers.
    • National Nutrition Mission (POSHAN Abhiyaan): Launched in 2018, this mission aims to reduce malnutrition among children and women through a convergence of various schemes and community-based approaches.
    • Mission Vatsalya: This initiative focuses on child protection services, ensuring that vulnerable children receive necessary support and care.
    • Child Protection Policies: The government has enacted several laws, such as the Protection of Children from Sexual Offences (POCSO) Act and the Juvenile Justice (Care and Protection of Children) Act, to safeguard children’s rights and ensure their welfare.
    • National Commission for Protection of Child Rights (NCPCR): The NCPCR plays a crucial role in promoting and protecting children’s rights in India. It has launched various initiatives such as the POCSO e-Box for reporting child sexual abuse and the Bal Panchayat Abhiyan to encourage child-led governance.

    How can global governance and national systems be strengthened to support children’s rights and well-being?

    Global governance: 

    • Strengthening International Mechanisms: The United Nations should develop specialized frameworks to protect children’s rights in the digital environment, ensuring online safety and privacy are integral to global governance policies.
    • Ensuring Accountability: States and corporations must be held accountable for violations of children’s rights, with the adoption of measures like the Guiding Principles on Business and Human Rights to ensure businesses prioritize child protection.
    • Fostering Global Collaboration: Promoting bilateral and multilateral cooperation can address challenges such as cyberbullying and online exploitation through shared best practices and coordinated efforts to safeguard children’s rights worldwide.

    National systems: 

    • Developing Child Rights Governance Systems: Nations should establish comprehensive frameworks that integrate children’s rights into laws and policies, aligning with the United Nations Convention on the Rights of the Child (UNCRC) to prioritize children’s needs in governance.
    • Strengthening Civil Society Organizations (CSOs): Enhancing the capacity of CSOs through training programs can improve their ability to advocate for and implement child rights initiatives while effectively engaging with government institutions.
    • Advancing Evidence-Based Advocacy: Utilizing data-driven approaches to shape policy priorities can ensure child rights are central to resource allocation and budgeting at global, regional, and national levels.
    • Empowering Children’s Participation: Encouraging children to actively participate in decision-making processes helps create policies that address their needs and aspirations, fostering a more inclusive governance system.
    • Establishing Robust Monitoring Systems: Implement mechanisms to regularly track and report on children’s well-being indicators to ensure accountability and measure progress in achieving child rights standards.

    Way forward: 

    • Integrated Global-National Synergy: Strengthen collaboration between international frameworks and national systems to prioritize children’s rights in governance, focusing on accountability, digital safety, and climate resilience through coordinated policies and resource allocation.
    • Child-Centric Policy and Participation: Develop evidence-based policies that directly address children’s vulnerabilities while empowering them to participate in decision-making, ensuring sustainable and responsive governance structures.

    Mains PYQ:

    Q The Right of Children to Free and Compulsory Education Act, 2009 remains inadequate in promoting an incentive-based system for children’s education without generating awareness about the importance of schooling. Analyse. (UPSC IAS/2022)