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Subject: Social Justice

  • The birth story no one prepared me for

    The birth story no one prepared me for

    Why in the News

    Preterm births in India are rising, and Delhi alone has recorded a 21 per cent increase over the past five years. A study by the Indian Institute of Technology Delhi with international universities analysed National Family Health Survey data for 2015 to 2020. It established that prolonged exposure to heat significantly raises the chances of preterm birth and low birth weight. Motherhood in India continues to be narrated through the language of labour pain, sacrifice and endurance. That language describes a full-term vaginal delivery and nothing else. Causation is moving towards environmental exposure no individual can control. Responsibility is still located in the mother’s body.

    What is preterm birth?

    1. A birth before 37 completed weeks: Preterm birth is delivery before 37 completed weeks of gestation, counted from the first day of the last menstrual period.
    2. Three severity bands: The World Health Organization classifies births before 28 weeks as extremely preterm, 28 to 32 weeks as very preterm, and 32 to 37 weeks as moderate to late preterm.
    3. Low birth weight is a separate marker: A newborn weighing under 2,500 g is classified as low birth weight, with or without prematurity. The risk compounds when both are present.
    4. India carries the largest absolute burden: India records the highest number of preterm births of any country, at roughly three million a year, which is close to a fifth of the global total.

    What is kangaroo mother care?

    1. Skin-to-skin contact as clinical treatment: Kangaroo mother care places the low birth weight infant upright against the parent’s bare chest for prolonged periods, combined with exclusive breastfeeding, to stabilise temperature, heart rate and breathing.
    2. It is recommended from birth: The World Health Organization advises immediate and continuous kangaroo mother care for infants born under 2,000 g rather than delaying it until the infant is clinically stable.

    What does care inside a neonatal intensive care unit actually involve?

    1. Time is measured by instruments, not routines: Days inside a neonatal intensive care unit (NICU) are structured around oxygen saturation levels, heart-rate monitors and machine alarms rather than feeding schedules or sleepless nights.
    2. The first contact is mediated by equipment: Early memories of motherhood are of incubators and wires rather than of cradling a child, with infants weighing a few hundred grams held for kangaroo mother care.
    3. The mother is a patient at the same time: A caesarean delivery leaves the mother recovering from major abdominal surgery. The infant is treated several corridors away, so hours of sitting are managed through incision pain.
    4. Stays run into weeks, not days: A NICU admission after a very preterm delivery commonly runs six weeks or longer, which is a period of hospital residence rather than a hospital visit.
    5. Solidarity forms sideways, not from clinicians: Support comes from nurses, guards, hospital staff and other mothers in the same unit, who mark small milestones together and register each other’s setbacks.

    Why do preterm births keep rising in India?

    1. Maternal nutrition: The nutritional health of mothers is a direct contributor, with anaemia and low pre-pregnancy weight raising the risk of early delivery.
    2. The changing pattern of pregnancies: Later first pregnancies, higher rates of assisted conception and more multiple births all shift the distribution towards earlier deliveries.
    3. Environmental factors: A significant part of the rise is attributable to environmental exposure rather than to maternal or clinical factors.

    What does the parallel rise in caesarean sections indicate?

    1. Caesarean rates have moved well past the clinical reference range: The National Family Health Survey records 21.5 per cent of deliveries as caesarean nationally, against the 10 to 15 per cent range the World Health Organization treats as the point beyond which population level benefits stop.
    2. The private sector drives the gap: Caesarean deliveries account for 47.4 per cent of births in private facilities against 14.3 per cent in public facilities. The gap points to provider incentives rather than to clinical need.
    3. An emergency caesarean is a different event from an elective one: A preterm emergency caesarean is a rescue procedure for foetal or maternal distress, and it arrives without the preparation an elective procedure allows.
    4. Timing carries its own risk: Caesarean delivery before 39 completed weeks raises neonatal respiratory morbidity, so a rising caesarean rate and a rising preterm rate reinforce each other.

    Who is held responsible when a birth goes wrong?

    1. The dominant script has no place for a preterm birth: An initiation into motherhood that begins at the doors of a neonatal unit has no available story, so the experience goes unnarrated rather than merely unrecognised.
    2. Scrutiny falls on the mother’s conduct: Society places the burden of a healthy pregnancy almost entirely on women, and a premature birth intensifies that scrutiny into questions about whether she travelled or rested enough. The mother’s body becomes the site of investigation.
    3. The evidence points the other way: Environmental exposure and clinical practice are population level determinants, and neither is amenable to individual maternal conduct.
    4. The psychological cost has no recognised name: Conversation around postpartum depression has grown, and the emotional realities of neonatal intensive care motherhood remain largely invisible.
    5. Even the support offered polices the mother: Nurses urge mothers to stay positive because infants sense their emotions. That instruction converts grief into a further maternal responsibility.

    Challenges in maternal and newborn care in India

    1. Neonatal intensive care capacity is thin outside metros: District level special newborn care units handle stabilisation but not ventilation or surgery, so very preterm infants must be transferred to a medical college or a private hospital. Eg. Referral transport for sick newborns remains the weakest link in the newborn care chain in most States. Fix. Attach a functioning level three unit to every district hospital with a dedicated newborn transport ambulance on a fixed response standard.
    2. Neonatal intensive care is catastrophic out-of-pocket expenditure: A six-week private NICU stay runs into several lakh rupees and sits outside most insurance cover for a newborn without an existing policy. Eg. Ayushman Bharat covers the mother’s delivery package but not an extended neonatal admission in every State’s package list. Fix. Add a defined neonatal intensive care package with a per-day rate to the national health insurance benefit list, effective from the date of birth.
    3. Perinatal mental health has no service line: Public maternity facilities have no counsellor attached to the neonatal unit, so the psychological consequences of a preterm birth go unscreened and untreated. Eg. Screening for postpartum depression is not part of the standard postnatal visit schedule. Fix. Post a trained counsellor at every special newborn care unit and add a validated screening question to the routine postnatal check.
    4. Caesarean rates are unaudited in the private sector: No facility level audit compels a hospital to justify its caesarean rate, so the rate rises without a clinical explanation. Eg. Facility caesarean rates above 50 per cent are recorded in several States without triggering review. Fix. Publish facility-wise caesarean rates using the Robson classification and make registration renewal conditional on a rate review.
    5. Heat action plans do not name pregnant women: City heat plans list outdoor workers and the elderly as vulnerable groups and generally omit pregnant women, so no advisory or workplace protection reaches them. Eg. Most State heat action plans carry no antenatal advisory component. Fix. Add pregnant women as a notified vulnerable category, with heat advisories issued through antenatal care contacts and Anganwadi workers.
    6. Kangaroo mother care coverage stays low: The intervention is cheap and evidence-backed, and it requires a mother to remain beside the infant for hours. Most public units are not physically designed for that. Eg. Many newborn units have no space for a mother to stay overnight. Fix. Make mother-side accommodation a licensing condition for any unit designated to handle low birth weight newborns.

    Conclusion

    Preterm birth in India is being pushed upward by heat exposure and other environmental determinants that no individual pregnancy can be managed against, and the clinical system is simultaneously delivering more babies surgically and earlier. The response has stayed at the level of the individual mother, whose conduct is scrutinised and whose psychological care is not provided at all. Recognising heat as a maternal health exposure, auditing caesarean practice and funding neonatal intensive care are the three interventions the evidence already supports. Until they are in place, the burden of a structural change will keep being carried privately.

    “[2025] Consider the following statements:

    Statement I: At the 28th United Nations Climate Change Conference (COP28), India refrained from signing the ‘Declaration on Climate and Health’.

    Statement II: The COP 28 Declaration on Climate and Health is a binding declaration; and if signed, it becomes mandatory to decarbonize health sector.

    Statement III: If India’s health sector is decarbonized, the resilience of its healthcare system may be compromised.

    Which one of the following is correct in respect of the above statements?

    (a) Both Statement II and Statement III are correct and both of them explain Statement I

    (b) Both Statement II and Statement III are correct but only one of the them explains Statement I

    (c) Only one of the Statements II and III is correct and that explains Statement I

    (d) Neither Statement II nor Statement III is correct

  • Ensuring equity amid India’s educational progress

    Ensuring equity amid India’s educational progress

    Why in the News

    The Unified District Information System for Education Plus (UDISE+) 2025-26 report records notable progress across India’s school education system. Progress is recorded in gross enrolment, student retention, dropout reduction, teacher availability and educational infrastructure. The same report records that regional and social disparities persist in access, resources, learning opportunities and educational outcomes. Differences in gross enrolment ratios, dropout rates, pupil teacher ratios and infrastructure availability now separate States and social groups from one another rather than separating India from an earlier baseline. What is contested is whether an improving national average can be read as equitable, inclusive and quality education.

    What is the Unified District Information System for Education Plus (UDISE+)?

    1. A school level administrative database: UDISE+ is the annual data system that collects information from every recognised school in the country, managed by the Department of School Education and Literacy under the Ministry of Education.
    2. Scale of the 2025-26 round: The report covers 1.47 million schools, 240 million students and 10.2 million teachers.
    3. What it measures: It records enrolment, retention, teacher deployment and school infrastructure, reported down to the district and school level.
    4. Why the numbers matter: The database is the official basis on which school education allocations are made and progress is monitored.

    What is the Gross Enrolment Ratio (GER)?

    1. Enrolment measured against an age group: GER is total enrolment at a school stage expressed as a percentage of the population in the official age group for that stage.
    2. Why a value above 100 is possible: Enrolment of under age and over age children pushes the ratio past 100 without meaning that every eligible child of that age is in school.

    What is the Pupil Teacher Ratio (PTR)?

    1. Students carried by each teacher: PTR is the number of enrolled students per teacher at a given school stage, so a higher value means each teacher carries a larger class load.

    What is the Gender Parity Index?

    1. Girls’ enrolment measured against boys’: The index is the ratio of female to male enrolment at a school stage, and a value above one shows more girls enrolled than boys.

    What is Aadhaar seeding of student records?

    1. Linking an enrolment record to a unique identity number: Seeding attaches a student’s Aadhaar number to the school record, which is how duplicate and inactive enrolments are removed from the count.

    Which States lead and lag on enrolment records and school profile?

    1. Aadhaar seeding of enrolled students: Andhra Pradesh leads at 99.6 percent, followed by Chandigarh at 99 percent. Meghalaya records the lowest rate at 35 percent against a national average of 90.2 percent.
    2. Share of schools and enrolment: Uttar Pradesh accounts for the highest share of both schools and student enrolment. Meghalaya and Himachal Pradesh have the lowest shares of schools relative to enrolment, which produces higher student school ratios.
    3. Composition of schools by stage: West Bengal records the highest proportion of foundational and preparatory schools at 79 percent and among the lowest secondary schools at 11 percent. Chandigarh is the reverse, with 83 percent secondary schools and 5 percent foundational and preparatory schools.
    4. Average enrolment per school: Chandigarh registers the highest at 1,194, followed by Delhi at 788. Ladakh records the lowest at 64, which marks the spread in school size across the country.

    How is enrolment distributed across social groups?

    1. Regional concentration of social groups: Chandigarh and Delhi have the highest proportions of General category students. Lakshadweep, Mizoram, Meghalaya and Ladakh have high proportions of Scheduled Tribe enrolment.
    2. Concentration of Scheduled Caste and Other Backward Classes enrolment: Punjab records one of the highest shares of Scheduled Caste enrolment. Other Backward Classes representation is particularly high in Tamil Nadu and Gujarat.
    3. Gross enrolment by social group at the national level: Other Backward Classes record the highest at 49 percent, followed by General at 27 percent, Scheduled Castes at 17 percent and Scheduled Tribes at 10 percent.
    4. Enrolment set against population: Those figures diverge from the corresponding population of each social group, which is where the enrolment gap between groups becomes visible.
    5. Girls ahead of boys on participation: The Gender Parity Index across all school levels shows higher girls’ enrolment and participation than boys in most States and Union Territories.
    6. Minority enrolment: Students from minority communities account for more than 20 percent of enrolment, with Muslims and Parsis among the major minority groups.

    How far apart are States on teacher availability?

    1. The spread tracks population density: PTR registers lowest in Union Territories and highest in densely populated States.
    2. The secondary stage carries the heaviest load: Foundational, preparatory and middle stage ratios are generally lower than the secondary ratio across most States.
    3. The highest secondary ratios: Jharkhand records the highest secondary PTR at 43, followed by Uttar Pradesh, which signifies a heavy workload on each teacher.
    4. The lowest secondary ratios: Sikkim records the lowest secondary PTR at 6, followed by Ladakh.

    What do the stage wise gross enrolment figures show?

    1. Foundational stage: Meghalaya records the highest at 131, followed by Mizoram. Bihar records the lowest at 24, preceded by Uttar Pradesh.
    2. Preparatory stage: Meghalaya again records the highest at 171, followed by Manipur. Gujarat records the lowest at 74, preceded by Bihar.
    3. Middle stage: Chandigarh and Meghalaya record the highest at 118, followed by Delhi. Bihar records the lowest at 70, preceded by Nagaland.
    4. Secondary stage: Chandigarh registers the highest at 109, followed by Goa. Bihar records the lowest at 48, preceded by Nagaland.
    5. The pattern across stages: One large State sits at or near the bottom at every stage, which concentrates the enrolment deficit rather than spreading it evenly across the country.

    What does the dropout data show about retention at each stage?

    1. Why the indicator matters: The dropout rate determines attainment and the transition rate to the next stage of schooling.
    2. Preparatory stage: Bihar accounts for the highest preparatory dropout rate at 7.9 percent, followed by Meghalaya. Delhi, Haryana and Maharashtra do not report dropout at this stage.
    3. Middle stage: Bihar records the highest middle level dropout rate at 9 percent, followed by Uttar Pradesh. Chandigarh, Maharashtra and Andhra Pradesh register no dropouts at this stage.
    4. Secondary stage: Ladakh records the highest secondary dropout rate at 14.8 percent, followed by Karnataka. West Bengal records the lowest at 1.5 percent, preceded by Telangana.

    Why has improved access not produced regular attendance?

    1. A school within reach is now the norm: Access to schooling has improved significantly over the years, and most children now have a school at a suitable distance.
    2. Terrain still decides regularity: Remote, hilly, tribal and border areas still have limited schools and transport facilities, so children there face greater difficulty attending regularly. Eg. Bageshwar district of Uttarakhand, Ganjam and Kandhamal districts of Odisha, Kathua district of Jammu and Kashmir, and Palghar district of Maharashtra.
    3. Social position compounds distance: Children from Scheduled Castes, Scheduled Tribes, minorities and economically poor families face barriers that limit enrolment, attendance and completion together.

    What limits infrastructure and teacher deployment in backward districts?

    1. Infrastructure has improved unevenly: School infrastructure has improved in several areas of the country on drinking water and electricity, and availability still varies across regions.
    2. Rural schools in backward districts lag: Educationally backward districts continue to struggle to provide a learning environment in rural schools compared with urban areas.
    3. One teacher, many roles: Rural and remote schools face teachers handling multiple classes and subjects alongside non teaching responsibilities allotted by the government.

    Which groups remain outside the gains?

    1. Girls’ schooling has advanced without closing retention: Progress in girls’ schooling has not removed the challenge of reducing dropout rates.
    2. The primary to secondary transition is weak: Improving the transition from primary to secondary education remains a stated gap.
    3. Facilities for disabled children fall short: Sufficient and suitable facilities for children with disabilities are not yet in place.
    4. What inclusion requires: Inclusive infrastructure, accessible classrooms and supportive teaching practices are the stated conditions for equitable education.

    Does progress in national averages amount to educational equity?

    1. Improvement and inequality sit in the same dataset: Educational inequality persists across accessibility, infrastructure, teacher availability, digital resources and social inclusion even as the aggregate indicators improve.
    2. The dimensions move together: Addressing these dimensions collectively is treated as essential, since a gain on one indicator does not carry across to the others.
    3. The paradox of progress: Regional and social imbalances continue to influence educational opportunities and learning conditions, so the national average understates what a child in a lagging district faces.

    What would a targeted equity response have to do differently?

    1. Investment directed at deprived regions: Targeted investment in educationally deprived regions is the first measure set out, in line with the National Education Policy 2020.
    2. Teacher deployment as an equity instrument: Deployment is set out as a requirement distinct from recruitment. Eg. The State spread in secondary stage ratios.
    3. Digital infrastructure as a school input: Improved digital infrastructure is named alongside physical infrastructure rather than as an add on.
    4. Dedicated support for disadvantaged groups: Stronger support for disadvantaged social groups, backed by inclusive social and economic policies, is required in addition to general spending.

    Conclusion

    India’s school education system has largely settled the access question and opened the equity question in its place. The 2025-26 data establishes progress at the national level and leaves the distribution unsettled, since the State a child studies in still predicts enrolment, teacher availability and completion. Progress will read as equity only when the distance between the best and the worst performing States narrows on the same indicators that have improved nationally.

    “[2022, GS2, 15 marks] The Right of Children to Free and Compulsory Education Act, 2009 remains inadequate in promoting incentive-based system for children’s education without generating awareness about the importance of schooling. Analyse.”

  • English indigenous or foreign language? Supreme Court for examining constitution

    Why in the News

    The Supreme Court on 20 August 2026 said the constitutionality of treating English as a non indigenous language under the three language policy will have to be examined, given the extent of its roots in Indian society. That classification decides which languages compete for a student’s single foreign language slot, so a descriptive label is operating as a rationing rule.

    What is the Three-Language Formula?

    1. What it requires: The three language formula requires a school student to learn three languages, of which at least two must be native Indian languages, described in the policy as Bhartiya Bhashas.
    2. Source and timing: The Central Board of Secondary Education (CBSE) is introducing it under the National Education Policy, 2020 from the academic year 2026-27.
    3. Sequence prescribed: The policy begins a child with the mother tongue, moves to another indigenous language, and leaves the third open to being either indigenous or foreign.

    What is the National Council for Teacher Education (NCTE)?

    1. National Council for Teacher Education: The National Council for Teacher Education (NCTE) is the statutory body that lays down norms for teacher education programmes and recognises the institutions running them. Its rules decide whether a school’s language teacher holds the Bachelor of Education qualification that recognition requires.

    Why is the classification of English as non-indigenous a constitutional question?

    1. The label under scrutiny: The bench said it will have to see whether English can be classified as a non indigenous language or an indigenous one, given the historical perspective of English and the extent of its roots into Indian society.
    2. Objection to the word native: A judge on the bench recorded a serious reservation about the expression native, holding that it carries a very colonial import and that indigenous is the correct term.
    3. Source of the expression: The Additional Solicitor General told the Court that non native is an expression coming from the new education policy, and the bench replied that the framers of the policy ought to have been conscious of the words they chose.
    4. The Board’s position: English is an official language under the Constitution and that status cannot be taken away, it is not treated like a foreign language, and it cannot be treated like a native language either.
    5. The presiding judge’s view: The Chief Justice of India said English could hardly be considered a foreign language.
    6. Why the label is reviewable: A classification that determines which language a student may take up is State action affecting a class of students, which brings it within constitutional review rather than leaving it to policy discretion alone.

    How does the classification restrict the study of other foreign languages?

    1. Two slots pre committed: Mandating at least two native Indian languages leaves a student only one slot for a foreign language.
    2. English absorbs that slot: Nearly all students choose English for the single slot, so French, Japanese and Spanish are effectively pushed out of the main curriculum.
    3. Enrolled students displaced: A large number of students already studying French and Japanese have to switch to a native language.
    4. Employment argument: Counsel for the petitioners argued that a second foreign language increases employment opportunities, and that the students affected come from middle and lower income homes.
    5. Textbook design problem: Textbooks placed online under the scheme begin with compound sentences rather than with the first letter, which makes learning an unfamiliar script from them impractical.

    Why is the Class 6 batch at the centre of the dispute?

    1. Cohort singled out: Classes 7 to 9 were exempted under Board guidelines, and the present Class 6 batch was slated to face full implementation.
    2. Terminal assessment: That batch faces a mandatory third language paper in the Class 10 Board examination by 2031.
    3. Reprieve proposed: The bench asked why the Class 6 students could not be given a reprieve from writing the third language paper in the Class 10 examination.
    4. Infrastructure not in place: The Court tied the reprieve to the fact that school infrastructure is still not adequately in place across the various education Boards.
    5. Start earlier instead: The bench held that the scheme should begin in a lower class, which would give students, families and school administrations elbow space to adapt.

    What capacity gaps does the Court identify in implementation?

    1. Choice on paper only: The option is 23 languages in theory, and in practice the range a school can actually offer is far narrower.
    2. Board asymmetry: Only around 4 per cent of schools are under the Central Board of Secondary Education and 96 per cent are under State Boards, so a Board level rule reaches a small share of the school system.
    3. Teacher education compliance: There are asymmetries in compliance with National Council for Teacher Education rules across schools and Boards.
    4. Qualified teacher shortage: There are inadequate numbers of Bachelor of Education qualified teachers for the languages the scheme would add.
    5. Sanskrit as the illustration: The bench asked how many Sanskrit teachers hold a Bachelor of Education qualification, noting that deep subject learning does not substitute for the prescribed teaching qualification.
    6. Compliance regime required: Schools will need an administrative compliance regime for the additional language, which they can absorb only if the change is phased in.

    What has the Court asked the Board to return with?

    1. One time reprieve: Whether a one time reprieve can be given to the current batch of Class 6 students from the third language Board examination.
    2. Human resources: How human resources are to be built to meet the demands of the three language scheme.
    3. Starting class: Whether the scheme should ideally be started in earlier classes rather than at Class 6.
    4. Response undertaken: The Additional Solicitor General said she would place these questions before the experts and appraise the Court.

    Does a mother tongue first policy expand or narrow a student’s choices?

    1. Cognitive case accepted: Early instruction in the mother tongue improves comprehension and retention, which the bench acknowledged as a good policy foundation.
    2. The count is not the constraint: The dispute is not over learning three languages but over the rule that two of them must be indigenous, which fixes the composition rather than the number.
    3. Choice shrinks at the top: Fixing two slots turns the third into the only site of choice, so every additional foreign language competes against English instead of sitting alongside it.
    4. Distributional effect: Students from middle and lower income homes depend on institutional provision for a second foreign language, and better resourced students can purchase it outside the school.
    5. Supply decides the outcome: A student in a school with two language teachers has a choice of two, whatever the 23 language menu states, so teacher supply and not the rule is the binding constraint.

    Challenges to implementing the Three-Language Formula

    1. Teacher cadre does not exist: A third language cannot be staffed from an establishment that was never recruited for it. Eg. Tamil Nadu has not maintained a Hindi teaching cadre in its government schools, so the posts a third language would require have no incumbents to draw on.
    2. State resistance on federal grounds: School education sits on the Concurrent List and States have rejected the formula as imposition. Eg. Tamil Nadu has followed a two language policy since 1968 and has declined central school scheme agreements that carry the three language requirement.
    3. Persistent non implementation: The formula has been official policy for six decades without uniform adoption. Eg. It was recommended by the Kothari Commission and adopted in the National Policy on Education, 1968, and no decade since has seen it implemented across all States.
    4. Migration breaks continuity: A child who moves between States loses the second indigenous language on transfer. Eg. A student learning Marathi in Maharashtra who relocates to West Bengal has to restart a new regional language at the same class level.
    5. Assessment weight against learning time: A Board paper in a language begun at Class 6 carries the same weight as papers in subjects taught from Class 1. Eg. The current Class 6 batch faces a third language paper in the 2031 Class 10 examination after five years of instruction.
    6. Material for less taught languages: Beginner grade teaching material is thin for classical and less taught languages. Eg. Textbooks placed online under the scheme open with compound sentences, which suits a scholarly reader rather than a Class 6 beginner.
    7. Private school offer disrupted: Schools that market a second foreign language lose that offer when the slot is taken. Eg. Private schools offering French, German and Japanese from Class 6 draw fee paying enrolment on that basis.

    Conclusion

    The dispute has moved from how many languages a school child must learn to who decides that English is not one of India’s own. The Court has said the constitutionality of classifying English as non indigenous will have to be examined, and has asked the Board to return on a one time reprieve for the Class 6 batch, on building teacher capacity, and on shifting the scheme to earlier classes. The Board has undertaken to place these questions before its experts, so the policy stands notified for 2026-27 with its core classification still under judicial scrutiny.

    “[2020, GS2, 15] National Education Policy 2020 is in conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient education system in India. Critically examine the statement.”

  • Climate resilience starts with the health workforce

    Why in the News

    Floods in Kerala and Assam have exposed the challenge of protecting lives during climate-related disasters, with attention going to rescue, relief camps and rebuilding. Analysis of climate-health governance across South and Southeast Asia shows that the workforce which prevents a disaster from becoming a prolonged public-health crisis is trained through fragmented, donor-supported projects rather than through the health system's own institutions.

    What is a climate-resilient health system?

    1. About: A climate-resilient health system is one able to anticipate, respond to, cope with and recover from climate-related shocks without interrupting routine health services.
    2. What it rests on: Its resilience ultimately depends on the workforce that delivers adaptation, since surveillance, emergency response and community outreach are performed by people rather than by plans.
    3. What changes under climate stress: Many of the foundational competencies required for climate adaptation already exist within health systems, and what changes is the context in which they must operate.
    4. The design principle: Climate change requires reorienting existing competencies through a climate lens and introducing new competencies where needed, rather than replacing what already exists.

    What is a heat action plan?

    1. About: A heat action plan is a city or region specific preparedness protocol that sets temperature thresholds, colour-coded warnings, and assigned responsibilities for health facilities, municipal bodies and emergency services during a heatwave.
    2. Why it is health-led: It converts a meteorological forecast into concrete health system action, covering hospital surge beds, oral rehydration supply, cooling spaces and outreach to outdoor workers and the elderly.

    What does the health workforce actually do during a climate disaster?

    1. Hospital preparedness: Hospitals prepare for medical emergencies, which is the visible clinical face of the response.
    2. Disease surveillance: Surveillance teams monitor disease outbreaks, since displacement and standing water raise the risk of communicable disease after a flood.
    3. Water quality testing: Laboratories test water quality, which determines whether relief camps and returning households face contamination risk.
    4. Community outreach: Community health workers reach vulnerable households, carrying care to those who cannot reach a facility.
    5. Cross-department coordination: Public health officials coordinate responses across departments, since the response involves disaster management, water supply, municipal services and health together.
    6. The net effect: It is the health workforce that prevents a natural disaster from becoming a prolonged public-health crisis, which is the least visible part of the response.

    What have states already put in place?

    1. Surveillance: States have begun to strengthen surveillance systems, which is the first line of detection for post-disaster outbreaks.
    2. Heat action plans: States have developed region-specific and city-specific heat action plans.
    3. Emergency preparedness: States have improved emergency preparedness arrangements within the health system.
    4. Programme integration: States have begun integrating climate considerations into several public-health programmes rather than treating climate as a separate vertical.
    5. The illustrative case: Kerala's response to the floods illustrates how health departments are increasingly incorporating public-health measures into disaster response.

    What does the South and Southeast Asia evidence show?

    1. The regional scope: The analysis covers climate-health governance across South and Southeast Asia, so the finding is regional rather than confined to one country.
    2. The central finding: Workforce development across the region remains fragmented, with no common architecture linking training to the health system's own institutions.
    3. The funding pattern: Climate-health training is largely confined to donor-supported or project-supported initiatives.
    4. What that implies: Capability rises and falls with the funding cycle of individual projects rather than accumulating within the system.
    5. Why the region matters for India: India's own state-level heat action plans and surveillance strengthening sit inside this regional pattern, so the fragmentation finding applies directly to Indian districts.

    Why does workforce capacity remain a surge response rather than a standing capability?

    1. The three questions the record raises: Whether these capacities can be sustained across all states, districts and levels of the health system; how surge capacities can be developed given the severe shortage of health workers across India; and whether capacities are being embedded across the workforce or continue to depend on individual relief-specific programmes and emergency mobilisation.
    2. The competency position: The competencies needed are largely present already, so the deficit is not one of knowledge.
    3. The institutional position: Those competencies sit in isolated training programmes rather than in the systems that produce, supervise and evaluate health workers.
    4. The consequence: Capacity is activated only during emergencies rather than translated into routine practice.
    5. The shortage constraint: The severe shortage of health workers across India limits how much surge capacity can be raised from an already stretched base.

    What would institutionalising climate-health competencies require?

    1. Beyond isolated training: Building climate-resilient health systems requires moving beyond isolated training programmes towards institutionalising climate-health competencies.
    2. The five integration points: These competencies should be integrated into pre-service education, professional development, supportive supervision, planning, and performance management.
    3. Pre-service education first: Placing climate-health content in pre-service education means every entrant carries the competency, rather than only those a project reaches.
    4. Supervision and performance: Embedding competencies in supportive supervision and performance management is what converts a completed training into observed practice.
    5. The three enablers: The integration must be supported by sustained governance, financing and institutional mechanisms.

    Challenges to Building a Climate-Resilient Health Workforce

    1. Absolute workforce shortage: Surge capacity cannot be drawn from a base that is already below norm, since redeploying staff for a flood response leaves routine services uncovered. Eg. Rural health facilities across India carry large shortfalls of specialists against Indian Public Health Standards, and community health centres report specialist vacancies in the range of two-thirds of sanctioned posts.
    2. Donor-cycle training: Competencies built through project funding disappear when the project closes, so the same district is trained repeatedly. Eg. Climate-health training across South and Southeast Asia remains largely confined to donor-supported or project-supported initiatives.
    3. Absence from pre-service curricula: Medical, nursing and allied health curricula do not carry climate-health competencies, so every entrant needs retrofitting. Eg. Heat illness protocols and post-flood outbreak management reach practitioners through workshops rather than through undergraduate training.
    4. Frontline worker load: Community health workers already carry multiple programme responsibilities, so a climate role is added without relief elsewhere. Eg. Accredited Social Health Activists deliver maternal health, immunisation, non-communicable disease screening and survey duties on an incentive-based payment structure.
    5. Data and early warning gaps: Health surveillance and meteorological forecasting run on separate systems, so an alert does not automatically reach a health facility. Eg. Heat action plans depend on India Meteorological Department warnings reaching district health officers in time for hospital preparation.
    6. Financing for adaptation: Adaptation finance for health competes with mitigation and infrastructure, so recurring workforce costs go unfunded. Eg. Global adaptation finance fell from 28 billion dollars to 26 billion dollars between 2022 and 2023, against a commitment to double it to 40 billion dollars by 2025.
    7. Attrition and contractual staffing: Much of the trained emergency workforce is on contract, so trained staff leave and the competency leaves with them. Eg. National Health Mission staff are engaged on contract across most States, with recurring demands for regularisation.

    Conclusion

    The health workforce is what prevents a climate disaster from becoming a prolonged public-health crisis, and its competencies are already largely present within health systems. The deficit is institutional, since climate-health training across South and Southeast Asia sits in donor-funded and project-funded initiatives rather than in pre-service education, professional development, supportive supervision, planning and performance management. Embedding those five points, supported by sustained governance, financing and institutional mechanisms, is what converts emergency mobilisation into routine practice. Until that happens, every flood and heatwave will draw on a surge capacity that has to be assembled afresh.

    Climate Change and Health in India

    1. The exposure: India faces heatwaves, floods, cyclones, droughts and air pollution simultaneously, so climate acts on health through multiple pathways rather than one.
    2. Heat: Rising heat exposure raises heat stroke, cardiovascular and renal illness, and reduces outdoor labour productivity, with outdoor workers, the elderly and pregnant women most exposed.
    3. Vector-borne disease: Warming and altered rainfall shift the range and season of malaria, dengue, chikungunya and Japanese encephalitis, moving transmission into districts and altitudes previously unaffected.
    4. Water-borne disease: Floods and cyclones contaminate drinking water and trigger diarrhoeal disease, cholera and leptospirosis outbreaks in the weeks after the event.
    5. Air quality: Ambient and household air pollution contribute to a very large share of India's non-communicable disease burden, with respiratory and cardiac mortality concentrated in the Indo-Gangetic Plain during winter.
    6. Nutrition: Crop yield loss and price shocks from extreme weather transmit into dietary quality, which shows up as child undernutrition rather than as a disaster statistic.
    7. The institutional response: The National Programme on Climate Change and Human Health, launched in 2019 under the National Health Mission, is the nodal programme, with State and district climate-health cells and nodal officers.
    8. The global frame: The Global Goal on Adaptation under the Paris Agreement now carries the 59 Belem Adaptation Indicators, the first global indicators for adaptation, spanning water, food, health, ecosystems, infrastructure and livelihoods.

    Government Initiatives

    1. National Action Plan on Climate Change: The 2008 framework of national missions, whose State Action Plans on Climate Change carry the health adaptation components at State level.
    2. National Action Plan for Heat Related Illnesses: Issued by the health ministry, it prescribes surveillance of heat-related illness and death, hospital preparedness, and health advisories during the heat season.
    3. National Disaster Management Authority heat guidelines: Guidelines for preparation of heat action plans, first issued in 2016 and revised subsequently, which States and cities use to build local plans.
    4. Ayushman Arogya Mandirs: Health and wellness centres delivering comprehensive primary health care, which are the delivery point for climate-sensitive surveillance and outreach at the community level.
    5. Integrated Disease Surveillance Programme and Integrated Health Information Platform: The national outbreak detection system, which is the mechanism through which post-flood and post-cyclone outbreaks are identified.
    6. Mission LiFE: A behavioural initiative on sustainable consumption, positioned as the demand-side counterpart to institutional climate action.

    Key Facts about Climate and Health Governance

    1. World Health Day: Observed on 7 April, marking the founding of the World Health Organization in 1948.
    2. National Doctors' Day: Observed on 1 July in India.
    3. Declaration on Climate and Health: COP28 at Dubai in 2023 was the first Conference of the Parties to formally address the health impacts of climate change, with a Declaration on Climate and Health endorsed by more than 140 nations, calling for climate-resilient health systems, extreme heat protocols and health co-benefits of mitigation. India did not sign it.
    4. Health Day at COP: COP28 also hosted the first dedicated Health Day on the official Conference of the Parties agenda, convened by the Presidency and the World Health Organization.
    5. Belem Adaptation Indicators: The 59 Belem Adaptation Indicators adopted at COP30 are the first global indicators for the Global Goal on Adaptation, and health is one of the domains they cover.
    6. Baku Adaptation Road Map: A two-year structured agenda running from 2026 to 2028 under the global goal on adaptation work programme, guiding progress on the Belem indicators and adaptation finance tracking.
    7. Adaptation finance goal: COP30 signalled a tripling of adaptation funding to 120 billion dollars a year by 2035 within the wider 1.3 trillion dollar pact, as a political signal rather than a binding commitment.

    Challenges in Climate and Health Governance

    1. Split institutional mandates: Climate policy sits with the environment ministry, disaster response with disaster management authorities and delivery with health departments, so no single authority owns climate-health outcomes. Eg. Heat action plans are issued under disaster management guidelines, and heat illness surveillance runs through the health ministry.
    2. Plans without financing: State and city plans are prepared without a dedicated budget line, so implementation depends on reallocating funds from other heads. Eg. Reviews of Indian heat action plans have found most lack identified funding sources and legal backing.
    3. Weak local vulnerability data: Plans use uniform thresholds rather than locally derived ones, so warnings misfire in humid or high-altitude districts. Eg. Heat thresholds calibrated for dry inland cities do not capture the combined temperature and humidity stress in coastal districts.
    4. Under-recording of climate-attributable deaths: Heat and flood-related mortality is recorded under proximate clinical causes, which understates the burden used to justify funding. Eg. Heat stroke deaths are frequently certified as cardiac or renal failure without the heat exposure being recorded.
    5. Primary care infrastructure gaps: Facilities lack cooling, uninterrupted power and water security, which are prerequisites for functioning during a heatwave or a flood. Eg. Many primary health centres operate without assured power backup for cold chain and emergency care.
    6. Fragmented surveillance integration: Meteorological, water quality and disease surveillance systems do not exchange data automatically, so early warning does not translate into facility-level preparation. Eg. Outbreak detection after floods relies on manual reporting through the Integrated Disease Surveillance Programme.
    7. International finance shortfall: Adaptation finance for the health sector remains a small fraction of climate finance, which pushes workforce costs back onto domestic budgets. Eg. Adaptation finance globally fell from 28 billion dollars to 26 billion dollars between 2022 and 2023.

    Way Forward

    1. Put climate-health in pre-service curricula: Introduce climate-health competencies into medical, nursing, allied health and public health curricula, so every new entrant carries them without retrofitting.
    2. Embed competencies in supervision and appraisal: Add climate-health tasks to supportive supervision checklists and to the annual performance appraisal of district health officers and facility staff.
    3. Fund workforce costs from domestic budgets: Provide a recurring National Health Mission budget line for climate-health cells, district nodal officers and refresher training, so capability does not lapse with donor projects.
    4. Localise heat and flood thresholds: Derive district-specific temperature, humidity and rainfall thresholds from local mortality and morbidity data, rather than applying uniform national cut-offs.
    5. Integrate the data systems: Link India Meteorological Department warnings, water quality testing and the Integrated Disease Surveillance Programme, so an alert automatically triggers facility-level preparation.
    6. Improve cause-of-death recording: Add climate exposure fields to death certification for heat, flood and cyclone events, so the burden is measured and can be budgeted against.
    7. Climate-proof health facilities: Provide assured power backup, cooling, water security and structural resilience at primary health centres and community health centres in high-exposure districts.
    8. Regularise the emergency workforce: Convert contract emergency and surveillance staff into regular cadres, so trained capacity remains in the system rather than leaving with the contract.

    Matching Previous Year Question

    “[2024, GS2, 15] 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.”

  • [20th August 2026] The Hindu OpED: The IISERs have a leadership problem

    Question (2014, GS2): “Should the premier institutes like IITs/IIMs be allowed to retain premier status, allowed more academic independence in designing courses and also decide mode/criteria of selection of students? Discuss in light of the growing challenges.
    Linkage: This question directly addresses the central conflict in your prompt: the struggle of premier national science and technology institutes to maintain their academic independence and elite status when confronted with structural and administrative constraints.

    Mentor Comment

    Several of the seven Indian Institutes of Science Education and Research are operating under temporary, divided or incomplete leadership, with chairpersons holding simultaneous charge of two or three other institutions and nominated positions for eminent scientists lying vacant. The institutions were created to give students an intellectually vibrant research environment and prize autonomy as an essential ingredient of good science, which sits against a statutory Board structure dominated by government officials and nominees.

    What are the Indian Institutes of Science Education and Research?

    1. Why they were created: The Indian government created the Indian Institutes of Science Education and Research (IISERs) to offer students an intellectually vibrant research environment and to bring them into research at a relatively early stage by the standards of the Indian system.
    2. What they prize: They treat autonomy as an essential ingredient of good science, specifically the ability of scientists to decide which questions are worth pursuing and with what resources, and top down control is inimical to that vision.
    3. Their statutory basis: They were brought within the framework of the National Institutes of Technology, Science Education and Research Act, 2007.
    4. How many there are: Seven IISERs are in operation, each with its own Board of Governors.

    How are IISER Boards of Governors constituted?

    1. The statutory requirement: The 2007 Act requires each IISER to have a Board of Governors that includes senior government officials and other government nominees.
    2. Named ex officio positions: The IISER statutes specify, among others, the secretary of higher education and the director of the Indian Institute of Science (IISc), Bengaluru.
    3. The accountability rationale: Publicly funded science should be publicly accountable, which is the justification for the government presence on the Boards.
    4. Where the rationale runs out: Suboptimal appointments or outright vacancies are objectionable because they lead to policy paralysis at best, which is a failure of accountability rather than an exercise of it.

    What does the current composition of the seven Boards show?

    1. The IISc director’s spread: The director of the Indian Institute of Science is an ex officio member of most IISERs.
    2. IISER Pune: The chair of its Board is also the chairperson of the Visvesvaraya National Institute of Technology, Nagpur.
    3. IISER Berhampur: Its Board chair was given additional charge while also chairing the Board of the Indian Institute of Information Technology, Guwahati. Nominated positions on the same Board lie vacant, including one for an Indian Institute of Technology director and two for eminent scientists.
    4. IISER Bhopal: Its current director is listed as director in charge, after the previous director left to join NITI Aayog in June.
    5. IISER Thiruvananthapuram: Its chairperson simultaneously chairs the Boards of the Indian Institute of Information Technology, Kottayam and the Indian Institute of Information Technology, Design and Manufacturing, Kurnool.
    6. The cumulative position: Interim appointments are routine and vacancies arise during transitions, and ex officio positions change when officials move between posts, but taken together several IISERs are operating under temporary or incomplete leadership.

    Who is leading India’s basic science institutions?

    1. IISER Pune’s chairperson: A retired Indian Administrative Service officer whose educational background is in commerce and journalism.
    2. IISER Pune’s director: A chemical engineer by training, whereas the IISERs have little focus on engineering.
    3. IISER Thiruvananthapuram’s chairperson: A surgeon.
    4. IISER Tirupati’s chairperson: A chemical engineer and the co founder of an industrial group.
    5. IISER Berhampur’s chairperson: An executive in the footwear industry.
    6. The measurable outcome: Going by awards, fellowships or global achievement and recognition, there are few outstanding scientists in positions of authority on the IISER Boards today.

    Why does the professional background of a chairperson matter for a basic science institution?

    1. There is no legal bar: No rule requires that the chairperson of a scientific institution must be a scientist.
    2. Why it matters regardless: It bears on each institution’s credibility and on its vision, both of which rest on who is seen to be setting the research direction.
    3. What the Boards do gain from outsiders: Expertise in administration, industry, finance and public policy is genuinely useful to a Board.
    4. What the case for scientists rests on: Institutions focused on basic science should draw their leadership from the scientific community, where many people combine distinguished research careers with substantial experience in running academic and research organisations.
    5. The practice that was dropped: The government had earlier appointed the finest scientists to the IISERs’ helm before discontinuing the practice.
    6. The question that actually arises: It is not whether the current leaders are competent, it is why India’s many accomplished scientists are not being asked to lead institutions whose central purpose is basic science.

    How does divided and interim leadership weaken institutional autonomy?

    1. Attention divided across institutions: Leaders whose attention is already split between two or three institutions cannot supply sustained direction to any one of them.
    2. Control shifting away from scientists: With outsiders and divided attention at the top, scientists have less control over decisions that affect their own work.
    3. Rotation instead of recruitment: The availability of a research cadre calls into question the practice of moving the same people between institutions rather than recruiting from the scientific community.
    4. Administration falling behind: People familiar with the IISERs’ functioning describe an administration losing its ability to keep up with students’ needs in respect of a good education in basic science.
    5. The internal assessment: A senior scientist at one of the IISERs described the position as one in which there is no vision or imagination and no sense of leadership propelling the institution towards its core goals of carrying out high quality frontier research in and teaching basic science at an international level.
    6. The powers that go unused: By design, the directors and the Board hold the power to institute positive changes, so the deficit is one of direction rather than of authority.

    Challenges to institutional autonomy in India’s basic science institutions

    1. Lagging decline masked by reputation: An institution whose governance has begun to decline can remain scientifically productive for years as long as the people who built its reputation remain and the institutional label is still valuable, which delays any corrective response. e.g. the IISERs continue to attract strong entrants through the joint admission route while several Boards run without full leadership.
    2. Concentration of authority: Weak collegial governance shifts decisions towards a small group at the top, reducing faculty participation in academic direction. e.g. the flagging of a risk of concentration of authority as a consequence of the IISERs’ present leadership arrangements.
    3. Risk averse research culture: Where leadership lacks a research background, funding and hiring decisions favour safe incremental work over frontier problems. e.g. the expectation of an increasingly risk averse institutional culture as the cumulative effect of the IISERs’ governance decline.
    4. Vacancies in nominated positions: Seats reserved for eminent scientists and institute directors go unfilled, removing the very expertise the statute intended the Board to carry. e.g. the IISER Berhampur Board, with one Indian Institute of Technology director position and two eminent scientist positions vacant.
    5. Interim leadership without a mandate: A director in charge cannot commit an institution to long horizon research investments. e.g. IISER Bhopal, run by a director in charge after the previous director left for NITI Aayog in June.
    6. Government nominee dominance: The statutory requirement of senior officials and nominees on the Board makes institutional direction dependent on the postings cycle of the civil service. e.g. the ex officio membership of the secretary of higher education on IISER Boards under the 2007 Act statutes.
    7. Underfunding of basic research: India’s gross expenditure on research and development remains below one per cent of gross domestic product, so institutional autonomy is further constrained by dependence on annual government grants. e.g. the persistent share of roughly 0.64 per cent of gross domestic product against the two per cent and above spent by comparable research economies.
    8. Faculty attrition to better resourced systems: Weak governance and uncertain research support push early career scientists towards positions abroad or in the private sector. e.g. the reliance of schemes such as Ramanujan and Ramalingaswami fellowships on reversing exactly this outflow.

    Conclusion

    The IISERs were created on the premise that scientists deciding their own research questions produces better science than top down direction, and the statutory Board structure was the accountability counterweight to that autonomy. The counterweight has become the whole of it, with chairpersons drawn from outside the scientific community, ex officio members spread across several institutions, and seats reserved for eminent scientists left vacant. Restoring the earlier practice of appointing distinguished scientists to the helm, and filling the nominated positions the statutes already provide, requires no change in the law.

    Basic Scientific Research in India

    1. What it covers: Basic research is investigation directed at understanding fundamental phenomena without a specified application, distinguished from applied research and from experimental development.
    2. Institutional spread: It is conducted through the Council of Scientific and Industrial Research laboratories, the Department of Atomic Energy and Department of Space institutions, the Indian Institutes of Science Education and Research, the Indian Institute of Science, the Tata Institute of Fundamental Research and the central universities.
    3. Scale of national spending: India’s gross expenditure on research and development stands at roughly 0.64 per cent of gross domestic product, against about two per cent or more in most comparable research economies.
    4. Composition of that spending: The government accounts for the larger share of research spending in India, whereas in most leading research economies the private sector accounts for the bulk of it.
    5. Global standing on output: India ranks among the top three countries in the world by annual volume of scientific publications, and its citation impact remains below that publication rank.
    6. The IISER model: The IISERs were designed as a distinct category from the Indian Institutes of Technology, combining a five year integrated science programme with a research faculty, so that undergraduates enter laboratories early.
    7. The funding reform: The Anusandhan National Research Foundation, established under the Anusandhan National Research Foundation Act, 2023, is intended to fund research across universities and colleges, with a substantial share of its corpus expected from non government sources.

    Government Initiatives for Science Education and Research

    1. Anusandhan National Research Foundation: Established under the Anusandhan National Research Foundation Act, 2023 as the apex body for seeding, growing and promoting research across the natural sciences, engineering, mathematics, environmental and earth sciences, health and agriculture, with a mandate to fund university and college research.
    2. INSPIRE: The Innovation in Science Pursuit for Inspired Research programme of the Department of Science and Technology offers scholarships to school students, undergraduate and postgraduate scholarships in the basic and natural sciences, and faculty fellowships.
    3. Kishore Vaigyanik Protsahan Yojana: A fellowship programme to identify and support students with an aptitude for research careers in the basic sciences, since merged into the INSPIRE stream.
    4. Ramanujan and Ramalingaswami Re entry Fellowships: Offered by the Science and Engineering Research Board and the Department of Biotechnology respectively to bring Indian scientists working abroad back into Indian institutions.
    5. PM Research Fellowship: Provides doctoral fellowships at institutions of national importance with an enhanced stipend and a research grant, to retain top undergraduates within the domestic research system.
    6. National Research Professorship and J.C. Bose Fellowship: Recognise and support distinguished scientists to continue active research beyond conventional retirement.
    7. Vigyan Jyoti and Women in Science and Engineering KIRAN: Target the participation of girls and women in science, technology, engineering and mathematics education and research careers.

    Key Facts about the IISERs

    1. Number and locations: Seven institutes, at Kolkata, Pune, Mohali, Bhopal, Thiruvananthapuram, Tirupati and Berhampur.
    2. Year of first establishment: The first two, at Kolkata and Pune, were established in 2006, followed by Mohali in 2007, Bhopal and Thiruvananthapuram in 2008, Tirupati in 2015 and Berhampur in 2016.
    3. Statutory status: They are Institutes of National Importance under the National Institutes of Technology, Science Education and Research Act, 2007.
    4. Administering ministry: The Department of Higher Education in the Ministry of Education.
    5. Flagship programme: A five year BS-MS dual degree in the basic sciences, with admission through the IISER Aptitude Test and other channels.
    6. Governance structure: A Board of Governors chaired by a chairperson, with a director as the chief executive, and a Senate for academic matters.
    7. Named ex officio Board members: The secretary of higher education and the director of the Indian Institute of Science, Bengaluru, among others.

    Back2Basics: National Institutes of Technology, Science Education and Research Act, 2007

    1. What it is: A central Act that declares certain institutions to be Institutes of National Importance and provides for their incorporation, governance and funding.
    2. Enacted: 2007, originally covering the National Institutes of Technology, and later extended to the IISERs and to the Indian Institutes of Engineering Science and Technology.
    3. What Institute of National Importance status confers: Autonomy to award its own degrees, direct central funding, and exclusion from the University Grants Commission’s affiliation framework.
    4. Governance it prescribes: Each institute has a Board of Governors as the principal executive body, a Senate for academic decisions, a chairperson, a director and a registrar.
    5. Composition requirement: The Board must include senior government officials and other government nominees, which is the provision that places the secretary of higher education and the Indian Institute of Science director on IISER Boards through the institute statutes.
    6. The Council: The Act also creates a Council for the institutes it covers, chaired by the Union Minister in charge, to coordinate across them.
    7. Why it governs this item: It is the statutory source of both the IISERs’ autonomy and the government dominated Board structure that the present appointments have made the operative feature.

    Way Forward

    1. Restore scientist leadership at the helm: Reviving the earlier practice of appointing distinguished scientists as chairpersons and directors requires no amendment to the 2007 Act, only a change in the selection practice.
    2. Fill the vacant nominated seats: Appointing to the eminent scientist and institute director positions already provided in the statutes restores the scientific expertise the Board structure was designed to carry.
    3. Bar simultaneous multiple chairmanships: A rule against holding the chair of more than one Institute of National Importance would end the divided attention that leaves several IISERs without sustained direction.
    4. Time bound filling of directorships: A fixed outer limit on how long an institute may run under a director in charge would prevent interim leadership becoming the standing arrangement.
    5. Publish selection criteria and search process: A transparent search committee process, with published criteria for research standing and institution building experience, would make appointments contestable on merit.
    6. Build a leadership pipeline from the research cadre: Structured administrative training for mid career scientists would widen the pool beyond the same individuals rotated between institutions.
    7. Strengthen Senate authority over academic direction: Vesting curriculum, faculty recruitment and research priorities firmly with the Senate would insulate scientific decisions from Board level turnover.
    8. Raise and stabilise research funding: Multi year block grants through the Anusandhan National Research Foundation would reduce the dependence on annual allocations that constrains long horizon research.

  • Census 2027: rights groups flag gaps in disability categories

    Why in the News

    Disability rights organisations have objected to the nine category disability question proposed for Census 2027, against the 21 specified disabilities recognised in law. The objection turns on a design choice, since the categories printed on the schedule decide which conditions can be counted at all, and a condition without its own box is recorded inside a broader one or not at all.

    What does Census 2027 propose to record on disability?

    1. The nine proposed categories: Seeing, hearing, speech, mobility, intellectual disability, mental illness, disability due to acid attack, disability due to chronic neurological disease, and blood disorder.
    2. What carries over from 2011: Six of the nine, namely seeing, hearing, speech, mobility, intellectual disability and mental illness, are the 2011 Census categories, with “mental retardation” renamed “intellectual disability”.
    3. What is new: Acid attack, chronic neurological disease and blood disorder are the three additions over the 2011 schedule.
    4. Multiple disability recording: The questionnaire allows up to three disabilities to be recorded for one person, entered in the order of severity.

    What are “specified disabilities” under the Rights of Persons with Disabilities Act, 2016?

    1. The statutory list: The Rights of Persons with Disabilities (RPwD) Act, 2016 recognises 21 specified disabilities in its Schedule, covering physical, intellectual, mental, blood related and multiple disabilities.
    2. The expansion it made: The Act replaced the Persons with Disabilities Act, 1995 and raised the recognised types from seven to 21, treating disability as a dynamic and evolving concept.

    Why do rights groups say the nine categories fall short?

    1. The assurance on record: The Union Minister of State for Social Justice and Empowerment stated in March 2026 that Census 2027 would capture data on all 21 disabilities.
    2. Conditions without a distinct box: Autism spectrum disorder, specific learning disabilities, dwarfism, leprosy cured persons and multiple disabilities including deafblindness are not distinctly placed under any proposed category.
    3. Distinct conditions collapsed into one: Thalassemia, haemophilia and sickle cell disease are reduced to the single category “blood disorder”, which erases the difference between three separate conditions with different prevalence and support needs.
    4. Other statutory conditions absent: Cerebral palsy, muscular dystrophy and multiple sclerosis are recognised in the Act but not separately represented in the proposed schedule.
    5. Scale of the objection: The statement of the National Platform for the Rights of the Disabled (NPRD), citing information from the Politics and Disability Forum, was endorsed by more than 400 signatories.

    What is the Registrar General’s defence of the design?

    1. Broad categories by design: The nine are described as broader categories that include other detailed specific disabilities within them.
    2. Severity ordering retained: The option to record up to three disabilities in order of severity is offered as the mechanism for capturing multiple disability.
    3. Consultation claimed: Categories were finalised after consultation with the Department of Empowerment of Persons with Disabilities, the Ministry of Social Justice and Empowerment, and other stakeholders.
    4. Enumerator competence: Field functionaries are not technically qualified to assess or confirm a specific disability, which is the stated reason for keeping categories broad.
    5. Training provided: A three day training covering all aspects of the questionnaire is held for enumerators and supervisors.
    6. Comparison with 2011: The 2027 schedule enumerates a larger number of disabilities than the 2011 schedule did.

    Why does the classification itself decide the count?

    1. The instrument sets the ceiling: An enumerator can only record what the schedule offers, so a condition without a category is absorbed into a broader one and disappears from the published table.
    2. Untrained recognition: Broad categories without a notified training module on which specific disability sits under which head leave the classification to the enumerator’s judgement.
    3. The respondent’s own knowledge: A person who neither communicates nor understands the correct name of their disability cannot correct a wrong entry, which compounds the error.
    4. Self declaration and stigma: Census disability data is self reported, and households under reported disability in earlier rounds because of stigma, which a broad category does nothing to correct.
    5. Downstream consequence: Undercounting a specific group weakens the evidence base for scheme design, budget allocation and reservation entitlements tied to that disability.

    What did the 2011 Census record on disability?

    1. Total count: The 2011 Census counted 2.68 crore persons with disabilities, which was 2.21 percent of the country’s population.
    2. Categories used: The 2011 schedule carried six of the nine categories now proposed.
    3. Concentration of the count: Movement or locomotor, hearing and vision related disabilities together accounted for over half of the country’s population with disabilities.
    4. What the 2011 base implies: A count already limited to six categories in 2011 sets the comparison base against which any 2027 increase will be read.

    Challenges to accurate disability enumeration

    1. Self reporting and stigma: Households conceal disability, particularly mental illness and intellectual disability, to avoid social consequences for marriage and employment. e.g. the 2011 Census figure of 2.21 percent sits well below global disability prevalence estimates of around 15 percent of population.
    2. Untrained enumerators on clinical categories: A three day training cannot equip a field functionary to distinguish autism spectrum disorder from intellectual disability. e.g. specific learning disabilities are invisible without assessment and were absent from the 2011 count entirely.
    3. Severity capping at three: Persons with more than three conditions lose the rest of their profile, which particularly affects multiple disability. e.g. deafblindness combines two sensory disabilities and has no distinct category in the proposed schedule.
    4. No linkage to certification data: Census figures are not reconciled with the Unique Disability ID database, so the two official counts diverge. e.g. UDID certification is issued against the 21 statutory categories while the Census will record nine.
    5. Question placement and time: The disability question sits late in a long household schedule, where fatigue produces default negative answers. e.g. the 2027 self enumeration form is completed by the respondent without any enumerator prompt at all.
    6. Definitional change across rounds: Renaming and regrouping categories between censuses breaks comparability of the time series. e.g. “mental retardation” in 2011 becomes “intellectual disability” in 2027, and three blood conditions are merged into one new head.

    Conclusion

    The dispute is not about whether Census 2027 counts persons with disabilities but about whether its nine category schedule can carry the 21 categories the law recognises. The Registrar General’s position is that the nine are containers holding the specific conditions, and the rights groups’ position is that a container without a notified mapping and enumerator training will not produce disaggregated data. The self enumeration window for snowbound areas is open until 31 August 2026, with the second phase of population enumeration in those areas from 1 to 30 September 2026 and a revisional round from 1 to 5 October 2026. Any change to the disability question must therefore be made before the main enumeration schedule is frozen.

    “[2026] Which of the following statements with regard to the persons with disabilities in India is/are correct?

    1. The Rights of Persons with Disabilities Act, an Act passed by the Parliament of India in 2018, mandates reservation in education and employment, places a legal duty on Governments to ensure accessibility and non-discrimination.

    2. The Sugamya Bharat Abhiyan focuses on achieving universal accessibility for Persons with Disabilities across three key domains, built infrastructure, transport systems and information and communication technology.

    3. The National Divyangjan Finance and Development Corporation (NDFDC) is a public sector organisation set up by the Ministry of Corporate Affairs as a not-for-profit company to promote entrepreneurship among Persons with Disabilities (PwDs).

    (a) 1 and 2

    (b) 2 only

    (c) 1 and 3

    (d) 1 only

  • [19th August 2026] The Hindu OpED: Education must change to account for AI

    Question (2023, GS3): “Introduce the concept of Artificial Intelligence (AI). How does AI help clinical diagnosis? Do you perceive any threat to privacy of the individual in the use of AI in healthcare?
    Linkage: This is the foundational question on AI awareness. Adapting education to AI requires first understanding its core concepts and cross-sectoral applications, which are now being integrated into school and higher education curricula.

    Mentor Comment:

    Artificial Intelligence (AI) is reshaping work in the sectors where India holds comparative advantage, including generic drugs, biosimilars and vaccine manufacture, and will eliminate a large share of entry level positions while leaving deep domain expertise in demand. This exposes a conflict between an education system built to load ever more content before entry into the workforce and an economy that now requires selection, synthesis, judgement and adaptation instead.

    What is the National Education Policy’s four year undergraduate structure?

    1. What it is: The National Education Policy, 2020 replaced the three year undergraduate degree with a flexible four year undergraduate programme offering multiple entry and exit points.
    2. Exit ladder: A certificate after one year, a diploma after two years, a bachelor’s degree after three years and a bachelor’s degree with research after four years.
    3. The research pathway: The fourth year is designed as a research pathway in which a student undertakes a supervised project rather than additional taught coursework.
    4. Credit portability: Credits earned at each exit point are deposited in the Academic Bank of Credits, allowing a student to re-enter and complete the degree later.
    5. Why it matters here: The four year structure with a research final year is the closest institutional equivalent to apprenticeship that the system already possesses.

    What is vibe coding?

    1. What it is: Vibe coding is the practice of producing working software by describing the desired outcome in natural language to an AI system, which generates and iterates on the code, rather than by writing the code line by line.
    2. Effect on work: It removes the routine coding task that has historically been the entry level rung in software employment.

    What are biosimilars?

    1. What they are: Biosimilars are biological medicines highly similar to an already approved reference biologic, with no clinically meaningful difference in safety, purity or potency.
    2. Why they differ from generics: A biosimilar is produced in living cells and cannot be copied exactly, so approval requires comparative analytical, non clinical and clinical evidence rather than simple bioequivalence.

    What is an automated fill finish line?

    1. What it is: A fill finish line is the final stage of pharmaceutical manufacture in which the bulk drug substance is filled into vials or syringes, stoppered, sealed, inspected and labelled under sterile conditions.
    2. Effect of automation: Robotic and isolator based fill finish removes human presence from the sterile core, which raises throughput and sterility assurance while eliminating operator roles.

    How is AI changing the nature of work itself?

    1. Change is rapid and unpredictable: The nature of work is changing at every level, and the direction of that change cannot be forecast with confidence.
    2. Routine work is the first casualty: Vibe coding threatens to render much routine coding obsolete, which removes the task that entry level employees have traditionally performed.
    3. Important work also becomes routine: With wisely configured agents and other tools, even important work can be made routine, so the change is not confined to low skill tasks.
    4. Employment shifts to oversight: Fewer employees remain, and their function becomes careful oversight of systems rather than execution of the task.
    5. No settled timeline: Assessments of when superintelligence arrives range from a few years to many years, so institutions cannot plan against a fixed date.

    How will AI reshape the sectors of Indian strength?

    1. Generic drugs and biosimilars: AI is reshaping molecule screening and formulation in generic drugs and biosimilars.
    2. Synthesis and quality control: Robotics and machine vision will increasingly handle synthesis and quality control in the same sectors.
    3. Vaccine design: AI can help design antigens and predict immune responses, changing the research stage of vaccine development.
    4. Vaccine manufacture: Robotic bioreactors, automated fill finish lines and AI managed logistics will make production faster, cleaner and more precise.
    5. Corporate adaptation is assumed: Indian industry will pivot to meet these changes and companies may survive and prosper, so the disruption falls on employment rather than on firms.

    Why does the disappearance of entry level jobs create a skills paradox?

    1. Two requirements point in opposite directions: Employers will still need people with deep domain expertise, and the entry level positions through which such expertise was historically acquired will disappear.
    2. Expertise cannot be front loaded: Deep domain expertise cannot be acquired at the point of entry, so it cannot simply be added to a degree programme as more coursework.
    3. Employee profiles change, not employer demand: Companies will prosper while their employee profiles change dramatically, so the market signal to students is ambiguous rather than absent.
    4. Oversight requires the expertise it displaces: The remaining employees must supervise systems whose outputs only an expert can evaluate, so the skill required is higher precisely where the training ladder has been removed.
    5. The gap is institutional, not individual: No individual can resolve a missing apprenticeship rung by studying harder, which is why the response has to come from the design of education.

    Why has the strategy of extending years of education run out of road?

    1. The historical pattern: Earlier technological revolutions were met by extending education, from basic literacy to primary school, then high school, then college, and increasingly professional master’s degrees.
    2. What each transition demanded: Every transition asked people to acquire and retain more knowledge before entering the workforce.
    3. Why the pattern breaks now: As AI systems advance, the comparative advantage no longer lies in humans storing ever more information in their heads.
    4. What replaces storage: The requirement is to know what must be understood deeply, what can be retrieved when needed, and how to learn quickly in unfamiliar situations.
    5. Adding material makes it worse: A future that cannot be predicted cannot be prepared for by adding ever more material to the curriculum.

    What kind of rigour must replace content coverage?

    1. Two apparently contradictory tasks: Education must thin out what it teaches while providing far more opportunities to learn on the fly.
    2. Not less rigour: The objective is a different kind of rigour rather than a reduction of it.
    3. The four capacities named: That rigour consists of selection, synthesis, judgement and adaptation.
    4. How it is built: Students need repeated experience of confronting problems whose answers are not in the syllabus, finding the relevant knowledge and applying it with judgement.
    5. The system’s starting condition: India’s higher education system contains isolated pockets of excellence embedded in a large undifferentiated mass that is difficult to reform as a whole.

    How can the four year undergraduate structure deliver apprenticeship at scale?

    1. The ideal model and its limit: The ideal way to train an expert is apprenticeship, one student working closely with one teacher or practitioner, and that model cannot be provided at scale at present.
    2. The available substitute: The National Education Policy’s four year undergraduate structure already provides a research pathway in the final year, the closest institutional equivalent available.
    3. What blocks it in practice: Residual coursework crowds out the immersion the policy intends, so the final year reverts to taught classes.
    4. The proposed fix: Universities should allow any remaining essential coursework to be completed online, freeing the year for immersion.
    5. Where students should be placed: Students should spend that year embedded in industry, university laboratories or national laboratories.
    6. What the placement teaches: Working alongside people solving real problems lets students encounter uncertainty and learn to acquire knowledge as it becomes necessary.

    Challenges to reorienting education for AI

    1. Faculty shortage and capacity: Immersion requires supervisors who themselves work on live problems, and Indian universities carry large vacancies in teaching posts, e.g. central universities have reported vacancy levels around one third of sanctioned teaching positions.
    2. Absence of industry placement capacity: There are not enough laboratories and firms willing to host a full cohort for a year, e.g. the National Apprenticeship Promotion Scheme has consistently engaged far fewer apprentices than its annual targets.
    3. Regulatory rigidity on credits: University statutes tie degrees to classroom contact hours, which blocks substitution of a year of placement for taught credits, e.g. many State universities still require minimum attendance percentages that a workplace year cannot satisfy.
    4. Assessment mismatch: Examination systems reward recall, which is the exact capacity AI has made least valuable, e.g. the majority of Indian undergraduate examinations remain terminal written papers rather than project defences.
    5. Digital access inequality: Moving residual coursework online assumes reliable connectivity and devices, which a large share of students lack, e.g. only about 57 percent of women have independent internet access against 72 percent of men.
    6. Employability and credential signalling: Employers screen on degree names and marks rather than on demonstrated judgement, so students resist a less legible qualification, e.g. campus recruitment for information technology services has long been anchored to aggregate marks thresholds.
    7. Uneven institutional quality: Reform designed for research capable institutions cannot be transplanted into colleges with no research infrastructure, e.g. a large majority of Indian undergraduate students study in affiliated colleges rather than in universities.
    8. Financing the transition: Placement years, laboratory access and supervision cost money that public institutions do not currently receive, e.g. public expenditure on education remains near 4.6 percent of gross domestic product against the National Education Policy’s 6 percent target.

    Conclusion

    The core problem is not that AI will destroy work but that it removes the entry level rung through which deep expertise was formed, while continuing to demand that expertise. Adding more content to the curriculum cannot answer this, and the response is to thin the syllabus and use the National Education Policy’s four year structure to place students inside industry and laboratories for a full year. That requires moving residual coursework online and treating immersion, not coursework, as the final year’s substance.

  • The challenge for school consolidation

    Why in the News

    A recent NITI Aayog Report flagged the closure of nearly 94,000 government schools across India over the past decade. Falling enrolment and a declining fertility rate underlie the closures and mergers. The debate weighs neighbourhood access against better resourced consolidated schools.

    What is school consolidation?

    1. Definition: the merging of under enrolled schools into better equipped composite schools with qualified teachers and improved infrastructure.
    2. Aim: to raise educational quality rather than merely cut costs.
    3. Constitutional placement: education sits on the Concurrent List, so states drive closure and merger policy.

    What is UDISE Plus?

    1. Full form: the Unified District Information System for Education Plus.
    2. Function: an education management information system that tracks schools, enrolment and teachers nationwide.
    3. It is the largest digital database of information related to school education in India.
    4. This portal, operated by the Union Ministry of Education, records the details of all recognized government and private schools in the country online.

    What do the data reveal between 2014-15 and 2024-25?

    1. Schools: the total number of schools fell by about 45,000, driven entirely by a fall of 94,000 government schools while private unaided schools grew.
    2. Enrolment: overall enrolment fell by 2.26 crore to 24.69 crore.
    3. Sector shift: government enrolment fell while private enrolment rose from 8.42 crore to 9.59 crore.
    4. Teachers: teacher numbers rose from about 90 lakh to over one crore, improving teacher availability.
    5. Demography: the total fertility rate fell from more than 3 in the early 1990s to about 2.0, below the replacement level of 2.1.

    Why does school size matter?

    1. Thin schools: thousands of schools run with a single teacher or a handful of students.
    2. Weak instruction: low size makes grade wise, subject specific teaching, laboratories and peer learning difficult.
    3. Teacher load: teachers handle multiple classes alongside administrative tasks.
    4. Hidden disparity: national averages mask overcrowded urban schools alongside near empty rural ones.

    What are the challenges to school consolidation?

    1. Travel distance: longer distances disadvantage young children, girls and students in remote or tribal areas.
    2. Access risk: closures can strip neighbourhood access unless safe transport is guaranteed.
    3. Cost driven mergers: decisions taken on financial grounds alone can undercut quality goals.
    4. Equity gap: consolidation must balance quality, efficiency and equitable access, not just efficiency.
    5. Data need: decisions should be data driven rather than administrative, with uninterrupted access ensured wherever schools merge.

    Conclusion

    The school numbers reflect a transformation, not merely closures, driven by demographic change and shifting preferences. Consolidation can raise quality but only if it protects access for the most vulnerable children. Success should be measured by whether every child reaches a well resourced school, with safe transport where schools merge.

    Back2Basics

    International Examples & Case Studies

    India (Project SATH-E & State Initiatives):

    1. Under NITI Aayog’s Project SATH-E, states like Madhya Pradesh, Jharkhand, and Odisha consolidated over 26,000 schools.
    2. Rajasthan horizontally merged co-located schools and built vertically integrated “Adarsh” (model) schools spanning grades 1-12. This reduced multi-grade teaching and doubled the presence of designated headmasters.

    China (Rural School Consolidation Policy):

    1. Implemented to centralize resources in middle-income rural areas. While it successfully built larger, better-funded institutions, longitudinal studies indicate unintended consequences.
    2. For instance, longer commutes occasionally limited written minority language facility and worsened educational equity for marginalized groups.

    The Nordic Countries & Western Europe: Ecosystem Integration

    1. Low demographic density in isolated rural pockets across Denmark, the Netherlands, and Norway.
    2. Unlike abrupt closures, Denmark and other Nordic nations leveraged regional clustering. Rather than completely standardizing environments, they implemented extensive public support networks, dedicated student transport, and digital infrastructure to ease student adjustments.
    3. Short-term disruption to student test scores was documented, particularly for students transferring from the smallest schools. However, these adverse effects weakened over time as institutional integration stabilized

    PYQ Relevance

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

    Linkage: The PYQ examines whether school education reforms ensure universal and equitable access under the RTE Act. The article assesses whether school consolidation can improve quality without compromising access for vulnerable children.

  • Extending creamy layer to SC, ST is Parliament’s call: Govt to top court

    Why in the News

    The Centre has told the Supreme Court that the creamy layer principle cannot be extended to Scheduled Castes (SCs) and Scheduled Tribes (STs) through judicial directions. It argued that any such change requires a decision by Parliament, as reservation for SCs and STs is based on historical and social discrimination rather than economic status.

    What is the Creamy Layer Principle?

    • Definition: Excludes the socially advanced and economically better off members of a reserved category from availing reservation benefits.
    • Origin: Introduced for Other Backward Classes (OBCs).
    • Current Position: The principle does not apply to SCs and STs, whose reservation is based on historical discrimination and social exclusion.

    What did the Centre argue before the Supreme Court?

    • Parliament’s Authority: Only Parliament can decide whether to extend the creamy layer principle to SCs and STs.
    • Constitutional Basis: Any exclusion must follow the procedure under Article 341(2) (and similarly Article 342 for STs).
    • Need for Evidence: Any income based classification should be preceded by a comprehensive empirical study.
    • Separation of Powers: Courts should not direct the executive to frame such a policy without legislative backing.
    • Reservation Basis: SC and ST identification depends on historical social disadvantage, not merely economic criteria.

    Key Judicial Precedents

    • State of Punjab v. Davinder Singh (2024): Held that sub classification within SCs and STs for equitable distribution of reservation benefits is constitutionally permissible.
    • E.V. Chinnaiah v. State of Andhra Pradesh (2005): Held that altering the SC list requires legislative action under Article 341.
    • Ashoka Kumar Thakur v. Union of India (2008): Clarified that the creamy layer principle does not apply to SCs and STs.

    What is the core issue?

    • Equitable Distribution: Petitioners seek greater benefits for the poorest sections within SCs and STs.
    • Social Justice vs Economic Criteria: The Centre maintains that SC/ST reservation addresses historical social stigma, not poverty alone.
    • Institutional Question: The case raises the issue of whether such reforms should come through judicial intervention or Parliamentary legislation.

  • [3rd August 2026] The Hindu OpED: Strong health systems for all with better public spending 

    PYQ Relevance
    [UPSC 2024] 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.
    Linkage: The PYQ focuses on strengthening public healthcare through better financing and governance. The article shows how efficient spending, preventive care, and stronger governance can improve grassroots healthcare despite limited funds.

    Mentor’s Comment

    As donor countries reduce health aid and developing countries face rising debt repayments, increasing health funding for low- and middle-income countries (LMICs) is not a realistic option in the near future. The focus has therefore shifted to using existing health budgets more effectively through full utilisation of funds, greater investment in preventive and public health, and better governance. However, while improving efficiency is essential, it cannot fully overcome the basic problem of inadequate per-person health spending.

    Why does the LMIC health financing gap appear to be narrowing but is actually widening?

    1. GDP-share convergence: The health expenditure gap between LMICs and high-income countries as a share of GDP narrowed from 2.05 percentage points in 2000 to 1.68 percentage points in 2023.
    2. Per capita divergence: In per capita terms, the same gap has expanded more than three-fold over the same period.
    3. Absolute shortfall: Per capita public spending on universal health coverage in LMICs, including government expenditure and off-budget aid, is about half the minimum benchmark identified by the World Bank.
    4. Misleading metric: A GDP-share comparison understates the real resource gap. LMIC economies and populations are growing, so per capita spending is the more accurate measure of unmet need.

    Why can LMICs no longer count on external aid or fiscal headroom to close this gap?

    1. DAH peak and reversal: Development assistance for health (DAH) peaked in 2021 during the COVID-19 pandemic and has declined sharply since.
    2. US cuts: The United States, historically the source of over a third of global DAH, announced a 67% cut to foreign assistance in early 2025.
    3. Allied cuts: The United Kingdom, France, and Germany followed with cuts of 39%, 35%, and 12% respectively.
    4. Projected decline: The OECD projects health funding could fall by up to 60% from its 2022 peak.
    5. Debt burden: Global public debt reached $102 trillion in 2024. Developing countries owed $31 trillion of this, growing twice as fast as advanced-country debt since 2010.
    6. Crowding out: Developing countries paid a record $921 billion in net interest payments in 2024, leaving less fiscal space for health.

    Why does allocated health money not reach the ground in LMICs?

    1. Execution rates: LMIC health budgets are executed at 85-90%, lower than execution rates for the general budget and for education.
    2. Deprioritisation at implementation: Underspending against allocation amounts to a deprioritisation of health at the implementation stage, even when the budget itself was adequate on paper.
    3. India infrastructure mission: A parliamentary panel found only about two-thirds of the allocation for the flagship health infrastructure mission was spent in 2024-25.
    4. India disease programmes: Within the National Health Mission, only 26% of the money earmarked for communicable and non-communicable disease programmes was used that year.
    5. Category-wise variation: Wage and salary budgets are implemented in full. Spending on goods and services is underutilised. Health workers are left without adequate supplies and equipment.

    Why does the composition of health spending matter as much as its volume?

    1. Curative bias: A large share of public health spending goes to curative care at the secondary and tertiary levels rather than preventive, primary care.
    2. India preventive share: India spends less than one-fourth of public health money on preventive care, per London School of Hygiene & Tropical Medicine estimates.
    3. Public goods logic: Public health money delivers the highest impact when spent on classic public goods such as infectious disease control or sanitation, where market failure prevents private provision.
    4. Evidence on outcomes: Public health spending markedly improves infectious disease outcomes through access, vaccination, and sanitation. It does far less for maternal, child, and non-communicable disease outcomes.
    5. Emerging pressure: Ageing populations will increase the need for spending on chronic disease risk factors, early detection, and management.

    How does governance quality determine whether health spending converts into health outcomes?

    1. Governance-spending interaction: Countries with lower corruption and stronger bureaucratic quality see greater positive effects of public health spending on outcomes such as child mortality.
    2. Converse risk: Increasing spending where governance is weak does not reliably improve outcomes.
    3. Decentralisation challenge: Growing decentralisation of service delivery makes subnational governance quality increasingly central to health outcomes.
    4. PFM components: Budget credibility, timely cash disbursement, and flexible budgets that can respond to unforeseen circumstances such as pandemics are central to good public finance management.
    5. Provider involvement: Involving public health providers in budget processes improves both their accountability and motivation.
    6. Procurement: Improving procurement processes helps achieve greater value for money in health-sector resources.

    Does spending health money better substitute for spending more, or does it merely defer the underlying financing question?

    1. Efficiency as necessity, not choice: With external aid contracting and fiscal space shrinking, efficiency reforms are being pushed as the primary lever, not because they are sufficient but because more money is currently unavailable.
    2. Limits of efficiency: Even full execution and optimal prioritisation cannot close a financing gap that stems from an absolute shortfall in per capita resources relative to benchmarks.
    3. Equity argument: Returns to health spending are greatest exactly where outcomes are poorest. Underfunded LMICs stand to lose the most from a financing pullback that efficiency measures alone cannot offset.
    4. Unresolved question: The article does not specify how the residual financing gap, after full execution and reprioritisation, will eventually be closed.

    Conclusion

    The contraction of development assistance for health and the fiscal squeeze from rising public debt have made the additional-financing pathway to closing LMIC health gaps unreliable. The immediate policy response must be to spend existing health budgets more fully, reprioritise toward preventive and public-goods spending, and strengthen governance and public finance management. These measures improve outcomes per rupee spent but do not eliminate the underlying financing shortfall. Since returns to health spending are highest where outcomes are worst, the case for restoring adequate financing remains unresolved.