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Subject: Social Justice

  • How marriage age and women’s health are linked?

    PM had announced a panel to fight malnutrition in young women and ensure they get married at the right age. Take a look at how the two are linked:

    How prevalent is underage marriage?

    • Data show that the majority of women in India marry after the age of 21.
    • Chart 1 shows the mean age of women at marriage is 22.1 years, and more than 21 in all states. This does not mean that child marriages have disappeared.
    • The latest National Family Health Survey (NFHS-4) found that about 26.8% of women aged 20-24 (Chart 2) were married before adulthood (age 18).

    Try this question for mains:

    Q. Discuss how marriage age and women’s health are linked with each other?

    How does the age of marriage correlate with health?

    • Preventing early marriage can reduce the maternal mortality ratio and infant mortality ratio.
    • At present, the maternal mortality ratio — the number of maternal deaths for every 100,000 children born — is 145.
    • India’s IMR shows that 30 of every 1,000 children born in a year die before the age of one.
    • Young mothers are more susceptible to anaemia. More than half the women of reproductive age (15-49 years) in India are anaemic.

    What delayed marriage can alter?

    • Poverty, limited access to education and economic prospects, and security concerns are the known reasons for early marriage.
    • If the main causes of early marriage are not addressed, a law will not be enough to delay marriage among girls.

    What do the data show?

    • Women in the poorest 20% of the population married much younger than their peers from the wealthiest 20% (Chart 5).
    • The average age at marriage of women with no schooling was 17.6, considerably lower than that for women educated beyond class 12 (Chart 6).
    • Almost 40% of girls aged 15-18 do not attend school, as per a report of the National Commission for Protection of Child Rights.
    • Nearly 65% of these girls are engaged in non-remunerative work.
    • That is why many believe that merely tweaking the official age of marriage may discriminate against the poorer, less-educated and marginalised women.

  • Reversing health sector neglect with a reform agenda

    The article analyses the issues India could face in implementing the universal health coverage.

    Context

    • Both India and the U.S. leads the Covid cases in the world and also lack effective universal health coverage (UHC).

    What explains the lack of UHC in both the countries

    • The lack of UHC is due to multiple long-standing factors and historical reasons that have put a damper on the UHC agenda.
    • This long legacy has two important and inter-related implications when it comes to health-care reform.
    • 1) Certain foundational aspects of these health systems that have been adopted over decades tend to dictate the terms of further evolution and lead to a number of compromises.
    • 2) The long legacy itself comprises a path-dependent trajectory that precludes far-reaching health-care reform.
    • This applies both to AB-PM-JAY and NDHM.

    India’s attempt at UHC: Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana

    • The government has looked poised to employ Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance as the tool for achieving UHC.
    • Taking the health insurance route to UHC driven by private players, rather than strengthening the public provisioning of health care, is reflective of the non-negotiability of private health care in India.
    • Covering the remaining population under the AB-PM-JAY presents massive fiscal and design challenges.
    • Turning it into a contributory scheme based on premium collections would be a costly and daunting undertaking, given the huge informal sector and possible adverse selection problems.
    • Distributing benefits among various beneficiary groups, and a formalisation and consolidation of practices in a likely situation of covering outpatient care, are formidable additional challenges.
    • One possible advantage for India over the U.S. could be a relative ease of integrating fragmented schemes into a unified system. The AB-PM-JAY has this ability.

    Issues with AB-PM-JAY

    1) Universal insurance will not be universal access

    • In India, almost two-third corporate hospital are located in cities.
    • So, such maldistribution of health-care facilities and low budgetary appropriations for insurance could mean that universal insurance does not translate to universal access to services.
    • So far, insurance-based incentives to drive private players into the rural countryside have been largely unsuccessful.

    2) Lack of regulatory robustness

    • AB-PM-JAY is without enough regulatory robustness to handle everything from malpractices to monopolistic tendencies.
    • This could have major cost, equity, and quality implications.

    National Digital Health Mission (NDHM)

    • Integration and improved management of patient and health facility information are sought through NDHM.
    • But in the absence of robust ground-level documentation practices and its prerequisites, it would do little more than helping some private players and adding to administrative complexity and costs.

    Consider the question “What are the challenges India faces in the implementation of universal health coverage? Suggest the measures to achieve it.”

    Conclusion

    Upheavals offer a window for reforms. We cannot afford to be complacent and think that the pandemic will automatically change the Indian health-care landscape. It will require mobilising concerted action from all quarters.

  • Tribes in news: Bondas

    The COVID-19 pandemic has reached the Bondas, a PVTGs community residing in the hill ranges of Malkangiri district in Odisha.

    Try this PYQ:

    Consider the following statements about Particularly Vulnerable Tribal Groups (PVTGs) in India:

    1. PVTGs reside in 18 States and one Union Territory.
    2. A stagnant or declining population is one of the criteria for determining PVTG status.
    3. There are 95 PVTGs officially notified in the country so far.
    4. Irular and Konda Reddi tribes are included in the list of PVTGs.

    Which of the statements given above are correct?(CSP 2019)

    (a) 1, 2 and 3

    (b) 2, 3 and 4

    (c) 1, 2 and 4

    (d) 1, 3 and 4

    Who are the Bondas?

    • The Bondas are Munda ethnic group who live in the isolated hill regions of the Malkangiri district of southwestern Odisha near the junction of the three states of Odisha, Chhattisgarh, and Andhra Pradesh.
    • They are a scheduled tribe of India and are also known as the Remo (meaning “people” in the Bonda language).
    • The tribe is one of the oldest and most primitive in mainland India; their culture has changed little for more than a thousand years.
    • Their isolation and known aggressiveness continue to preserve their culture despite the pressures of an expanding Indian population.

    Back2Basics: Particularly Vulnerable Tribal Groups (PVTGs)

    • There are certain tribal communities who have declining or stagnant population, low level of literacy, pre-agricultural level of technology and are economically backward.
    • They generally inhabit remote localities having poor infrastructure and administrative support.
    • These groups are among the most vulnerable section of our society as they are few in numbers, have not attained any significant level of social and economic development.
    • 75 such groups have been identified and categorized as Particularly Vulnerable Tribal Groups (PVTGs).

  • Increasing the age of marriage for girls and related issues

    The article analyses the issues with objectives of increasing the age of marriage for girls.

    Poverty of mother: Important factor

    • Raising the age of marriage is the could be the way to improve the health and nutritional status of mothers and their infants.
    • An article published in the journal The Lancet Child and Adolescent Health analyses data on stunting in children and thinness in mothers in the latest round of the National Family Health Survey 4 (2015-16).
    •  The authors examine the strength of the association between many different causal factors.
    •  As it turns out, the poverty of the mother plays the greatest role of all by far.
    • Instead of early pregnancy causing malnourishment, they may both be the consequences of poverty.
    • The best way to go about breaking such a cycle would be to pick the factors perpetuating it, it would be the poverty of the mother in this case.

    Declining fertility rate in India

    • India’s fertility rates have been declining to well below replacement levels in many States, including those with higher levels of child marriage.
    • This could be the reason for the shift from fuelling fears about booming populations to expressing concern for the undernourishment of children.
    • So, the problem of “populations explosion” is not the real problem as the demographic data suggests.

    Concern

    • The change in the marriage age will leave the vast majority of Indian women who marry before they are 21 without the legal protections.

    Conclusion

    The proposal and the objective to be achieved through raising the age of marriage needs reconsideration for the reasons cited above.

  • What is the National Health ID System?

    In his address to the nation on Independence Day, the PM has launched the National Digital Health Mission which rolls out a national health ID for every Indian.

    Try this question for mains:

    Q.What is the National Health ID System? How will it benefit transforming healthcare facilities in India?

    National Health ID System

    • This system finds its roots in a 2018 NITI Aayog proposal to create a centralised mechanism to uniquely identify every participating user in the National Health Stack.
    • It will be a repository of all health-related information of a person.
    • According to the National Health Authority (NHA), every patient who wishes to have their health records available digitally must start by creating a Health ID.
    • Each Health ID will be linked to a health data consent manager — such as National Digital Health Mission (NDHM).
    • The Health ID is created by using a person’s basic details and mobile number or Aadhaar number.
    • This will make it unique to the person, who will have the option to link all of their health records to this ID.

    What was the original proposal for the health ID?

    • The National Health Policy 2017 had envisaged creation of a digital health technology eco-system aiming at developing an integrated health information system.
    • In the context of this, the central government’s think-tank NITI Aayog, in June 2018, floated a consultation of a digital backbone for India’s health system — National Health Stack.
    • As part of its consultation, NITI Aayog proposed a Digital Health ID to greatly reduce the risk of preventable medical errors and significantly increase the quality of care.

    Stakeholders in the national health ID

    • As envisaged, various healthcare providers — such as hospitals, laboratories, insurance companies, online pharmacies, telemedicine firms — will be expected to participate in the health ID system.

    Back2Basics:

    https://www.civilsdaily.com/news/national-digital-health-mission-ndhm/

  • [pib] E-Sanjeevani Tele-Medicine Platform

    1.5 lakh teleconsultations were recently completed on the “eSanjeevani” and “eSanjeevani OPD” tele-medicine.

    Why Telemedicine?

    Telemedicine can increase the efficiency of care delivery, reduce expenses of caring for patients or transporting to another location, and can even keep patients out of the hospital.  

    E-Sanjeevani Platform

    • E-Sanjeevani is a platform-independent, browser-based application facilitating both doctor-to-doctor and patient-to-doctor tele-consultations.
    • It provides the ease of accessing the health records at the comforts of one’s home.
    • The application is based on invite-system which restricts it to the actual beneficiaries of the application.
    • It has a user-friendly interface which facilitates both tech-savvy and novice doctors/users in the rural and urban environment to access the application.
    • This eSanjeevani platform has enabled two types of telemedicine services viz. Doctor-to-Doctor (eSanjeevani) and Patient-to-Doctor (eSanjeevani OPD) Tele-consultations.
    • The former is being implemented under the Ayushman Bharat Health and Wellness Centre (AB-HWCs) programme.

    Services included:

    The telemedicine platform hosts speciality OPDs which include:

    • Gynaecology, Psychiatry, Dermatology, ENT, Ophthalmology, antiretroviral therapy (ART) for the AIDS/HIV patients, Non-Communicable Disease (NCD) etc

    With inputs from:

    https://www.cdac.in/index.aspx?id=hi_pr_eSanjeevani

  • [pib] Electronic Vaccine Intelligence Network (eVIN)

    The eVIN has reached 32 States and Union Territories (UTs) and will soon be rolled out in the remaining States and UTs of Andaman & Nicobar Islands, Chandigarh, Ladakh and Sikkim.

    Try this question from CSP 2016:

    Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

    (a) Immunization of children and pregnant women

    (b) Construction of smart cities across the country

    (c) India’s own search for the Earth-like planets in outer space

    (d) New Educational Policy

    About eVIN

    • The eVIN is an innovative technological solution aimed at strengthening immunization supply chain systems across the country.
    • This is being implemented under the National Health Mission (NHM) by the Ministry of Health and Family Welfare.
    • It aims to provide real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in the country.
    • This system has been used during the COVID pandemic for ensuring the continuation of the essential immunization services and protecting our children and pregnant mothers against vaccine-preventable diseases.

    Components of eVIN

    • eVIN combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real-time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country.
    • At present, 23,507 cold chain points across 585 districts of 22 States and 2 UTs routinely use the eVIN technology for efficient vaccine logistics management.

    Benefits of eVIN

    • It has helped create a big data architecture that generates actionable analytics encouraging data-driven decision-making and consumption-based planning.
    • It helps in maintaining optimum stocks of vaccines leading to cost savings. Vaccine availability at all times has increased to 99% in most health centres in India.
    • While instances of stock-outs have reduced by 80%, the time taken to replenish stocks has also decreased by more than half, on an average.
    • This has ensured that every child who reaches the immunization session site is immunized, and not turned back due to unavailability of vaccines.

  • Issues metropolitan cities face

    Metropolitan cities of India suffers from various issues. This article analyses such issues and suggests some steps to deal with them.

    Inadequate public health infrastructure

    • India’s public health expenditure in 2018 was a mere 1.28% of GDP.
    • According to the World Bank, India’s out-of-pocket health expenditure was 62.4% in 2017, against the world average of 18.2%.
    • Manpower in the health sector is low with India’s doctor-population ratio being 1:1,457  against WHO norm of 1:1,000.

    Governance issues

    • Factors underlying city governance include spatial planning, municipal capacities, empowered mayors and councils and inter-agency coordination, and ward-level citizen participation.
    • Twenty-seven after the 74th Constitutional Amendment Act, these reform agendas continue to be slow in implementation.
    • India’s metropolitan cities have weak capacities in finance and staffing.
    • Bengaluru’s average percentage of own revenue to total expenditure is 47.9%, Chennai 30.5%, Mumbai 36.1% and Kolkata at 48.4%.
    • According to ASICS 2017, Mumbai has the highest number of officers per lakh population at 938 in the country.
    • Yet it is abysmally low compared to global cities such as Johannesburg with 2,922 and New York with 5,446 officers per lakh population

    Limited powers of mayors

    • The leaders steering India’s metropolitan cities are toothless.
    • No big metropolitan cities with 10 million-plus population has a directly-elected Mayor.
    • Mumbai’s Mayor has a tenure of 2.5 years, Delhi and Bengaluru, a mere one year.
    • Mayors do not have full decision-making authority over critical functions of planning, housing, water, environment, fire and emergency services in most cases.
    • Our metropolitan cities are far from being local self-governments.
    • Parastatal agencies for planning, water and public transport report directly to State governments.
    • The State government also largely controls public works and police.
    • Globally, metropolitan cities are steered by a directly-elected leader.
    • Evolved examples include the Tokyo metropolitan government and recent experimental models such as combined authorities in the United Kingdom and Australia.

    Suggestions

    • India needs home-grown solutions suited to its context and political realities while imbibing lessons on institutional design from global examples.
    • It is time the Central and State governments lead efforts towards a metropolitan governance paradigm.
    • The first steps should include empowered Mayors with five-year tenure, decentralised ward level governance, and inter-agency coordination anchored by the city government.

    Lack of transparency, accountability and citizen participation

    • Transparent cities with institutional platforms encouraging citizen participation improve urban democracy.
    • No metropolitan has functional ward committees and area sabhas.
    • An absence of citizen participation is worsened by poor transparency in finance and operations.
    • As per ASICS 2017, India’s big metropolitan cities on average score 3.04/10 in transparency, accountability and participation.

    Significance of smaller cities

    • A World Bank report notes that despite the emergence of smaller towns, the underlying character of India’s urbanisation is “metropolitan”.
    • Under this metropolitan character, new towns emerge around existing large cities.
    • According to a McKinsey report, in 2012, 54 metropolitan cities and their hinterlands accounted for 40% of India’s GDP.
    • The report also estimates that by 2025, 69 metropolitan cities, combined with their hinterlands, will generate over half of India’s incremental GDP between 2012 and 2025.
    • Despite this, India is yet to begin an active discourse on cohesive metropolitan governance frameworks.
    •  Studies by the Centre for Policy Research point that India’s spatial feature exhibits the growth of small towns beyond the economics of large agglomerations.
    • This indicates that while India’s urban vision should focus on its metropolitan cities to reap the benefit of scale, it shouldn’t ignore smaller cities.

    Consider the question “Examine the issues in the governance of metropolitan cities. To what extent the limited power of mayors contributes to the issues of the metropolitan cities in India?”

    Conclusion

    India should use the current pandemic as an opportunity to introspect and reform the way its metropolises are governed.

    Back2Basics: ASICS 2017

    • The Annual Survey of India’s City-Systems (ASICS) 2017 evaluates quality of governance in cities, covering 23 major cities in India across 20 states based on 89 questions.
    • Indian cities scored between 3.0 and 5.1 on 10, with Pune topping the charts for the first time.
    • Other cities that came in the top five include Kolkata, Thiruvananthapuram, Bhubaneswar and Surat, with scores in the range of 4.6 to 4.5.

  • Technical Platform on the Measurement and Reduction of Food Loss and Waste

    The Food and Agriculture Organization (FAO) has unveiled a new platform to help accelerate the global reduction in food loss and waste.

    Try this PYQ from CSP 2016:

    Q. The FAO accords the status of ‘Globally Important Agricultural Heritage System (GIAHS)’ to traditional agricultural systems. What is the overall goal of this initiative?

    1. To provide modern technology, training in modern farming methods and financial support to local communities of identified GIAHS so as to greatly enhance their agricultural productivity.
    2. To identify and safeguard eco-friendly traditional farm practices and their associated landscapers, agricultural biodiversity and knowledge systems of the local communities.
    3. To provide Geographical Indication status to all the varieties of agricultural produce in such identified GIAHS.

    Select the correct answer using the code given below.

    (a) 1 and 3 only
    (b) 2 only
    (c) 2 and 3 only
    (d) 1, 2 and 3

    About the Platform

    • The Technical Platform on the Measurement and Reduction of Food Loss and Waste brings together information on measurement, reduction, policies, alliances, actions and examples of successful models applied to reduce food loss and waste across the globe.
    • The platform will contain information on measurement, reduction policies, alliances, actions and examples of successful models applied to reduce food loss and waste.
    • The platform will be officially launched on the first International Day of Awareness of Food Loss and Waste on 29 September 2020.

    How will it work?

    • The platform is as a gateway to information on food loss and waste from various resources, including the largest online collection of data on what food is lost and wasted.
    • Links to related portals from development partners are also provided.

    Why need such a portal?

    • Food loss and waste is a sign of food systems in distress. Nutritious foods are the most perishable, and hence, the most vulnerable to lose.
    • Not only food is being lost, but food safety and nutrition are being compromised as well.
    • At least 14 per cent of food is lost (food wastage and food loss together), valued at $400 billion annually.
    • In terms of greenhouse gas emissions, the food that is lost is associated with around 1.5 gigatonnes of carbon dioxide equivalent.
    • Major losses are seen in roots tubers and oil-bearing crops (25 per cent), fruits and vegetables (22 per cent), and meat and animal products (12 per cent).
    • Reducing food loss and waste can bring about many benefits: more food available for the most vulnerable; a reduction in greenhouse gas emissions; less pressure on land and water resources; and increased productivity and economic growth.

    Food loss vs food wastage

    • There is a difference between food wastage and food losses.
    • Food is wasted when it is discarded by consumers or is disposed of in retail due to its inability to meet quality standards.
    • Food loss, on the other hand, occurs when it is spoilt or spilt before reaching the final product or retail stage.
    • For example, dairy, meat, and fish can go bad in transit because of inadequate refrigerated transport and cold storage facilities.

    Back2Basics: Food and Agriculture Organisation (FAO)

    Objective: Lead international efforts to defeat hunger

    Members: FAO has 194 Member Nations, two associate members and one member organization, the European Union

    Headquarters: Rome, Italy

    Year Founded: Established in 1945

  • In news: National Centre for Disease Control (NCDC)

    India’s premier organisation mandated to collect data about diseases, the NCDC is failing in its task as the spread of COVID-19 continues unabated.

    Practice question for mains:

    Q. Health infrastructure in India is hardly capable of handling any pandemic. Critically comment.

    About the National Centre for Disease Control

    • The NCDC carries out nationwide disease surveillance through its Integrated Disease Surveillance Programme (IDSP).
    • It is a vertical programme under Directorate General of Health Services.

    Its formation

    • This programme has been present in the country in different avatars since 1997 when the National Surveillance Programme for Communicable Diseases was set up.
    • This was upscaled to the Integrated Disease Surveillance Project in 2004, with assistance from the World Bank, to address the demands of the WHO’s International Health Regulations, 2005.
    • Under this, each country had to assess public health emergencies of international concern within 48 hours and report them to WHO within the next 24 hours.
    • It was then included in the 12th Plan (2012-17) under the Union Health Ministry and renamed IDSP.

    Mandate of the NCDC

    To aid the process of an investigation, NCDC has put down 10 steps that need to be followed for each outbreak:

    • Determine the existence of an outbreak
    • Confirm the diagnosis
    • Define a case
    • Search for cases
    • Generate hypothesis using descriptive findings
    • Test hypothesis with the analytical study
    • Draw conclusions
    • Compare hypothesis with established facts
    • Communication of findings
    • Execute preventive measures

    Why did NCDC fail?

    • IDSP’s manual says weekly and monthly updates are mandatory for each State and UTs even if no outbreaks are reported.
    • But this has never been observed to date.
    • There is an overlap between the diseases being followed by IDSP and other agencies like the National Vector Borne Disease Control Programme
    • The fact that IDSP does not collect mortality data was also a concern. Moreover, the IDSP was not investigating zoonotic diseases.