Role of NGOs & Other Organizations
Role of NGOs & Other Organizations Social Entrepreneurship It refers to a business venture where the entrepreneur’s main motive is to provide social services at low cost to the needy as opposed to making a profit. Eg: Grameen Bank of Mohammad Yunus in Bangladesh Potential of Social Entrepreneurship Provision of Social Services: A financially sustainable social enterprise model can be an invaluable asset in ensuring the provision of social services in untouched areas of the country through low-cost innovative solutions. Eg: Teach for India foundation’s work in providing education to children in remote regions of the country Correcting Gender Hierarchy: Social enterprises have time and again demonstrated their ability to emancipate women economically and in turn enhance their social position within and outside households. Eg: Kathkatha that helps empower women and children living in brothels by providing them with an alternate source of livelihoods Establishing Forward and Backward Linkages: Social enterprises act as bridges linking producers of traditional art and craft industries to global markets and supply chain. They also function as channels for raw materials for local product manufacture. Eg: Hastashilpi Gurukul Challenges to Social Entrepreneurship Access to Credit: Due to their narrow profit margins, social entrepreneurs have a hard time gaining access to formal credit. This compromises quality and coverage of service delivery Lack of Expertise: Social enterprises are formed by a few individuals who come together to give effect to an idea. They may not have the requisite expertise to effectuate the same efficiently. Weak Organization: The informal nature of organization given how loosely knit they are can be detrimental to the stability of social enterprises Way Forward Handholding Support: Social entrepreneurs can be provided handholding support in initial stages until they acquire proficiency in their area of entrepreneurship Incubators and PPP: Social enterprises that offer feasible ideas should be provided financial incentives in the form of taxes and a sustainable market financing model should be built up that is not merely dependent on charity alone. Read Also NGO Enroll today with the best civils service academy and take your first step towards your Civils journey. Feel free to reach out to us for any inquiries, collaborations, or support. We’re here to help. Join Now
Social Justice for Vulnerable Sections
Social Justice- Vulnerable Sections Poverty Absolute poverty in India has reduced from 50 percent in 1993-94 to below 5 percent in present day according to the Tendulkar poverty line of 1.91$ purchasing power parity. Poverty lines in India and all over the world by WEF and WB have been monetized on the basis of cost of basic amenities which have been increasingly diversified to include calories, nutrients, proteins, health, education, electricity, transportation, drinking water and sanitation. Poverty Detection Increasing Diversification of Requirements: The Tendulkar and Rangarjan committees have widened the amenities for requirement. The purchasing power required for this aggregate consumption basket has been fixed as poverty line. Unit of Analysis: The Tendulkar and Rangarajan lines follow different units as the basis for poverty identification- individual and households respectively Automatic Exclusion and Inclusion: The Socio-Economic caste census has brought in parameters that automatically exclude (tax payer) and include (manual scavenger) citizens into beneficiary list Rural- Urban Divide: Indian poverty line indicators are reflective of the rural urban divide in terms of varying consumption patterns and the skewed access to amenities like drinking water, electricity and sanitation where rural areas appear highly disadvantaged. The falling agricultural incomes have further eroded their financial capability. Reasons for Poverty Overpopulation: Being the 2nd most populous country in the world, India has great strain on natural resources of land and water which deprives a select few on the basis of financial capability Loss of Agriculture Income: Fragmentation of lands, climate changes and declining fertility of soil has led to declining incomes of farmers causing a downward spiral in rural economy Lack of livelihood opportunities: India has a huge demographic potential that may become a liability unless sufficient opportunities are created for them with regard to employment and entrepreneurship Coverage of secondary and higher education (Accessibility and Affordability issues) Highest out of pocket expenditure in Health: A lack of a comprehensive health insurance policy and poor public sector healthcare has caused a highly vulnerable urban and rural population deprived of sanitation and hygiene to spend big on the treatment of diseases Solutions Needed Targeted Welfare Approach: The government can focus on targeted areas of backward regions in states of U.P, Bihar and Madhya Pradesh. Greater impetus can be given to skill development initiatives and entrepreneurship opportunities to leverage demographic asset of theses regions Participative Development: The government can curb direct financial assistance and instead seek to create livelihood opportunities for the deprived to make them self-reliant. SHG platforms and MGNREGA can serve the same purpose Universal Provision of Social Services: Public expenditure must be drastically increased and public partnerships sought to plug infrastructural gaps in rural and remote regions of the country in health and education sector. A universal health insurance under the U.K model should be ushered in to reduce the out of pocket expenditure for healthcare Diversification of welfare provisions: The government’s welfare provisions may be diversified in accordance with widening purview of poverty. The nutrition basket of PDS and mid-day meal schemes can be diversified to accommodate proteins and micro-nutrients for the population Plugging leakges: The Aadhaar based DBT can be used to directly transfer subsidies to the deserving t increase transparency and plug leakage of funds in welfare endeavours of the government Eg: Wages of MGNREGA In the future, the government may explore the provision for provision of UBI through this platform. CSR Programmes Issues Diversion of funds Green Washing Emancipating own employees Regional and Sectoral Imbalance Way Forward The government has launched the National CSR data portal which contains all filed information with respect to expenditure across states, districts and developmental sectors. This can help in evaluating effectiveness of CSR projects and consolidating CSR activities. Increased transparency in financial and non-financial information also keeps a check on fund diversion thereby increasing accountability on companies to spend productively. MAHARASHTRA’S SOCIAL BOYCOTT BAN LAW Targeted at informal caste panchayats (or village councils) and denial of service to citizens due to virtue of caste, morality, social acceptance, political inclination or sexuality – ostracism by dominant sections of society A clear example of a renewed political will of the Maharashtra Government to place individual liberties over social acceptance or cultural tolerance in a marked departure from previous governments who have often favoured the cause of the group over the individual What it includes? Specifies practices which come under social boycott- ‘preventing performance of religious or caste customs and traditions’, ‘denial of right to perform funeral or marriages’, ‘denial of public facilities to communities – halls, medical, education services’ Criminal Offence with imprisonment of upto 3 years Ensures trials are completed within 6 months of filing of report Concern People of the religion may advocate that their fundamental right of freedom to manage religious affairs may be violated and challenge the legislation in court with regard to its constitutionality New legislation does not address inter community social ostracism like denial of housing to minorities, attacks due to virtue of diet or dress Way Forward Legislation is a basic foundation for implementation of democratic principles which in this case is equality. The government should politically take steps to ensure that a climate of prejudice and intolerance is gradually replaced with one of social harmony. Domestic Workers’ Rights- Domestic Workers Regulation of work and Social Security Bill, 2016 Currently unrecognized as an economic activity, Indian state has not implemented ILO’s Convention 189 on Decent Work for domestic workers to bring domestic work under state regulation Largely constituted by citizens belonging to vulnerable communities – women, tribal community, SC/ST Prejudiced to be a security risk are subjected to police verification affects dignity enshrined in constitution Face risk of domestic violence, abuse, sexual harassment Intense work, persistent surveillance and quasi-magisterial authority of employer implode the dignity of domestic workers Lack of adequate redressal mechanisms Provided protection under Sexual Harassment of Women at Workplace ( Prohibition, Prevention and Redressal) Unorganised Sector – No minimum wages, poor conditions of work, no security Read Also National Register of Citizens Prospective Solution Domestic Workers Regulation of work and Social Security Bill,2016 aims to monitor domestic workers by making mandatory registration of employer and
Social Justice in education sector
Social Justice- Education Sector Education: Private vs Public Sector Recent data trends from the MHRD suggests a growing privatization in the education sector. Between 2010 and 2015 student enrolment in government schools have fell by 13 million while on the private side it has increased by 17.5 million. Issues in the Private sector Quality: Recently, the World Development Report brought out by the World Bank elucidated that private schools perform better only because they accommodate children from affluent background Affordability: Charge exorbitant fees from parents of children and hence are out of reach for a large section of the population. The NSSO recently stated a 175% increase in average annual private expenditure on education. Obsolete Curriculum: Lacks excellence and imagination and is non-committed to meeting global standards. As a result, students fare badly in global exams for measuring learning outcomes Programme for International Student Assessment Test (PISA) Safety and Security: Have been cases where children have suffered from sexual and physical abuse even causing death. Private institutions have not been able to take adequate precautionary measures in preventing the same Ryan murder case Lack of Transparency and Accountability in its functioning: Private schools are hard to monitor and require large quantum of financial and human resources. The WB’s report opines that it would be more straightforward and expeditious for the government itself to provide quality education Public Sector Institutions Although greater in number, they fail to meet the demands of aspirational families and students of the country Accessibility: The proportion of public institutions providing education to private sector institutions is still low compared to other countries Segregation: Generally seen as institutions for poor and marginalized sections of society Quality: Greatly compromised in terms of infrastructure and teaching expertise leading to low learning outcomes among students. The ASER report by Pratham sites inability to read, write and do arithmetic among students Way Forward Private education should be given more space in lieu of lack of quality public education and the lack of finances available for spending on the same Monitoring Framework: Strict regulation and monitoring from responsible authorities to ensure that the current limitations of private education is addressed and it remains accountable to provide affordable quality education in a safe and secure environment for children Stepping up spending on Education: India currently spends 4% of its GDP on education and should ideally aim to raise it to 6% that is globally accepted and recommended. New Education Policy: India’s NEP that is due in December shall focus on providing Universal, free, safe and quality public education to all its young citizens Read Also Agricultural credit in India Establishment of National Testing Agency The Centre has approved the creation of a National Testing Agency which would be an autonomous body registered under Indian Societies Act,1860 with the responsibility of conducting tests for entrance to higher educational institutions. NTA thus relieves the pressure on CBSE and AITCE from conducting entrance tests and also ensures there is an independent agency that measures merit level of students. Primary Education Introduction The Economic Survey 2017 points out that in a techno-intensive world, India’s primary education output breeds Human Capital Regression that subverts India’s demographic dividend, threatening to be a demographic disaster. Issues Poor learning outcomes: ASER (Annual Status of Education Report) 2018 brought out by Pratam illustrates that there is a learning deficit and poverty of basic reading and arithmetic skills among children Gender Disparity: Despite consistent improvement, UNESCO’s Gender Parity report flags concerns that in the backward regions of the country, girls have 42% less chance of receiving primary education Teacher Quality and Quantity: The low pupil-teacher ratios and the poor quality of teaching has adverse effect on learning outcomes. Obsolete Curriculum: Curriculum in several public schools are not relevant to current ground realities. Hence there is a need to reform the curriculum for holistic development of children with focus on extra-curricular activities as well. Infrastructural Gaps: Class rooms, benches, desks, toilet facilities, books Employability: The poor learning outcomes offshoot the disability that school education has little utility in job creation. Such an aspect is relevant even at primary education Reasons for Poor Performance Lack of Funding: Public expenditure on education as a percentage of GDP is insufficient to plug existing infrastructural gaps in educational institutions. There is a lack of coordination for need-based infrastructural development and diversion of funds allotted for the same. The T.S.R report has called on the government to increase its public expenditure on education to 6% of GDP Quality of Teachers: There is a serious lack in the quantity and quality of teachers particularly in schools in rural areas that have detrimentally affected reading and arithmetic ability of students. The T.S.R committee report has mentioned in its report to set a cut off of 50% marks for graduate examination for teachers and to conduct a period-wise examination for teachers to sustain and monitor their quality Lack of Regulation: Primary level schools have largely laid ignored by monitoring and regulatory authorities that has led to such a sever depreciation in quality of imparting education Obsolete Curriculum: The education curriculum and methods of teaching fail to focus on learning aspects, logical reasoning and innovation among students Way Forward Plug Infrastructural Gaps: The government can increase its public expenditure to 6% of the GDP on education as stated in the TSR Subramanian Committee Report. It can look into collaborations with private organizations and CSOs to plug infrastructural deficiencies Ensuring Teacher Quality: As cited in the TSR Subramanian committee’s report, minimum cut off of 50% marks for graduate examination for teachers and to conduct a period-wise examination for teachers to sustain and monitor their quality can enhance teacher quality levels Revamping Curriculum: The curriculum can be revamped to provide holistic education to children to focus on learning outcomes and aim to induce their critical thinking and logical reasoning capacity rather than seeking conformity to syllabus Atal Innovation Mission seeks to induce innovation in children through play spaces equipped with state of art technologies Pre-School Education: Ensuring the right to quality pre-school education can help lay foundations for effective impartation of primary education Outcome-based monitoring: Levels of education may be assessed based on learning outcomes of children rather than infrastructural and human resource inputs alone. The National Achievement Survey performed by the NCERT aims to do the same. Enhancing Employability of Education: Skill courses currently imparted between classes 9 and 12 may be advanced to class 6
Health Sector in India – Holistic Study Part 1
Preventive Health Care Poverty, Malnutrition, Hunger, Substance Abuses, Sanitation, Clean Drinking Water, Food Safety, Immunization. Curative Health Care Communicable and Non-communicable Diseases Issues in India’s Health Sector Accessibility : Regional disparity in the provision of healthcare services – Lack of PHCs and CHCs in certain rural areas of the country. Hence rural population are denied access to primary healthcare which aggravates their health problems and eventually become a burden on tertiary health sector which is not equipped to deal with the high inflow of patients. Inadequate doctor to patient ratio: According to the National Health Profile, India has a million doctors to treat its 1.3 billion Doctors largely render services in urban areas and hence rural population are left vulnerable Affordability: Lack of Public Expenditure: India is currently spending only 1.2% of its GDP on the health sector. This reflects the low level of political commitment for ensuring health care and how it has never been an electoral issue Prices of Drugs: Even when medical services and expertise is available and affordable, an average citizen in India spends a large amount of money on drugs prescribed. The nexus between doctors and pharmaceutical companies has often exploited the patients to earn large profits No Health Insurance Policy and Minimal Coverage: The citizens spent highest on medical services from out of their pocket Quality Infrastructure: Government hospitals are often ill-equipped to provide specialized care and devices and medical infrastructure are old and need of maintenance and repair. There is also an issue of lack of adequate beds in public hospitals Technical Expertise: The NITI Aayog in its Action Agenda points out that India faces a huge challenge in the number, distribution, skill and quality of health care expertise. Inefficiency in Regulation and Monitoring Mechanism: Medical Council of India consumed with Nepotism and Corruption means healthcare institutions are neither adequately monitored nor regulated in their management or administration giving them a free hand at providing lacklustre services to citizens Read Also Social Justice in Education Sector Triple Burden of Diseases Fight with Communicable Diseases: NITI Aayog reports India lost 33% of its DALYs owing to the communicable diseases Non-Communicable Diseases (Lifestyle): According to India: The Health of Nation’s States Report brought out by ICMR, 61% of India’s disease burden consisted of CMNNDs till 1990 but fell to 33% in 2016. NCD has replaced this vacuum surging from 31% to 55%. Threats of Rising NCDs Diverse requirements from the health sector that needs to cater to both CMNNDs as well as NCDs The burden of Expenditure: NCD treatment is more expensive as compared to CMNND disease thus putting further pressure on the government’s economic resources NITI Aayog reports a rising morbidity and mortality cost attributed to NCDs Threat of New diseases Prospective Solutions Universal healthcare: Correct regional disparity in provision of health care Services : Set up PHCs and CHCs in unserved and underserved areas. Recruit greater number of ASHA workers and ensure the smooth functioning so that they can act as bridge between villagers and access to healthcare services. Incentivize Service in rural areas: Doctors and nurses should be financially incentivized to serve in rural and remote areas to ensure that people in these areas are not left behind for access to quality medical care Correcting Affordability Rapidly Increase Public Spending: As per NHP, public health expenditure needs to be doubled to 2.4% of GDP from current 1.2%. Even such an increase would pale in comparison to what other countries are spending on their healthcare sector Gen Oushadi Shops: To sell affordable medicines in the form of generic drugs to citizens Introduce a health insurance policy: The government through the NHPS is aiming to provide such an insurance coverage to 10 crore beneficiaries. Enhancing Quality Strategic Engagement and System Strengthening with Private sector Partnership: Enhance technical, infrastructure and specialized healthcare service quality by forming partnerships with private sector entities Raising public spending Overhaul Monitoring and Regulation Mechanism : Introduce exit eligibility test for doctors, incentivize working in rural areas and replacing MCI with National Medical Commission Holistic development of public health addressing all social determinants including nutrition, sanitation and drinking water. The focus on entirety shall be a far cry from the sole focus on provisioning of health care Preventive> Cure: The public health system through the promotion of healthy life styles, prevention of injuries and detection and control of infectious diseases can achieve preventive cure. The state must then reprioritize its goals to transition from curative to preventive Role of the Government: The NITI Aayog advices the government to play a stewardship role in setting and enforcing rules to guide the health system. A data driven decentralized model can help in bettering health outcomes National Health Policy, 2017 First National Health policy in 15 years seeks to ensure universal access to affordable quality healthcare services to all citizens in the country. Universal Accessible Affordable Primary Healthcare Comprehensive Healthcare package including palliative, rehabilitative and geriatric healthcare Providing digital health card for access to health services from all over India Gen Oushadi Shops to enhance access to affordable generic drugs Preventive and Promotive Focus with Pluralistic Choice Integration of traditional medicines into mainstream health care services Co-location of AYUSH with western medical facilities in public hospitals Make in India for a Healthy India Production of Active Pharmaceutical ingredients Enables to reduce import of drugs and creation of customized indigenous drugs Eases affordability for drugs in market Fostering Patient Focus and Quality – Assurance Based Approach Establishment of National Healthcare Standards Organization Maintain Quality of healthcare Digital intervention Electronic Database for access to patient records for all doctors from anywhere in India Tele-medicine yielding dual benefits of employment generation and better and equitable access to medical services in far flung regions Establishment of National Digital Health Authority System Strengthening and Strategic Engagement Entering into sustainable models of partnerships with private sector entities, both for-profit and not-for profit to improve quality of healthcare services rendered in terms of infrastructure and technical expertise Objective to improve access to quality screening, diagnosis, treatment services for cardiovascular, pulmonary diseases and cancer in district hospital through PPP Increase Public expenditure to 2.5% of GDP Primary healthcare Issues Coverage: There exists a regional
Health Sector in India – Holistic Study Part 2
Privatisation Of Health Sector Introduction The increased role of the private sector in the Health sector has raised a concern whether India is moving from the UK based patient-centric model to the American insurance-driven health delivery system. A careful analysis of the privatization of healthcare is needed to elucidate its ramifications. The recent NHP, 2017 lays emphasis on systemic strengthening and strategic engagement with the private sector to comprehensively improve health service delivery in the country. Why necessity? Lack of public investment in the health sector means there is a huge demand-supply mismatch with regard to the provision of healthcare services. Partnerships with private sector entities enable quality screening, diagnosis, treatment services accessibility to patients with better infrastructure and technical expertise NITI Aayog Guidelines Co-habitation of private sector entities engaged in the provision of such services within public hospitals to provide specialized healthcare and treatment for cardiovascular, pulmonary diseases and cancer Conditions for entering into PPP – State government Must accommodate a minimum number of state referred patients who are eligible to avail NCD services for cashless treatment of their ailments (To avoid commercialisation) In selecting public hospitals, a criteria of minimum patient strength and bed strength needs to be followed so that hospitals with largest inflow of patients gain most from partnerships Minimum services to be offered – IPD, OPD, Emergency services, critical care State governments need to leverage national and state initiatives and schemes for maximizing potential of privatisation – RSBY and NHPS Benefits of Privatization Access to Specialized Healthcare: PPP model would improve accessibility to specialized health care in terms of human expertise, technology and equipment Enhance Infrastructural Quality: PPP model would provide a mechanism for private sector to engage with the public utilising government facilities and infrastructure of district hospitals. A viability gap funding by the state government needs to be set up for this. Economies of Scale: Private parties would share ambulance services, mortuary services and blood banks with the district hospitals while public hospitals benefit from superior quality of human resources as well as increased capital of private players Better Diagnosis: It would ensure timely diagnosis and detection of diseases given the expedition of advanced medical devices reducing regional disparity in provision of such services GeneXpert devices to diagnose TB Holistic Medical Growth: Expansion of Private-sector servicesà Greater investment in research and developmentà Greater procurement of medical infrastructureà Job creation and growth in the medical field Way forward and Concerns Commercialisation: Privatized healthcare model works on pure economics of demand and supply. If there is no effective regulation, the citizens may fall prey to the exploitation of the private health sector machinery India has the highest Out of Pocket expenditure of 86% according to WHO Unethical Practices: An unregulated private sector can breed unethical practices like false diagnosis and testing of medicines. Such practices may have adverse effects on the health of patients. Health being a state subject, NITI Aayog has limited advisory powers and hence a top down approach may not be suitable for a subject in the state list. Hence different states may adopt different guidelines which can lead to coverage disparity between them Neglected Diseases: The demand supply chain invariably works on the purchasing power of citizens. Diseases which affects the poor and vulnerable may continue to lie ignored in the face of privatization of health care India continues to fight against WHO classified neglected tropical diseases like Lymphatic Filariasis Regional Disparity: Danger of private sector institutions cherry picking districts with individuals who have high paying capacity thus widening the existing regional disparity in provision of quality health services Inefficiency of Public Healthcare System: Handing over public healthcare services to private sector reflects inefficiency of public health care services and abdication of governments duty from providing affordable quality healthcare to all citizens Conclusion The primary responsibility for providing affordable universal healthcare services rests on the state. A well regulated private sector based on the pillars of trust, accountability and efficiency can be a boon to India’s citizens. Parameters for Assessing Health Sector Total Fertility Rate Ideally should be around 2.1 – Currently around 2.3 Huge regional disparity with backward regions having higher TFR close to 37 (Bihar) and other regions having lower fertility rate (as low as 1.24 in Sikkim) – National Family Health Survey Hence targeted differential policy is required In areas of High TFR – Solutions Empower women by providing with skilling and livelihood opportunities – As women are empowered and gain voice within households gradually the population decreases. A high correlation currently exists between women’s illiteracy levels and TFR rates as witnessed in the EAG states. Poverty Alleviation: The lower economic rung in the society always looks upon children as economic assets rather than liabilities. Hence alleviating them out of poverty can have a contraction effect on population Family Planning and Use of Contraceptives: Precisely what Mission Parivar Vikas under MHFW seeks to implement targeting the UP, Bihar belt Discouraging early marriages: Sukanya Samriddhi Yojana and Beti Bachao Beti Padao Provide opportunities and scholarships for higher education of women: The West Bengal government’s Kanyashree Prakalpa is an astute initiative in this direction. Infant Mortality Rate Number of deaths per 1000 live births in 1 year India – 41 per 1000 live births Neo-Natal Mortality: 29 per 1000 live births Causes of Child Mortality Maternal Health Issues: Poor nutritional status of the mother can affect the survival of the child. NFHS notes 20% children born with low birth weight in the country having high risk of mortality The government has launched the National Nutrition mission with convergence across departments. This can address the nutrition requirements of the mother and child through the Anganwadis Poor Institutional delivery: The lack of expertise in delivery, poor antenatal and neo natal health services can cause infant mortality. The lack of infrastructure like warm towels can increase risks of infant mortality The PM Matritva Suraksha Abhiyan and the PM Janani Suraksha Yojana emphasizes on providing vital ante-natal and neo-natal care to reduce IMR Vulnerability to Diseases: The lack of hygiene and sanitation facilities render the children vulnerable to pneumonia and diarrhoea. Diarrhoeaà Low capacity of nutritionà Stunting, Wasting and Child mortality The Swachchh Bharat Abhiyan and the NRDWP aim to provide households with clean drinking water Under Nutrition: The NFHS notes that 33% of under 5 deaths in India are due to malnutrition
Health Sector In India- Holistic Study Part 3
National Rural Health Mission (NRHM) Introduction The NRHM aims to provide a fully functional, community-owned, decentralized healthcare delivery system with inter-sectoral convergence at all levels to ensure action on multiple indicators – water, sanitation, education, nutrition, social and gender equality Features Main target to provide access to affordable quality healthcare services to rural population Section Focus: Special focus on vulnerable sections: Women and Children: RMNCH+A – Reproductive, Maternal, New born, Child and Adolescent Region Focused: Targeted focus on improving primary healthcare services in Empowered Action Group States and North-East Community Participation: Improved Community level participation through Mahila Arogya Samiti, Rogi Kalyan Samiti and Village Health and Nutrition Council ASHA – Accredited Social Health Activists Community Health volunteers called Accredited Social Health Activists (ASHAs) have been engaged under the mission for establishing a link between the community and the health system ASHA is the first port of call for any health-related demands of deprived sections of the population, especially women and children, who find it difficult to access health services in rural areas. Rogi Kalyan Samiti (Patient Welfare Committee) Group of trustees of the hospital to Manage affairs of hospitals Janani Suraksha Yojana (JSY) JSY aims to reduce maternal mortality among pregnant women by encouraging institutional delivery. Under the scheme, cash assistance is provided to eligible pregnant women for giving birth in a government health facility. National Mobile Medical Units (NMMUs) Many un-served areas have been covered through National Mobile Medical Units (NMMUs). National Ambulance Services Free ambulance services are provided in every nook and corner of the country connected with a toll-free number and reach within 30 minutes of the call. Janani Shishu Suraksha Karyakram (JSSK) As part of recent initiatives and further moving in the direction of universal healthcare, Janani Shishu Suraksha Karyakarm (JSSK) was introduced to provide free to and fro transport, free drugs, free diagnosis, free blood, and free diet to pregnant women who come for delivery in public health institutions and sick infants up to one year. Rashtriya Bal Swasthya Karyakram (RBSK) – In line with Article 45 of DPSP (Early Childhood Care) A Child Health Screening and Early Intervention Services have been launched in February 2013 to screen diseases specific to childhood, developmental delays, disabilities, birth defects and deficiencies. The initiative will cover about 27 crore children between 0–18 years of age and also provide free treatment including surgery for health problems diagnosed under this initiative. Mother and Child Health Wings (MCH Wings) With a focus to reduce maternal and child mortality, dedicated Mother and Child Health Wings with 100/50/30 bed capacity have been sanctioned in high case load district hospitals and CHCs which would create additional beds for mothers and children. Free Drugs and Free Diagnostic Service A new initiative is launched under the National Health Mission to provide Free Drugs Service and Free Diagnostic Service with a motive to lower the out of pocket expenditure on health. District Hospital and Knowledge Centre (DHKC) As a new initiative District Hospitals are being strengthened to provide Multi-specialty health care including dialysis care, intensive cardiac care, cancer treatment, mental illness, emergency medical and trauma care These hospitals would act as the knowledge support for clinical care in facilities below it through a telemedicine centre located in the district headquarters and also developed as centres for training of paramedics and nurses. National Iron+ Initiative The National Iron+ Initiative is an attempt to look at Iron Deficiency Anaemia in which beneficiaries will receive iron and folic acid supplementation irrespective of their Iron/Hb status. This initiative will bring together existing programmes (IFA supplementation for: pregnant and lactating women and; children in the age group of 6–60 months) and introduce new-age groups. FROM NRHM to NHM Why NHM? Integrated Focus on rural and urban areas earlier missing in NRHM Holistic Focus: Focus expanded from mother and children centric health issues to diverse sections of society Long Term Vision: NRHM lacked long term vision as it was launched in mission mode Regional Equity: Highly variable delivery of services across states NUHM Envisages to meet healthcare needs of urban population with special focus on urban poor and other vulnerable sections seeking to improve their outreach to primary healthcare services and reducing their out of pocket expenditure in availing healthcare services. Focus on meeting healthcare needs of slum population with convergence with schemes of other ministries engaged in enhancing related health determinants- water, sanitation, education, housing etc – Ministry of Urban Development, Housing and Urban Poverty Alleviation, MHRD and MWCD Pathway to achieving NUHM goals Need-based healthcare delivery system to meet diverse healthcare needs of urban poor and other vulnerable sections like street vendors, rickshaw pullers, coolies, construction workers Availability of resources for providing primary healthcare to urban poor Institutional mechanism and management system to deal with rapidly growing urban population (multi-sector convergence – water, housing, sanitation) Partnership with the community and local bodies for proactive involvement in planning, implementation and monitoring of health activities Partnerships with NGOs, health service providers and other stakeholders Projects under NHM Kayakalp Award scheme that recognizes excellence in the cleanliness of public health facilities Objectives Inculcate a culture of cleanliness in public health facilities in a structural manner with bio-waste disposals and protocol creation and concurrence Promote cleanliness, hygiene and infection control practices in healthcare facilities Create and share sustainable practices related to improved cleanliness in public health care facilities Build confidence of users in public health facilities Introduce a culture of peer review and assessment of performance related to hygiene, cleanliness and sanitation Indradhanush (Will be covered under Immunization) Preventive Health Care Poverty World Bank defines poverty as a social phenomenon in which a particular section of the society is unable to fulfil their basic needs Measuring Poverty- Absolute and Relative scales – Tendulkar and Rangarajan Absolute Poverty: The deprivation of an individual or household with respect to objective levels of living standard is referred to as absolute poverty. Eg: India has 26.9 crores as of 2011-12 below its poverty line India has been successful in reducing its absolute poverty. The number of poor has come down from 40crore in 2004 to 26 crore in 2011. Such a rapid reduction in poverty levels are a result of key government interventions
Health Sector In India
Health Sector In India HUNGER Malnutrition: FAO defines malnutrition as population denied of dietary intake for prolonged period. Chronic malnutrition is defined as hunger. Quote: “Hunger is quiet violence” – Amartya Sen Hidden Hunger: Refers to the condition of an individual who is consuming requisite dietary intake but is deficient of micro nutrients. It can be addressed by diversifying diet to include micro nutrients and by fortifying commonly consumed food that is part of the staple diet of individuals. Measuring Hunger Global Hunger Index: Brought out by IFPRI Parameters: Stunting, Wasting, Child Mortality and Undernourishment (Adults) India has the largest number of people affected with hunger according to FAO report: 194 million in India are hungry. Although it has improved, the rate of improvement is insufficient. The Global Hunger and Malnutrition Index also shows that over 40% of the world’s hungry children are from India. Hungama Report (Nandi Foundation) Child undergrowth (42%) and Anaemia (63%) Child stunting in urban areas – 22% Introduction on Malnutrition or Hidden Hunger India has a paradoxical mix of obese and malnourished children. It is no longer necessary to focus on adequate nutrition alone. Our policy focus must shift to appropriate nutrition transforming our objective of food securityà nutrition security. Reasons of Malnutrition Accessibility/ Affordability to Food: Poverty is the overwhelming reason for hunger and malnutrition in the country as several households are incapable of consumption at sustained levels due to insufficient household income Lack of Awareness: Education among mothers: Hugama report by Nandi Foundation finds a strong correlation between malnourishment in children and educational attainment of mothers Balanced Nutrition: Even educated mothers in urban areas are unaware of the difference between right nutrition and calorie intake. This has led to the phenomenon of hidden hunger among children Lack of Health and Hygiene: A child’s ability of consumption is greatly affected by his health and vulnerability to epidemics and other diseases. Diarrhoea for example drastically reduces child’s capability to intake food and nutrients. Provision of clean drinking water, clean environment, sanitation facilities, solid waste management, robust sewerage and drainage networks can reduce vulnerability of children as well as adults to such diseases enabling them to acquire requisite nutrition Obesity India is second in the number of Obese children with more than 14 million obese children. The reasons for such alarmingly high levels of obesity in India are: Lifestyle Problems: Children in urban areas particularly are gorging on junk foods with little focus on exercise, balanced diet and intake of vitamins and micro-nutrients. Excessive fat containing foods are consumed causing obesity Passive Nature of Children: Obesity’s rise in the modern world has been co-terminus with the rise of technology and other forms of entertainment. They have become couch potatoes in their homes with little outdoor activity contributing to their obese nature Consequences Vulnerability to Diseases: Several non-communicable diseases including CVDs, diabetes and cancers are linked to obesity Social Stigma: Indian society in particular runs a deep running stigma on obese individuals that hinder them from leading a dignified life in society. Hinders Productivity: Obesity impairs health which affects productivity of the young working population. An obese population is a bane to India’s demographic asset. [the_ad id=”5735″] Possible Measures to Control Obesity Awareness on Balanced Diet: Proper awareness can be propagated among students and parents regarding the importance of a balanced diet. School and local governance bodies can act as focal centre in coordinating such activities along with CSOs Taxesà Behavioural Change: The rising acceptance for fat containing westernized diet among the youth can be curbed by introducing fat taxes. Such taxes can be a potent disincentive to habitual consumption of fat foods Regulate Junk Food Production: Junk food producing companies can be regulated to ensure lesser availability of affordable junk food. Obesity as Health Service: Obesity management should be promoted as a specialised health service within urban areas focussing on youth in particular. Conclusion In a country which has surplus food grains and guarantees the right to food for all, it is morally, politically and economically unacceptable that children are denied the right nutrition. Government Interventions to Address the Issue of Hunger and Malnutrition National Food Security Act, 2013 Legally secures citizens the right to food security and puts an obligation on the state to ensure the same. Constitutional inspiration Article 47: The State shall endeavour to improve the nutrition level of the general public and improve public health and standard of living NFSA and Targeted PDS TPDS is simply the executive machinery or framework for implementing the legislation that secures citizens right to food. NFSA prescribes usage of excluded households in Socio-economic caste census as criterion for beneficiary identification while states implementing PDS still use old classification of BPL families citing unavailability of data. NFSA is a region targeted legislation after considering recommendations of Shantakumar Commitee to reduce coverage and increase efficiency – Rural Areas(75%) and Urban (80%) whereas PDS has higher coverage NFSA guarantees entitlement of 5kg per person or 35 per family while PDS varies depending on states NFSA puts in a grievance redressal mechanism which is absent in PDS Criticism of NFSA Not Addressing Issue of Hidden Hunger: Only focus on carbohydrate rich diet and fulfilment of adequate dietary intake, lack of attention on micro nutrients or fortification of staple diet One-size fits all policy: NFSA prescribes distribution of rice and wheat in general in all regions and does not take into account geographical and cultural variations and preferences of dietary intake Financial Burden: Fulfilling the right to food in a nation of 194 million hungry can put great pressure on the state’s financial reserves grossly affecting its fiscal deficit Identification of Excluded Households: Challenge for state governments and required greater coordination between central and state governments NFSA not applicable during war, natural disasters and famine New Initiatives Required under NFSA Covering the excluded but deserving: Old, destitute, immobile and disable sections of population need to provided food security and Door to door delivery should be initiated for the same (Chhattisgarh PDS provides free meals to destitute and homeless) Addressing Issue of Hidden Hunger: Diversifying nutrient basket and fortification of staple diet to ensure adequate proportion of micro
Features and Provisions of the Constitution
Features and Provisions of the Constitution Constitutionalism It is a political doctrine which means the power of leaders and government bodies is limited by provisions that are enforced through established procedures. Constitutionalism guarantees the claims of citizens against the state and ensures powers, rights and obligations of both citizen and state are well defined in a contractual relationship. Passive Euthanasia The Supreme Court in Common Cause vs Union of India upheld Passive Euthanasia through the concept of living will whereby a patient makes an advance directive for withdrawal of medical treatment. Any adult with sound mind can express the will in clear and unambiguous terms based on informed consent. A guardian or close relative is to give the go ahead for passive euthanasia in cases circumstances within the living will arrive. Evolution of the Verdict In the P. Ratinam vs Union of India case, the Supreme Court recognized the right to die as inherent in right to dignified life. It struck down IPC 309 thus decriminalizing suicide. In the Gian Kaur vs State of Punjab case, Supreme Court reversed its stand stating that the right to die is not part of the right to life holding both euthanasia and suicide as unlawful. Right to die, the SC then opined was inconsistent with a dignified life In the famous Aruna Shanbaug vs Union of India case, the Supreme court allowed passive euthanasia in exceptional circumstances under strict monitoring of the apex court. Why Passive Euthanasia? Right to Die with Dignity: The Supreme Court has upheld that passive euthanasia can provide a dignified death to a dying patient who may be forced to undergo pain due to unwarranted medical support. The right to a dignified death is included in right to a dignified life guaranteed by Article 21 of the Indian constitution Justice Chandrachud’s Court: “To deprive a person of dignity at the end of his life is to deprive him of meaningful existence” Omission Process: As opposed to active euthanasia, passive euthanasia does not wilfully accelerate the process of death. It merely allows the natural course of death to take over suspending any medical assistance to the patient. Thus, the ethical issues arising from it are minimal in comparison to active euthanasia Pain relief: A dignified death for terminally ill patients can spare them and their family agony of being in a precarious medical condition Savings for the Family: Life support systems and medical assistance comes at great economic cost for families while they simply prolong the inevitable worsening the suffering. Euthanasia can relieve them of the meaningless financial stress that is placed on the family Scope of Passive Euthanasia on Fundamental Rights Dignified Death under Dignified Life: Widening interpretation of Article 21 Right to Bodily Integrity under Article 21 Freedom of choice of treatment under right to personal liberty in Article 21 Right to privacy as identified in Puttuswamy vs Union of India Freedom of Religion: Passive Euthanasia can be interpreted to be in line with the voluntary practice of human sacrifice in many religions. Thus, it widens the boundaries of Article 25 also that grants freedom to practice any religion. Jain practice of Santhara and Sallekhana Passive Euthanasia is also in conflict with many religions which are opposed to the idea of suicide or euthanasia Issues with Passive Euthanasia Alternative Palliative care as an option for relieving pain Right to be killed: Technological determinism in the field of healthcare may lead to involuntary and non-voluntary euthanasia giving doctors power to decide on life of a patient. Whether the consent is informed or not needs to be observed Duty to Kill on doctors on the directive of the patient Duty to Die: Right to die may be misused by some at the expense of vulnerable communities to force them into accepting death Way Forward Assess mental health of patients to ensure consent is informed and without alternatives District Level Doctors Panel: The M R Rajagopal Committee recommends a district panel to process the living will that is made of District Medical Officers Active Euthanasia Active Euthanasia refers to the practice of ending a life of an individual suffering from an incurable disease. Passive euthanasia only withdraws medical support while active euthanasia includes an active intervention to end the life of individuals Read Also Health Sector in india Supreme Court’s Stand While Passive Euthanasia remains legal through the concept of living will, active euthanasia is unlawful. Suicide involves overt acts culminating in unnatural death Issues with Active Euthanasia Possibility of Misuse: Active euthanasia performed by an act of commission can be manipulated and misused to end life of those suffering from curable diseases Lack of Awareness in Choice: The patients opting for active euthanasia may not be making an informed choice with regard to active euthanasia administering Organ Rackets: Active euthanasia might be misused to extract and sell organs of patients for illicit monetary benefits Right to Convert The scope within Fundamental Rights Article 25: Freedom of conscience to choose one’s own religion, profess and practice it. Right to convert is implicit in freedom of religion. However, the right to propagate one’s own religion does not entail the right to forceful conversion of another into one’s own Right to Privacy: The choice of a religion is an individual autonomous decision part of the individual private sphere Article 21: Individual exercises his personal liberty in converting or choosing a religion Issues Anti-Conversion laws: Implemented and in force in M.P, Uttarakhand, Jharkhand and Odisha, they have been criticized to abridge freedom choosing one’s own religion Religion not defined in the Constitution Coercive Conversions: The role of coercion in conversion for terrorism and for numerical gains has been noted. Anti-conversion laws have evolved as an instrument to tackle them. Court Judgements Hadiya vs Union of India: The SC held that the right to marry and choose religion is an intrinsic part of meaningful existence. Neither the state nor patriarchal supremacy can interfere in an individual’s decision Conclusion Right to conversion shall be an intrinsic and implicit part of freedom of conscience of religion ensured by Article 25 as long as it is without elements of fraud, allurement or coercion Citizenship Amendment Bill, 2016 Provisions of the Bill Provision of Citizenship to Religious Minorities: Amend the Citizenship Act, 1955 to make undocumented Parsis, Christians, Jains, Hindus, Buddhists and Sikhs who are migrants from Afghanistan, Pakistan and Bangladesh eligible for citizenship Reduced Requirement of Domicile Period: The amendment reduces the residency period of migrants from 11 years to 6 years Issues of the Bill Violation of Equality: The provision of citizenship to communities based on religion violates Articles 14 and 15 of
Comparison of Indian Constitution with that of other Countries
Comparison of Indian Constitution with that of other Countries Features Parliamentary Sovereignty & Judicial Supremacy The doctrine of the sovereignty of the parliament is associated with the British Parliament while the American constitution stipulates judicial supremacy. The Indian constitution occupies the middle ground by synthesizing both aspects to advocate constitutional supremacy. The scope of Judicial review is narrower in the case of Indian constitution whereas it is elaborate for U.S. This is because the Indian constitution stipulates procedure established by law as opposed to due process of law. Hence the judiciary cannot look into the justness, fairness and extent of arbitrariness of the law it can only comment on the concurrence of the procedure so defined The parliamentary sovereignty of the Indian parliament is limited by the Federal Framework Constitutional Supremacy Fundamental Rights Judicial Review Federal Unitarian Balance The Indian Constitution has a mix of federal and unitary characteristics with a bias towards Unitarian features and is thus intended to exhibit cooperative federalism (Granville Austin) or quasi-federalism (K C Wheare). It establishes a federal form of government, advocates supremacy of the constitution, exclusive subjects for state legislatures and executive, independent judiciary and bicameralism However, there also exist certain unitary features like a strong centre, single constitution, integrated judiciary, single citizenship, flexibility of the constitution, provision for emergency, predominance of parliament over state legislatures in concurrent and residue list, All India Services etc. India is identified as a ‘Union of States’ and not as a federation in American constitution. This means 2 things: Indian Union is not an agreement between different states coming together like the American Federation States hence have no right to secede from the Union unlike the American Constitution Hence the federal-unitary balance of the Indian constitution is weighed towards the unitary side as opposed to federations of Australia and U.S. In these countries, federal governments have equal powers as the centre and are able to function with greater autonomy India’s quasi-federal structure is similar to Belgium and Spain as the union government holds greater power and regulation of federal governments. All of these countries have adopted a bias towards unitary form due to vast inherent ethnic, religious and social diversity that caused secessionist fears among drafters of the constitution. Hence to consolidate the unity of the country, they adopted a quasi-federal structure in a harmonious balance of stability and ease of administration. Idea of Secularism Indian constitution stipulates a positive affinity for all religions as opposed to the negative affinity for secularism in some western countries. Hence it keeps all religions equidistant from the state. The constitution grants freedom of religion for individuals recognizing their conscience and for groups recognizing their right to manage religious affairs. It also provides safeguards for religious minorities in matters of setting up education centres and administering them in accordance with the law. The state has hence limited opportunities to intervene in religious affairs by regulating economic, political and social activity and also providing for reform in religion in India. In France and several other western countries, the secularism exhibited is of negative affinity as the state completely absolves from interfering in matters of religion. Even the public display of religious symbols is prohibited in these countries. The secularism embedded in the constitution evolved out of the need to protect religious pluralism in India whereas it evolved out of fear of religious authoritarianism in western countries. Hence Indian constitution seeks to give equal respect and protection to all religions because of the multi religious nature of Indian society Protection to Minorities Indian constitution uniquely recognizes the discrimination suffered by certain minority sections and accords specific protections for the same. The abolishment of untouchability and provision for reservation as well as the cultural and educational rights ensured for religious and linguistic minorities are evidence of the same. The Indian constitution is unique in recognizing the need to protect minorities and its diverse culture from forced homogenization by the dominant and majority sections. Such a provision arose out of the need to protect a multicultural society that celebrates plurality with the motto of ‘Unity in Diversity’ Preventive Detention The idea of preventive detention and emergency provisions are often described by critics as regressive ideals that are remnants of the colonial era. No other country or constitution calls for preventive detention while the Constitution of India empowers the parliament or state legislatures to make any law which can give effect to preventive detention. The Constitution makers also found it pertinent to include such a regressive restriction on individuals under fundamental rights part of the constitution which also entailed questions by several critics labelling fundamental rights as being highly restrictive in nature. Emergency Provisions India borrowed from Government of India Act, 1935 the provisions for emergency which would place serious restrictions on the fundamental rights of individuals. Such a provision was deemed necessary to protect unity, sovereignty and integrity of the country in the event of armed rebellion, external war or aggression A Borrowed Constitution Ambedkar proudly proclaimed that the ‘Indian Constitution had been framed after ransacking all the known constitutions in the world’ The Indian constitution borrowed several features from its Western counterparts as illustrated by the following: Political Part from Britain: The organization of polity in the country, the parliamentary form of government, balance between executive and legislature and the idea of principle cabinet government Philosophical Part from U.S and Irish: Fundamental rights was mainly inspired by Bill of Rights and DPSP was guided by the Irish Constitution Structural Part: The federal system of administration, the judiciary, governors, emergency powers, public service commission are derived from Government of India Act, 1935 Fundamental Duties and Ideal of Justice in Preamble: USSR Amendment of Constitution: South Africa Why Borrowed Constitution? How is it justified? Although the Indian constitution makers borrowed heavily from their counterpart constitutions of various countries, the amalgamation was harmoniously adapted into the Indian context. The Indian constitution is not merely a blind copy of these constitutions, but is a reflection of global values of equality, liberty and democracy that India too shares with the world community. As Ambedkar rightly noted, in the 11th hour of formation of the Indian state, it is difficult to
Constitutional Amendment Bills
Constitutional Amendment Bills Women’s Reservation Bill (108th Amendment Bill) 1/3rd of seats in Lok Sabha and state legislative assemblies 1/3rd of seats reserved for Scheduled Caste and Scheduled Tribe be reserved for women of those groups Reserved seats be allocated to different constituencies in state or union territory Reservation to cease after 15 years of the commencement of the act Constitutional Mandate The government can provide for positive discrimination by way of Article 15(1) for women and vulnerable sections to enhance their representation and empower them. Article 38(2) provides that the government shall strive to reduce inequality in status, income and opportunity among its citizens For the Bill Women Empowerment: Political empowerment through affirmative action can increase the agency of women in families and society. The evidence of panchayat reservation hold good Gender Representativeness: Currently only 10% of parliament is composed of women, the bill if passed can provide for gender diversity in voice of India’s temple of democracy Correct Patriarchal Power Structures: Improved women’s representation can equitably distribute power between genders in society Political empowerment of women can generate greater political will in resolving women specific issues like foeticide, rape, violence and social discrimination Gender sensitivity in parliamentary discussions can increase Gender Neutral Laws: Having women representation in parliament can help correct discriminatory laws of marital rape that reflects patriarchy Read All Notes by UPSC Topper Ravisankar Sarma Issues with the Bill Rotation of Constituencies may limit MP to understand and work for a specific constituency. Parties may then give ticket to male candidates Perpetuate Inequality of women as many would perceive that they are competing on favouritism rather than on merit Heterogeneous Nature: Providing reservation for women as a whole does not take into account the class, caste and power divisions among women of the country. Thus, it can bridge gender divide but may breed nepotism, favouritism and crony capitalism if women from upper classes, caste or political families are chosen No Reservation in Rajya Sabha and Legislative councils No Reservation for OBC women 123rd Constitutional Amendment Bill The necessity of the Bill No constitutional status affects fund flow and independence of the commission No authority in providing advices to state and central governments for socio-economic welfare of the backward section No power to directly look into grievances of the backward class Streamline Jurisdiction: Remove power of NCSC to look into complaints of backward classes and vest it with the NCBC The mandate of the Bill Provide Constitutional status to NCBC for improved functional authority and autonomy Provide authority to NCBC to look into specific complaints of backward classes regarding violation of rights Provide for advisory jurisdiction for NCBC regarding socio-economic development of backward classes to central and state governments Powers of civil court for NCBC to Summon people and examine oath Requiring production of document or public record Receiving evidence Investigating and monitoring constitutional and legal safeguards provided to backward classes Delineation of BCs: Under the amendment, the President is provided with the power to determine socially and educationally backward classes Present reports to President on working of safeguards and the report would be tabled in parliament and state legislative assemblies Concerns The President on behalf of Union government provided with the power to determine BCs takes away the federal power and authority vested in states to determine BCs Enroll today with the best civils service academy and take your first step towards your Civils journey. Feel free to reach out to us for any inquiries, collaborations, or support. We’re here to help. Join now
