Healthcare in India

Healthcare in India

           

Various factors like low levels of education, lack of environmental sanitation and safe drinking water, under-nutrition, poor housing  conditions, tobacco consumption, poverty, unemployment, unhealthy lifestyle  etc. impact health.

The delivery of health care largely rests with the States, Health being a state subject. The allocation of funds to health sector inter-alia is dependent on the overall resource availability of the Government, competing sectoral priorities, as also the absorptive capacity of the system.

As per Economic Survey 2015-16, the expenditure by Government (Central and State Governments combined) on health as percentage of Gross Domestic Product (GDP) for 2015-16 (BE) was 1.3 per cent.

As per 12^th Five Year Plan document, total public funding by the Centre and States, plan and non-plan, on core health is envisaged to increase to 1.87 per cent of GDP by the end of the Twelfth Plan.  The Draft National Health Policy 2015 envisages raising public health expenditure progressively to 2.5% of the GDP.

The allocation to States/UTs under National Health Mission by Centre Government for last three years is as under :

(i)                 2013-14  -  Rs. 19,989.01 Crore

(ii)               2014-15  -  Rs. 19,132.72 Crore

(iii)             2015-16  -  Rs. 16,213.09 Crore

To improve access to healthcare in tribal and hilly regions, the Government under National Health Mission has taken several steps which inter-alia include:

·      All the North Eastern States which have a high tribal population and other hilly states get funds under NHM from Government of India in the proportion of 90 (GoI Share):10 (State Share) as against share of funding in the ratio of 75:25 between Government of India and non-North Eastern States and non-hilly States.

·         Relaxed norms for setting up of health facilities.

·         Strengthening of Sub- Centre.

·         Relaxed Norms for treatment of Specific Diseases

·         Incentives are provided to health personnel serving in remote, underserved and tribal areas.

·         Relaxing the norm of one ASHA per 1000 population to one ASHA per habitation in Tribal/hilly anddifficult areas

·         Relaxation of norms for setting up of sub-centres in difficult hilly areas by introducing a new norm of “Time to care”. Under this norms, a sub centre can be set up within 30 minutes of walk from habitation.

family Planning Programme

family Planning Programme

Under the RMNCH+A approach, family planning programme has been integrated with maternal, neonatal, child and adolescent health programme to give it a thrust.

The details of various schemes run by the Government to promote family planning are given below:

Various schemes run by the Government to promote family planning

New interventions under Family Planning

·         New Contraceptive Choices: The current basket of choice has been expanded to include the new contraceptives viz. Injectable contraceptive, Centchroman and Progrsterone Only Pills (POP).

·         Redesigned Contraceptive Packaging: The packaging for Condoms, OCPs and ECPs has now been improved and redesigned so as to influence the demand for these commodities

·         New Family Planning Media Campaign: A360 degree media campaign has been developed to generate contraceptive demand.

·         Enhanced Compensation Scheme for Sterilization- The sterilization compensation scheme has been enhanced in 11 high focus states (8 EAG, Assam, Gujarat, Haryana)

·         Promotion of IUCDs as a short & long term spacing method - Introduction of Cu IUCD-375 (5 years effectivity) under the Family Planning Programme.

·         Emphasis on Postpartum Family Planning (PPFP) services with introduction of PPIUCD and promotion of minilap as the main mode of providing sterilization in the form of post-partum sterilization to capitalize on the huge cases coming in for institutional delivery under JSY.

·         Scheme for ensuring drop back services to sterilization clients

·         Appointment of dedicated RMNCH+A counsellors at high case load facilities.

·         Assured delivery of family planning services - In last four years states have shown their commitment to strengthen fixed day family planning services for both IUCD and sterilization.

·         Scheme for Home delivery of contraceptives by ASHAs at doorstep of beneficiaries has been expanded to the entire country w.e.f.  17^th Dec, 2012

·         Scheme for ASHAs to ensure spacing in births:

o   Under the scheme, services of ASHAs are being utilized for counselling newly married couples to ensure delay of 2 years in birth after marriage and couples with 1 child to have spacing of 3 years after the birth of 1st child.

o   The scheme is being implemented in 18 states of the country (8 EAG, 8 North East, Gujarat and Haryana). Additionally the spacing component has been approved in West Bengal, Karnataka, Andhra Pradesh, Telangana, Punjab, Maharashtra, Daman Diu and Dadra and Nagar Haveli

·         Celebration of World Population Day & fortnight (July 11 – July 24):

o   The World Population Day celebration is a step to boost Family Planning efforts all over the country.

o   The event is observed over a month long period, split into an initial fortnight of mobilization/sensitization followed by a fortnight of assured family planning service delivery.

o   June 27 to July 10: “Dampati Sampark Pakhwada” or “Mobilisation Fortnight”

o   July 11 to July 24 “Jansankhya Sthirtha Pakhwada” or “Population Stabilisation Fortnight”

On-going Interventions under Family Planning Programme

·         Ensuring quality care in family planning services by establishing Quality Assurance Committees in all state and districts.

·         Increasing male participation and promotion of ‘Non Scalpel Vasectomy’’.

·         ‘National Family Planning Indemnity Scheme’ (NFPIS) under which clients are insured in the eventualities of deaths, complications and failures following sterilization and the providers/ accredited institutions are indemnified against litigations in those eventualities.

·         Compensation scheme for sterilization acceptors - under the scheme MoHFW provides compensation for loss of wages to the beneficiary on account of undergoing sterilisation.

·         Accreditation of more private/ NGO facilities to increase the provider base for family planning services under PPP.

·         Improving contraceptives supply management up to peripheral facilities

·         A rational human resource development plan is in place for provision of IUCD, Minilap and NSV to empower the facilities (DH, CHC, PHC, SHC) with at least one provider each for each of the services and Sub Centres with ANMs trained in IUCD insertion

·         Emphasis on Minilap Tubectomy services because of its logistical simplicity with less failure rates.

·         Demand generation activities in the form of display of posters, billboards and other audio and video materials in the various facilities

The Government approves the budget for family planning through the budget heads of family welfare and the National Health Mission (NHM) every year based on proposals received from the states in their state Programme Implementation Plans (PIPs).

Centre beats 10 years of JNNURM in approving houses for urban poor

Centre beats 10 years of JNNURM in approving houses for urban poor

This is an evidence of ‘Government with a difference’ says Shri M.Venkaiah Naidu

12.84 lakh affordable houses sanctioned as against 12.40 lakh under JNNURM

2 lakh houses approved for Tamil Nadu, Karnataka, Gujarat, MP, Punjab, Rajasthan, Meghalaya today

Rs.70,145 cr investment so far approved in affordable housing; Rs.32,717 cr only under JNNURM

32 States/UTs benefit with housing projects in 2,329 cities/towns

Minister names well performing States; asks others to gear up

Demonetization will have positive impact on real estate sector, says Shri Naidu

Central Government today announced that it has so far approved construction of 12,83,616 affordable houses for urban poor in 2,329 cities and towns crossing the 12,40,968 mark approved under the ten years of Jawaharlal Nehru Urban Renewal Mission (JNNURM).

Making the announcement at a media conference here today, Minister of Housing & Urban Poverty Alleviation Shri M.Venkaiah Naidu said that his ministry today cleared construction of 1,97,402 housed for Economically Weaker Sections (EWS) under Pradhan Mantri Awas Yojana(Urban) in seven States and there by crossing the JNNURM mark in a very short period.

Shri Naidu further asserted  that this speed, scale and spread of reaching out to urban poor  in a short time since the launch of PMAY(Urban) in June last year is an evidence of “Government with a difference”  and it  “speaks volumes about the sense of urgency that this Government is according to make a difference to urban sector, which is the need of the hour”.

The Minister elaborated that this speedy performance was made possible by a paradigm shift in the approach to urban development including housing by empowering the State and city governments to formulate, evaluate and approve projects unlike in the past when every project report was assessed and approved by the Ministry resulting in huge delays in implementation. Also, enhanced scale of central assistance, awareness campaign resulting in increased demand, inclusion of new components covering a wide range of urban poor helped in quick approvals, Shri Naidu said.

The Minister informed that that as required under the Mission Guidelines ,over 20 States have undertaken reforms relating to Single Window Clearences for construction projects, doing away with Non-Agricultural Permission, formulating Master Plans earmarking land for affordable housing, grant of additional FAR etc., to promote affordable housing etc, so far. This he said is an ample evidence of “Governance with a difference based on the principles of Reform, Transform and Perform advocated the Prime Minister Shri Narendra Modi”.

                Comparing performance under PMAY(Urban) and JNNURM, Shri Naidu said that as against investment of Rs.32,717 cr approved under JNNURM, a huge investment of Rs.70,145 cr has already been cleared under PMAY(Urban). While central assistance of only Rs.17,405 cr was committed during the previous ten years, Rs.19,009 cr has already been approved under the new scheme. While only 939 cities were covered earlier, 2,329 cities and towns have already been sanctioned housing projects so far, Shri Naidu said.

The Minister stated that Tamil Nadu, Gujarat, Madhya Pradesh, Bihar, Jharkhand, Chattisgarh, Uttarakhand, Himachal Pradesh and West Bengal as ‘good performing’ States under PMAY(Urban) so far in terms of starting construction work under approved projects.

States sanctioned affordable houses by the Ministry of HUPA today are: Tamil Nadu-1,13,327 houses with an investment of Rs.3,714 cr, Karnataka- 31,880 (Rs.1,186 cr), Gujarat-18,248 (Rs.1,096 cr), Madhya Pradesh-16,448 (Rs.813 cr), Punjab-16,187 (Rs.447 cr), Rajasthan-1,280 (Rs.50 cr) and Meghalaya-32 (Rs.1.00 cr).

Shri Naidu also informed that to enable timely execution projects under Atal Mission for Rejuvenation and Urban Transformation (AMRUT), State Action Plans for the next three financial years are being sanctioned in one go to enable advance planning and implementation to realise mission targets by 2019 as envisaged

Study on Climate Change

Study on Climate Change

“The Intergovernmental Panel on Climate Change (IPCC) constituted by the World Meteorological Organisation, in cooperation with United Nations Environment Programme is an internationally recognised body of professional experts having a mandate to assess research on climate change and present its findings in the form of ''assessment reports'' every 5-7 years. The Fifth Assessment Report (AR5) of IPCC is the latest in a series of such reports released during the period 2013-14. AR5 consists of three Working Group Reports and a Synthesis Report. Some salient features of AR5 are as follows:
Global temperatures have risen by about 0.8°C over the last century and sea levels have risen by about 20 cm.
In many regions, snow and rainfall patterns have changed.
Snow, ice, permafrost and glaciers are melting at the poles and around the rest of the world.
Extreme weather events are becoming more frequent. For example, heat waves are lasting longer and becoming more intense.
However, IPCC Reports do not provide country-level assessment on the impact of climate change. Such country level assessments are conducted as part of National Communication (NATCOM) prepared by the Government of India periodically. The 2nd National Communication to the United Nation Framework Convention on Climate Change (UNFCCC) was submitted by the Government in 2012.The First Biennial Update Report (BUR) to UNFCCC was submitted by the Government on 22 January 2016.
In addition, a scientific study to assess the impact of climate change was undertaken and a report entitled “Climate Change and India: A 4X4 Assessment - A Sectoral and Regional Analysis for 2030s” was published in 2010. The study assessed impacts of climate change on four key sectors of Indian economy, namely, agriculture, water, forests and human health in four climate sensitive regions of India, namely, the Himalayan region, the Western Ghats, the Coastal region and the North-Eastern Region.
The above study projects a variable rate of change in agriculture production including losses in some crops, change in the composition of the forests and net primary productivity. The extreme precipitation events are likely to increase in all the regions. Water yield is projected to increase in the Himalayan Region, whereas it is likely to be variable across other three regions. Malaria is projected to spread to new areas and threats of its transmission are likely to increase for longer duration.
The above studies have helped in assessing emissions of greenhouse gases and identification of climatic impacts, risks and vulnerability of different sectors. Further, the studies have also led to formulation of State Action Plans on Climate Change, as well as, various policies, measures and programmes at the national level with a view to addressing the threat of climate change.”

Impact of Air Pollution

Impact of Air Pollution

“World Health Organisation (WHO) has published a report titled “Ambient Air Pollution: A global assessment of exposure and burden of disease” which presents summary of methods and results of the latest global assessment of ambient air pollution exposure. According to this report, air pollution has become a growing concern with an increasing number of acute air pollution episodes in many cities worldwide including Delhi.

Ministry of Environment, Forest and Climate Change has not carried out any study on change in genes of foetus vis-a-vis trans-generational impact. However, Department of Science and Technology under climate change programme has supported a National Network on Climate Change and Human Health comprising of eight research projects including impact of air pollution on human health. Indian Council of Medical Research (ICMR) has also extended financial assistance under various extramural and other research schemes on air pollution.

The major steps taken by the Government to control pollution include notification of National Ambient Air Quality Standards; formulation of environmental regulations / statutes; setting up of monitoring network for assessment of ambient air quality; introduction of cleaner / alternate fuels like gaseous fuel (CNG, LPG etc.), ethanol blending; promotion of cleaner production processes; launching of National Air Quality index; universalization of BS-IV by 2017;leapfrogging from BS-IV to BS-VI fuel standards by 1st April, 2020; comprehensive amendments to various Waste Management Rules and notification of Construction and Demolition Waste Management Rules; banning of burning of leaves, biomass, municipal solid waste; promotion of public transport and network of metro, e-rickshaws, promotion of car pooling, Pollution Under Control Certificate, lane discipline, vehicle maintenance; regular co-ordination meetings at official and ministerial level with Delhi and other State Governments within the NCR; issuance of directions under Section 18(1)(b) of Air (Prevention and Control of Pollution) Act, 1981 and under Section 5 of Environment (Protection) Act, 1986; installation of on-line continuous (24x7) monitoring devices by major industries; collection of Environmental Protection Charge on more than 2000 CC diesel vehicles in Delhi; and ban on bursting of sound emitting crackers between 10 PM to 6 AM etc.”

The richest 1% of Indians now own 58.4% of wealth

The richest 1% of Indians now own 58.4% of wealth
The share of the top 1% is up from 53% last year, shows a Credit Suisse report
The richest 1% of Indians now own 58.4% of the country’s wealth, according to the latest data on global wealth from Credit Suisse Group AG, the financial services company based in Zurich. Credit Suisse has published the report every year since 2010.

The share of the top 1% is up from 53% last year. In the last two years, the share of the top 1% has increased at a cracking pace, from 49% in 2014 to 58.4% in 2016. The accompanying Chart 1 has the details.

Does that mean the trend of the very rich getting richer is because of the Modi government? Not really—as the chart shows, the share of the top 1% in the country’s total wealth improved from 40.3% in 2010 to 49% in 2014. But the numbers do suggest that the very rich are expanding their share at a faster clip now. The richest 10% of Indians haven’t done too shabbily either, increasing their share of the pie from 68.8% in 2010 to 80.7% by 2016. In sharp contrast, the bottom half of the Indian people own a mere 2.1% of the country’s wealth.

Data from Credit Suisse shows that India’s richest do well for themselves whichever government is in power. In 2000, for instance, the share of the richest 1% was a comparatively low 36.8% of the country’s wealth. In the last 16 years, they have increased their share from a bit more than a third to almost three-fifths of total wealth.

Very clearly, most of the gains from the country’s high rate of economic growth have gone to them.

How does India compare with other countries? Well, the Credit Suisse numbers confirm what we see on a daily basis—that India is one of the most unequal societies. Consider this: while the top 1% in India own 58.4% of the country’s wealth, the top 1% in China own 43.8%, in Indonesia they own 49.3%, in Brazil 47.9%, in South Africa 41.9%. Chart 2 has the details. But perhaps our richest need to try harder—the top 1% in kleptocratic Russia own 74.5% of the nation’s wealth.

For Modi’s smart-city vision to become a reality, India needs smart villages first

Increasing rural-urban divergence in fertility due to poor education levels and low incomes in villages is slowing India’s urbanization, says a research paper

Among the cities selected for Modi government’s smart cities project, Uttar Pradesh accounts for the most. The move seems justified, given the fact that it is India’s most populous state. However, if urbanization performance were to be a benchmark, there is reason to be sceptical about the prospects of these smart cities.

Between the 2001 and 2011 census, share of population living in urban areas in Uttar Pradesh increased from 20.7% to 22.3%, a rise of merely 1.5 percentage points. Kerala, which was the best performer, increased its share from 25.9% to 47.6% during this period. Other states with commendable track records were Goa, Nagaland, Tripura and Andhra Pradesh, whereas Bihar, Meghalaya and Himachal Pradesh showed the least growth in their urban population share.

What explains such divergence in urbanization performance of states across India?

The intuitive explanation of weight of non-farm economy in a state’s GSDP does not seem to answer all questions. While some of the better performing states such as Maharashtra, Tamil Nadu and Kerala have a higher weight on non-farm sector in their GSDP, there does not seem to be a one-to-one relation between the two variables. For example, Odisha has a higher share of non-farm economy, but it fares poorly in terms of urbanization. For Andhra Pradesh the reverse seems to be true.

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A recently released paper by Chinmay Tumbe, an assistant professor of economics at IIM-Ahmedabad, has shown that state-wise divergence in rural-urban population growth might be the key factor behind difference in pace of urbanization in India.

Tumbe underlines the fact that cities in northern India have been experiencing a faster growth in population than those in the southern parts of the country. Despite this, it is the south which has progressed faster in terms of share of population living in urban areas. The solution to the puzzle lies in the rural-urban differential in natural rate of growth of population in northern and southern India, Tumbe argues. What this means is despite urban population rising faster in the north than the south, the share of urban population in the north has fallen behind that of the south because a much-faster rise in rural population has brought down the share of urban population.

The increasing divergence between rural-urban natural rates of growth of population is because birth rates have come down at a much faster pace in cities than in villages, whereas decline in death rates have become more or less equal.

While the increasing gap has been a pan-Indian phenomenon, its magnitude is much larger in the northern parts of the country, statistics given in the paper show.

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Tumbe takes the well-established factors of income and education gap to explain the population growth gap. A lot of research shows that education increases awareness about contraception methods and also increases the opportunity cost of child birth in case of women. Higher income families are known to have fewer children as they can spend more on their education and thus make up for the lost quantity in quality in terms of future income from children. Tumbe’s econometric exercise taking rural literacy as a proxy for education and agricultural productivity as a proxy for income turns out to be statistically significant and explains 26% of fertility difference between the north and south.

The first part of this data-journalism series had highlighted the role of circular migration behind India’s slow pace of urbanization and argued for providing better infrastructure for women in cities to facilitate urbanization growth in India. The arguments presented here underline the need for bringing down fertility rates by improving income and education levels in cities. The short point is, if India is really interested in having smart cities in the near future, it must make its villages smarter as well.