NITI Aayog launches the National Index for Performance on Health Outcomes

NITI Aayog launches the National Index for Performance on Health Outcomes

A ‘Performance on Health Outcomes’ index, spearheaded by NITI Aayog along with Ministry of Health and Family Welfare, to nudge States towards transformative action in the Health sector was launched today at NITI Aayog, New Delhi.  Shri C.K. Mishra, Secretary-Health and Shri Amitabh Kant, CEO NITI Aayog jointly released the guidebook for the exercise in the first of a series of regional workshops to be conducted across the country until February.

The features of the index, measures and methods of data submission will be disseminated to the States through these workshops. The index has been developed over several months, with inputs from domestic and international experts, including academicians and development partners, seeking feedback from States through multiple iterations and pre-testing the indicators in two States prior to its finalization. It is meant to capture the annual incremental improvements by States, rather than focus on historical achievements.  

It includes indicators in the domains of health outcomes governance and information and a few key inputs and processes. This initiative is envisioned to bring about the much required improvements in social sector outcomes, which have not kept pace with the economic growth in this country. It will be used to propel action in the States to improve health outcomes and improve data collection systems.

Monitorable indicators that form a part of Sustainable Development Goal in Health have been included in order to align these initiatives. It is anticipated that this health index will assist in State level monitoring of performance, serve as an input for providing performance based incentives and improvement in health outcomes, thereby also meeting the citizens’ expectations.  

The exercise involves the participation of several partners including technical assistance from the World Bank, mentor agencies to hand-hold States, where required, during the exercise and third party organizations to validate the data submitted prior to calculation of the index. Data will be entered and results published on a dynamic web portal hosted by NITI Aayog.

A similar exercise has also been launched for the Education and Water sectors.

Highlights of the Achievements of the Ministry of Water Resources, River Development and Ganga Rejuvenation

Highlights of the Achievements of the Ministry of Water Resources, River Development and Ganga Rejuvenation

Year End Review 2016

Ministry of Water Resources, River, Development & Ganga Rejuvenation

GANGA REJUVENATION

·         The Union Cabinet had approved the proposal for taking up Hybrid Annuity based Public Private Partnership (PPP) model under Namami Gange Programme which aims to reform the wastewater sector in India.

·         As a major initiative towards fast track implementation of Namami Gange Programme the first company of Ganga Task force Battalion was deployed at Garhmukteshwar.

·         As part of Namami Gange programme, Government of India has set up “Clean Ganga Fund” for encouraging contributions from Resident Indians, Non-Resident Indians, Persons of Indian origin, Institutions, and corporates towards Ganga Rejuvenation. The total contribution received as on 4th March 2016 in Clean Ganga Fund was Rs. 87.69 Crores.

·         An Implementation Agreement for Ganga Rejuvenation under the Namami Gange Programme was signed in New Delhi on 16^th April, 2016 between the Ministry of Water Resources, River Development and Ganga Rejuvenation and German International Cooperation (GIZ) of Germany.

·         National Mission for Clean Ganga under the Ministry of Water Resources, River Development and Ganga Rejuvenation in collaboration with Indian Institute of Technology, Kanpur (IITK) announced the formal launch of Centre for Ganga River Basin Management and Studies (CGRBMS) in New Delhi.

·         41 Sewage treatment plants development / rehabilitation under 34 projects, having total capacity of 808.23 mld, were sanctioned in the Ganga Basin States since inception of NGRBA Programme.

·         The Empowered Steering Committee (ESC) of the National Ganga River Basin Authority (NGRBA) had approved projects for Development of Ghats and crematoria. The total estimated cost of the projects is Rs. 2446 crore.

·         Ministry of Water Resources, River Development and Ganga Rejuvenation has constituted a committee to prepare draft Ganga Act. Justice Shri Girdhar Malviya (Retd.) was appointed the Chairman of the committee.

·         The empowered steering committee (ESC) of National Ganga River Basin Authority (NGRBA) has approved various projects worth Rs. 400 crore (approx).

·         Ministry of Water Resources, River Development and Ganga Rejuvenation (MoWR, RD&GR) signed an MoU in Delhi with the Ministry of Agriculture and Farmers Welfare (MoA&FW) for speedy implementation of Namami Gange programme.

·         The Union Cabinet approved the River Ganga (Rejuvenation, Protection and Management) Authorities order, 2016.  The order lays down a new institutional structure for policy and implementation in fast track manner and empowers National Mission for Clean Ganga to discharge its functions in an independent and accountable manner.

·         The Ministry released an amount of Rs. 315 crore to the Ministry of Drinking Water and Sanitation for the implementation of Ganga action plan under Swachh Bharat Mission (Gramin) during the current financial year.

·         The Government availed financial assistance in the form of developmental loans granted by Japan International Corporation Agency (JICA), amounting to Rs. 496.90 Crore for projects on Yamuna.

·         As on 30th September 2016, 128 projects were sanctioned under Namami Gange Programme (including the existing projects sanctioned under NGRBA Programme) at an estimated project cost of Rs.9419 crore.

           RIVER  DEVELOPMENT

·         Based on the satellite imageries, Indian Space Research Organisation (ISRO) conducted a study on Paleo-channels in the North-Western part of India. This study revealed that the Paleo-channels originate from Himalayas as well as Aravallies and flow further south in the States of Haryana, Punjab, Rajasthan and Gujarat.

·         A revised Bill has been drafted to constitute a Corporation named Brahmaputra Barak North-East River Development Corporation (BBNERDC).

           WATER RESOURCES

·         The Union Minister of Water Resources, River Development and Ganga Rejuvenation, Sushri Uma Bharti announced that Jal Manthan convention will become an annual feature.

·         Jal Manthan-2 convention on the theme “Integrated Approach for Sustainable Water Management” was held in New Delhi on 24^th February, 2016.  

·         Workshop on lessons learnt from the ongoing Dam Rehabilitation and Improvement Project (DRIP) was held in New Delhi on 19 February, 2016.

·         Overall allocation of resources for the Ministry of Water Resources was increased from Rs 7,431 crore in 2015-16 to Rs 12,517 crore in the Union Budget for 2016-17 through budgetary support and market borrowings. This shows an increase of more than 168%.

·         The fourth edition of India Water Week was observed from 04 to 08 April, 2016. It was inaugurated by Union Minister for Water Resources, River Development and Ganga Rejuvenation Sushri Uma Bharti in New Delhi.

·         A Water Film Festival was held at Water Expo-2016 in New Delhi on 8^th April, 2016.

·         The Govt. had approved  the National Hydrology Project under Central  Sector  Scheme  as an Externally  aided  Project with support  from the World  Bank  for  Rs.  3679.77 crore.

·         Union Minister for WR, RD and GR Sushri Uma Bharti launched nine projects for rural sanitation initiatives under Namami Gange Programme for conservation of river Ganga in Sahibganj, Jharkhand on 13^th May, 2016.

·         Prime Minister Shri Narendra Modi jointly inaugurated the Afghan-India Friendship Dam (Salma Dam) with President of Afghanistan Dr. Ashraf Ghani at Chist-e-Sharif in Herat province in Western Afghanistan on 10^th June, 2016.

·         Union Ministry for WR, RD and GR called a Meeting of representatives of Governments of Odisha and Chattisgarh in New Delhi to consider the various water resources issues/projects in Mahanadi Basin. The meeting was called in pursuance of the assurance given by Union Minister for WR, RD and GR Sushri Uma Bharti in Parliament on July 26, 2016.

·         Government had started an initiative called “Ganga Gram” under Namami Gange Programme.  Under this, the villages will be developed as model villages by developing sustainable sanitation infrastructure and cleanliness practices. In the first phase government has started the Ganga Gram initiative in 306 villages.

·         Union Minister for Water Resources, River Development and Ganga Rejuvenation Sushri Uma Bharti and Union Urban Development Minister Shri M Venkaiah Naidu launched Smart Ganga City Scheme in ten important cities through video conference. These cities are – Haridwar, Rishikesh, Mathura-Vrindavan, Varanasi, Kanpur, Allahabad, Lucknow, Patna, Sahibgunj and Barrackpore.

·         Union Minister for Water Resources, River Development and Ganga Rejuvenation Sushri Uma Bharti has launched various projects worth Rs. 560 crore under Namami Gange programme at Ganga Barrage in Kanpur.

·         Ministry of Water Resources, River Development and Ganga Rejuvenation constituted a high level technical team to visit the Cauvery basin area to assess the ground realities in the basin. Shri GS Jha, Chairman, Central Water Commission was appointed the Chairman of this team.

·         First installment of Rs. 1500 crore were released to the states as central assistance for 99 prioritized irrigation projects under Accelerated Irrigation Benefits Program (AIBP).

‘Chardham Mahamarg Vikas Pariyojna’

PM to Lay Foundation Stone of ‘Chardham Mahamarg Vikas Pariyojna’

Prime Minister Shri Narendra Modi will lay the foundation stone of the ambitious Chardham Mahamarg Vikas Pariyojna’on 27^th December, 2016 at Parade Ground in Dehradun. The project aims at improving the connectivity to the Char Dham pilgrimage centres in the Himalayas, making journey to these centres safer, faster and more convenient. 

The Chardham project includes developing 900 km of national  highways in Uttarakhand at a total cost of Rs. 12000 crores. Work for 17 projects worth Rs 3000 crores have already been sanctioned and tendered. The entire length of the highways will be two-laned with paved shoulder and with a minimum width of 10 metres.  There will be tunnels, bypasses, bridges, subways and viaducts to prevent traffic bottlenecks. A team of experts have been engaged to identify zones prone to landslides, and environment friendly techniques are being incorporated in the design to make these zones safer. 

First 2G (Second Generation) Ethanol Bio-refinery in India to be set up at Bathinda (Punjab);

First 2G (Second Generation) Ethanol Bio-refinery in India to be set up at Bathinda (Punjab); Foundation Stone laying ceremony to be held on 25th December, 2016

The Foundation Stone laying ceremony for setting up the first Second Generation (2G) Ethanol Bio-refinery in India is being held on 25^th December, 2016 at village Tarkhanwala, Bathinda (Punjab), with an approximate investment of Rs 600 crores.  Hindustan Petroleum Corporation Limited (HPCL), a Central Government Public Sector Undertaking, is setting up the project.

 Minister of Food Processing Industries, Smt. Harsimarat Kaur Badal, Minister of State (I/C) Petroleum & Natural Gas, Shri Dharmendra Pradhan, and Deputy Chief Minister of Punjab, Sardar Sukhbir Singh Badal shall jointly lay the Foundation Stone.

 The Government of India is encouraging production of Second Generation (2G) Ethanol from agricultural residues to provide additional sources of  remuneration to farmers, address the growing environmental concerns and support the Ethanol Blended Petrol (EBP) programme for achieving 10% Ethanol Blending in Petrol.

 The Bathinda Bio-refinery will be utilizing agriculture residues for production of 100 KL per day or 3.20 crore litres per annum of ethanol which may be sufficient to meet the 26% of the ethanol blending requirement of the State. The proposed Bio-refinery will generate employment for about 1200 -1300 persons in the Biomass supply chain and generate an additional income of approximately Rs 20 crores per annum for the farmers through purchase of their agriculture residues. The project shall also help in reducing CO₂ emissions from the paddy straw which currently is being burnt after harvesting.

 One of the major outputs of this Bio-refinery shall be Bio-fertilizer approximating 30,000 tonnes per annum which shall be incorporated into the soil for improving soil fertility and overall productivity of farms in Punjab. The Bio-refinery shall also produce more than 1.00 lakh Kg of Bio-CNG per annum which can cater to transport and clean cooking requirements.

 Oil PSUs, in line with vision laid down by Government of India, are planning to set up twelve (12) 2G Ethanol Bio-refineries across 11 States viz. Punjab, Haryana, U.P., M.P, Bihar, Assam, Odisha, Gujarat, Maharashtra, Karnataka and A.P.

 The estimated investment for the 12 Bio-refineries is Rs 10,000 crores. These Bio-refineries shall produce around 35- 40 crore litres of Ethanol annually, thus contributing significantly towards the EBP programme.

 Recently, in Petrotech-2016 on 07.12.2016, Oil PSUs also entered into 6 MoUs with Technology licensors and State Governments for setting up Bio-refineries in Dahej (Gujarat), Panipat (Haryana), Bina (M.P.), Bargarh (Odisha) and Bathinda (Punjab).

 The Bio-refinery at Bathinda is the first step towards achieving 10% blending of Ethanol in petrol. Similar 2G Bio-refineries at other places are expected to be started soon.

DRDO successfully flight tests Smart Anti-Airfield Weapon

DRDO successfully flight tests Smart Anti-Airfield Weapon

The Defence and Research Development Organization (DRDO) yesterday successfully flight tested the Smart Anti-Airfield Weapon (SAAW), from an Indian Air Force (IAF) aircraft. SAAW, an indigenously designed and developed 120 kg. class smart weapon, developed by DRDO, is capable of engaging ground targets with high precision up to a range of 100 kms. The light weight high precision guided bomb is one of the world class weapons systems.
The captive and release trials were tracked by Radar and Telemetry ground stations at ITR during the entire duration of the flight. The performance of all systems were satisfactory with all the mission objectives achieved.
Secretary, Department of Defence (R&D) & Chairman, DRDO, Dr S. Christopher, congratulated DRDO and the IAF teams for the successful mission.
Scientific Advisor to RM and DG (Missile and Strategic Systems), DRDO, Dr G. Satheesh Reddy, lauded the scientific community of the DRDO for their efforts towards the design and development of this state-of-the-art smart weapon within the set time frame.

Designing effective public policy

Designing effective public policy
Behavioural science should be used to design effective evidence-based public policy
For the most part, designing policy has meant passing a law, a sanction or penalty that imposes a fine or imprisonment to effect desired behavioural change or action. It assumes that the connection between law and actual behavioural is linear. It assumes that people are aware of the law, realize it applies to them, that people weigh the costs of breaking the law with the risk of being caught, overcome the temptations of the moment, in favour of willpower and self-discipline, and comply.
However, in spite of alcohol being prohibited in Gujarat, Nagaland, and Bihar, it is still readily available in these states, and has helped create a network of bootleggers, liquor mafia, spurious liquor, and a complicit police. There are fines for not adhering to traffic laws like honking unnecessarily or not stopping the car before a zebra crossing, but they are far from being effective in getting people to take the desired action. There is a fine for littering, but our roads are strewn with litter. Even when retailers charge for plastic bags, its consumption continues to grow. Fines and sanctions curb people’s fundamental right to choose and, therefore, are met with resistance and are often counterproductive.
A nudge, on the other hand, is a way of encouraging or guiding behaviour without mandating, instructing, sanctioning or monetarily incentivizing. It leaves people with the freedom of choice and yet guides them to act positively. Instead of shutting down choices, a nudge changes behaviour with a lighter touch, a more empirical and behaviourally-focused approach to policymaking.
A pioneer in designing effective public policy by using behavioural design nudges is the Behavioural Insights Team (BIT) or the “Nudge Unit” of the UK. It was started in 2010, headed by David Halpern and advised by Richard Thaler, with the backing of then Prime Minister David Cameron. Like any new idea, it had its sceptics in government. But over the first two years itself, it demonstrated the value behavioural science could bring in designing policy, based on empirical methods, that led to better outcomes, easier services for the public and most importantly saved government money.
BIT conducts dozens of experiments in the form of randomized controlled trials or rapid low-cost trials in areas such as healthcare, tax, energy conservation, crime reduction, employment and economic growth. Among some of its popular work is how it helped the tax department collect more taxes. BIT worked with the tax department to send out different versions of letters to people who owed tax to test systematically if changing the wording based on behavioural science literature would make a difference. They tested whether adding a single sentence such as “most people pay their tax on time” would boost repayment rates. And it did. By several percentage points, bringing in tens of millions of pounds. It’s because social norms are powerful in getting people to take action. Wording can make a big difference in behaviour change—imagine 3G, 4G and Wi-Fi being reworded as “radiation”.
Another experiment was about motoring fines. It showed that adding an image of the owner’s car to the ticket, captured by the camera, made the owner significantly more likely to pay unpaid car tax. In a third experiment, they encouraged people to insulate their lofts or attics. Insulation reduces heat loss, reduces energy bills and costs much less compared to the overall monetary benefits, yet people weren’t insulating their lofts. They tested two offers—an attic-clearance service and extra discounts. The attic-clearance scheme was more than three times more popular than extra discounts because the biggest issue was attic clearance rather than cost.
In the area of employment, getting the unemployed to think about what they could do in the next two weeks, instead of asking what they had done in the previous two weeks, significantly increased the number of unemployed who got work faster, trimming millions of days off benefits. In behavioural science, such a nudge is termed “implementation intention”.
In the area of pensions, employees now automatically joined the company-sponsored pension scheme by default but still had the option of opting out. So now the default was automatic enrolment rather than actively choosing to do so, making good behaviour easy. That led to more than five million new pensioners. Behavioural science studies by David Laibson, Shlomo Benartzi and other behavioural scientists show that changing the default beats financial education hands down.
Other BIT experiments have showed how simple behavioural design nudges can reduce carbon emissions, increase organ donations, increase quit-rates of smoking, reduce missed medical appointments, help students finish their courses, reduce discrimination and boost recruitment. And like the examples mentioned above, they are low cost, simple and scalable.
India has hundreds of problems to solve that require effective public-behaviour change—waste segregation, energy conservation, reducing road accidents, fuel conservation, cleanliness, adherence to medication, tobacco addiction, open defecation, reducing crime, hand-washing, tax evasion, alcoholism, etc. Instead of relying on law, fines, threats and monetary incentives, why not apply behavioural science and test simple, low-cost behavioural design nudges to see what works? Test, learn and adapt. After all, evidence-based policy is the best policy.

Reforming healthcare in India

Reforming healthcare in India
India’s largely unorganized healthcare sector is focused on curing sick people rather than preventing sickness itself
India faces a triple-disease burden of maternal and child health, infectious, and non-communicable diseases. This is despite India’s status as the third-largest economy in the world, with annual spending of over Rs6 trillion on healthcare on its 1.3 billion population.
What prevents India’s healthcare system from delivering world-class services, especially for the over 800 million people of rural India? India’s tax-based funding of healthcare is far too low and barely supports a government-owned health system which is almost exclusively focused on basic maternal and child health. Health insurance covers less than 5% of total health expenditure. The formal private network is a minuscule component of India’s health sector and is focused on secondary and tertiary care for urban India.
As a result, over 60% of healthcare expenditure in India is incurred by individuals whenever they seek care. Money is spent on seeking healthcare services from several informal providers and on purchasing large quantities of irrational medicines directly from pharmacies. As a result, India’s largely unorganized healthcare sector is focused on curing sick people rather than preventing sickness itself.
Healthcare has some peculiar features which makes it impossible for free-market solutions to work. Unlike other expenses, those on healthcare tend to have a high degree of variability and are most often unexpected. However, we humans have an innate tendency to not even think about our health until we get really sick. As a result, we do not buy health insurance, but are prepared to spend heavily on hospitals, while almost completely avoiding expenses on primary care and early diagnosis to treat incipient conditions. This is compounded by the fact that an average individual is not even aware of his/her health status and is completely dependent on the doctor or surgeon for medical advice.
Several countries have, therefore, not taken the path of free markets and have built high-performing health systems. A careful study reveals three essential principles that are central to the design of each of these successful health systems: pre-payment with pooling; concentrated purchasers with organized providers; and the government’s role as an active shaper and steward of the entire health system.
Pre-payment is the first principle. Countries have either used higher taxation levels to achieve this or have required residents to mandatorily purchase some form of health insurance. Britain is an example of a largely tax-financed health system while Germany is largely reliant on mandatory health insurance. Japan mandates citizens to enrol with one of its several insurers for universal coverage. The money thus collected is then aggregated into large pools which are able to absorb the high level of variability of health expenditure.
The second principle is that these pools are managed by one or more large agencies, which use pooled money to pay for healthcare for their members, and thereby discipline both providers and consumers. Britain uses public trusts, Germany sickness funds, Japan uses multiple insurers and Thailand adopts a single national health security office which buys only from primary care-led integrated providers. In several countries, there is a distinction between the roles of the purchaser of health services and the providers of healthcare. In such examples, a public trust or designated organization could receive pooled finances, acting as a purchaser. Providers could be a mix of public and private accredited facilities that compete for contracts based on high-quality services and on a capitation basis. Health insurers provide a wider suite of innovative products, covering outpatient and primary care. This enables the shift towards a futuristic healthcare design where payments to healthcare providers are based on achievement of outcomes.
The third and most crucial design principle in all effective health systems is that the government plays an active role in designing and supervising the entire health system, instead of focusing only on the management of a health system owned by itself.
Countries have taken these design principles and applied them to their own sociocultural context, as they deemed appropriate. By doing so, countries have shaped and organized an effective provider market over time, and have almost entirely eliminated healthcare-related hardships and impoverishment. Leading health systems, such as Thailand and the privately-owned Kaiser Permanente in the US, have gone one step further and now require providers to share the risk of the ill-health of the customer, thus ensuring that providers become sharply focused on customers’ well-being and continued good health.
Designing an effective health system of this type is an uphill yet achievable journey. In the 1960s, countries such as Thailand, Brazil and South Korea had health statistics similar to or worse than India’s in 2010, but transformed the status quo over four decades. In India, each state represents a different social, economic, and cultural environment, and will need a customized approach towards its health systems’ redesign.
However, there is no fundamental reason why each state cannot use these guiding principles to aspire to build a strong health system. It is clear from global experiences that for any country that has achieved successful reform of its healthcare system, these three core design principles have played a singular role, without relying on free markets