Social Justice

Minimum Income Guarantee Bill in Rajasthan

Context: The Rajasthan government stated intent of enacting a Minimum Income Guarantee Law in the next few days.

Minimum Income Guarantee Bill

The Rajasthan government while introducing the bill, said “According to the basic spirit of the Constitution, every person has the right to live with dignity.”

Provision of the bill

Minimum Income Guarantee Scheme will include a provision for giving pension of at least Rs 1000 per month to elderly, widow, single women, with a guaranteed annual increment of 15 per cent per year. After the law is made, “giving pension will become a legal obligation.”
Families who complete 100 days in Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) will get 25 days extra employment on a permanent basis. Kathodi, Sahariya and Specially abled people will get employment for 200 days instead of 100 days.

MGNREGA as a Right based approach of entitlement

The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), 2005 made 100 days unskilled work a legal right for a rural resident. Which makes it a rights-based approach for providing social protection.

It is a public employment guarantee scheme designed to provide employment and basic income security to the rural working-age population in India, as well as improve their livelihoods through the development of durable assets.
MGNREGA combines rights-based entitlements with demand-driven employment and citizen-centred planning and monitoring in its design.

Benefits of MGNREGA over Cash transfer

MGNREGA solved the hitherto difficulty of selecting recipients under a cash transfer scheme by making it a universal right for all rural residents who could self-select based on their need for employment.
The “targeted” safety net approach of using BPL lists to identify beneficiaries for cash transfer is plagued by the misuse of power by the rural elite and bureaucracy, resulting in the benefits reaching people who were not supposed to receive them.
MGNREGA provides wage income as a legal entitlement for labour done and replaces doles with salaries that are quantified.
MGNREGA combined development rights with citizenship rights thereby giving citizens the platform to mobilise and assert their rights to plan works, earn a minimum wage and evaluate the outcomes of the programme through social audits.
MGNREGA contributed to the resolution of market problems by increasing the negotiating power of MGNREGA workers in the open labour market.
The inability to address authentication errors, inaccessible banking systems and lack of proactive facilitation to the most marginalised make cash transfer less effective in comparison to MGNREGA.

Global Cases of social welfare programme

Brazil

Bolsa Família is the current social welfare program of the Government of Brazil, part of the Fome Zero network of federal assistance programs. Bolsa Família provided financial aid to poor Brazilian families.

Mexico

Oportunidades was the first national conditional cash transfer program targeting poor and extremely poor households and that integrated three basic social rights –health, education and nutrition.

Way Forward

The most logical and effective method by which delivery systems, even within a rights-based framework, can be made to respond to people’s needs is to make sure that the state agencies are accountable. Officials are accountable not just to their administrative superiors, but also to the people.
For any mass scale delivery of rights, a strong people-centric accountability mechanism needs to be in place — the mechanism must be codified by law. The failure to deliver should be dealt with in a given time frame and in a decentralised manner. Accountability should be fixed on individual officials.

Poverty & UNDP

Context: The UN report noted that deprivation in all indicators declined in India and “the poorest States and groups, including children and people in disadvantaged caste groups, had the fastest absolute progress.”

Different types of Poverty

Absolute Poverty

Absolute poverty means poverty defined using a universal baseline with no reference to other people’s income or access to goods. The failure of meeting this baseline thus means that the individual is poor.

It incorporates the deficiency of basic food, clean water, prosperity, refuge, guidance and information and puts a money value on them to calculate a baseline.

Relative Poverty

Relative poverty is the level of poverty which changes depending on the context–it’s relative to the economic context in which it exists. Relative poverty is present when a household income is lower than the median income in a particular country.

For example, if the disposable income of a household is less than 50% of the median income of the country the household is relatively poor.

Situational Poverty

Situational poverty occurs when “a family temporarily experiences financial constraints due to an illness, job loss, or other temporary event”.

Generational Poverty

Generational poverty is a condition in which poverty has become a familial pattern for at least two generations, although it typically affects multiple generations. Sometimes, situational poverty may lead to Generational poverty.

Subjective Poverty

Subjective poverty is an individual’s perception on his or her financial/material situation. This kind of Poverty is defined on the basis of individual feeling, i.e., those who say that they feel poor represent subjective poverty.

Different Methods of measuring Poverty

Head Count Ratio or Poverty Ratio

Absolute poverty may be measured by the number or ‘head count’ of those whose incomes fall below the ‘poverty line’. Head Count Ratio is the percentage of that population in the total population.

Multi-dimensional Poverty

Multidimensional poverty encompasses the many deprivations that people can experience across different areas of their lives. This could include a lack of education or employment, inadequate housing, poor health and nutrition, low personal security, or social isolation.

In 2005/2006, about 645 million people were in multidimensional poverty in India, with this number declining to about 370 million in 2015/2016 and 230 million in 2019/2021.

Multidimensional Poverty Index (MPI) is released by the United Nations Development Programme (UNDP) and the Oxford Poverty and Human Development Initiative (OPHI).

The MPI as a poverty index can be pictured as a stacked tower of the interlinked deprivations experienced by poor individuals, with the aim of eliminating these deprivations.

Source UNDP

Causes of improvement

During the last two decades, India has implemented several social protection programmes with the aim to improve living standards, and these have helped the Indian government in poverty reduction.

Implementation of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) since 2006 has significantly increased household consumption and accumulated more nonfinancial assets.
Minimum Support Price (MSP), Public Distribution Systems (PDS), PM-POSHAN and other programmes have addressed the problem of food security.
Code on social security, Code on wages etc. have increased labour earnings and security of job which played significant roles in poverty reduction.
PM- Jan Dhan Yojana and biometric identity cards under Aadhar have also transformed the anti-poverty programmes by replacing the current cumbersome and leaky distribution of benefits under various schemes using the Direct Benefit Transfers (DBT) programme.
Saubhagya scheme, PM-Sahaj Har Ghar Bijali Yojana etc. helped in improving the standard of living.
Swachh Bharat mission, National Rural Drinking Water Programme, Total Sanitation Campaign, Jalmani Programme etc. have helped in improving the sanitation outcomes.

B 7 rtirwmZxhnM2DDOcb4jrlWmuP6HUBOd g4H6VbLj3b28D2ZxRwe6oMPY9anEYayY3OhKwTshsLjxZ7dyde9PQCy8wpHqMq5FrsELMGKHXClzjaY15gFz7qJab ssGkAcYM 8lpKcJYHFv DHtg

Current status of MPI in India

India was among the 19 countries that halved their global Multidimensional Poverty Index (MPI) value during one period - for India it was 2005/2006–2015/2016.

According to the report, people who are multidimensionally poor and deprived under the nutrition indicator in India declined from 44.3% in 2005/2006 to 11.8% in 2019/2021, Child mortality fell from 4.5% to 1.5%.
Those who are poor and deprived of cooking fuel fell from 52.9% to 13.9% and those deprived of sanitation fell from 50.4% in 2005/2006 to 11.3% in 2019/2021.
In the drinking water indicator, the percentage of people who are multidimensionally poor and deprived fell from 16.4 to 2.7 during the period, electricity (from 29% to 2.1%) and housing from 44.9% to 13.6%.

Way Forward

Government may focus on the implementation of programmes which faces the problem of rigidity, non-adaptability to local conditions, late disbursement of funds, reallocation of funds to unrelated recurring expenditure, and wide-ranging rent-seeking practices.
DBT, technological improvement Programmes and sanitation programmes has been criticised because of digital divide and urban biasness in their implementation. Through initiatives for education and awareness, the Indian government could enhance the implementation its policies.

Demographic transition and change in women’s lives

Context: India's population has skyrocketed from 340 million at Independence to 1.4 billion, thanks to improved public health and medical advancements. This unexpected decline in mortality has transformed the lives of Indians, especially women, as they navigate longer lifespans and the consequences of fewer children.

Demographic transition

Demographic transition refers to the process of changes in population characteristics that occur as societies develop over time.

India’s Demographic transition

The growth of population was fuelled by receding starvation, improved public health and medical interventions.
In 1941, male life expectancy was about 56 years and only 50% of boys survived to age 28. Today, life expectancy for men is 69 years and nearly 50% of them live up to 75 years of age.
Due to rapid decline in mortality rates, the Total Fertility Rate (TFR) fell from 5.7 in 1950 to 2.1 in 2019. #As per National Family Health Survey 5

Dynamics of Male Child in India

Social norms and patrilocal kinship patterns combined with lack of financial security reinforce a preference for sons.
According to India Human Development Survey (IHDS), 85% of women respondents expected to rely on their sons for old age support, while only 11% expected support from their daughters. #Report
Nowadays, Parents who want to ensure at least one son among their one or two child family, often resort to sex selective abortion.

Impact of declining fertility on Women’s life

Increased opportunities for Education: With declining fertility, women may choose to delay starting a family in order to pursue education, career goals, or personal aspirations. This can provide women with greater opportunities for personal and professional growth. In India, there has been significant progress in women's educational attainment, with over 70% of girls enrolling in secondary education.
Focus on family planning: Declining fertility rates often coincide with increased availability and acceptance of family planning methods. This empowers women to have greater control over their reproductive choices, allowing them to plan the timing and number of children they want to have.
Reduce gender disparities in society: When women have fewer children, they can allocate more time and energy towards their own pursuits, including education, careers, and personal interests. This can help break traditional gender roles and promote gender equality by challenging societal expectations placed on women as primary caregivers.
Improved employment opportunities: With fewer children to care for, women can participate more actively in the labour force, contributing to household income and economic growth. Women's financial independence can lead to greater decision-making power within families and promote their overall well-being.
Reduced maternal and infant mortality: When women have fewer pregnancies, the overall risk of complications and health issues associated with childbirth is reduced. Improved access to healthcare services, prenatal care, and skilled birth attendants further enhances maternal and infant health outcomes.

How early marriage and aging impacts Women’s empowerment?

Early motherhood may not lead to increased participation in the labour force for women. By the time their childcare responsibilities decrease, they may have missed out on opportunities in occupations that require specialized skills, leaving them with limited options for employment, mostly in unskilled work.
For widowed women, the lack of access to savings and property results in dependence on children, mainly sons, bringing the vicious cycle of son preference to full circle.

Practical strategies to harness Gender Dividend:

Enhancing women’s access to employment and assets will reduce their reliance on sons and could break the vicious cycle of disadvantage, stretching from childhood to old age.
Expansion of anganwadis to include a creche can result into increased participation of mothers in the work. E.g., Randomised control trial in Madhya Pradesh showed positive results as per World Bank.
State support should be provided for childcare, as it creates space for education and employment for Women. #CaseStudy: State support for childcare declined, employment rates for mothers fell from 88% to 66% in urban China.
Government can make staffing creche an acceptable form of work under National rural employment guarantee scheme (NREGS).
Self-help group movement can be harnessed to setup neighbourhood childcare centres in urban and rural areas.

Fully harnessing the gender dividend is crucial for realizing the long-awaited demographic dividend, and a significant aspect of accomplishing this is by ensuring optimal access to childcare.

Palliative care

Context: A new set of operational guidelines of NP-NCD, issued by the government, limit the focus of palliative care in India to people with cancer.

About Palliative care

It is the branch of medicine focusing on improving the quality of life and preventing suffering among those with life-limiting illnesses like heart failure, kidney failure, certain neurological diseases, cancer, etc.
It aims to identify patients at risk of over-medicalisation at the expense of quality of life and financial burden on the family.
It also aims to improve the quality of life by addressing the physical, psychological, spiritual, and social domains of the health of people suffering from life-limiting diseases
It is often misinterpreted as end-of-life care.
Beneficiaries are terminal cases of Cancer, AIDS etc.
The goal is the availability and accessibility of rational, quality pain relief and palliative care to the needy, as an integral part of Health Care at all levels, in alignment with the community requirements.

Need for palliative care

Palliative care in India has largely been available at tertiary healthcare facilities in urban areas. Due to this skewed availability of services, it is accessible to only 1-2% of the estimated 7-10 million people who require it in the country.
India has experienced a steep rise in the burden of lifestyle-related non-communicable diseases. Nearly 1.4 million people are diagnosed with cancer in India every year while diabetes, hypertension, and respiratory diseases are also on the rise. All these diseases need palliative care sooner or later in the disease trajectory.
Post-independence India has made considerable efforts to improve the health of its people like the introduction of the three-tier health system, multiple national health programmes and schemes, and the Ayushman Bharat Health Insurance Scheme. But despite these efforts, 55 million people in India are pushed below the poverty line every year due to health-related expenditures. Over-medicalisation plays a significant role in this financial burden.

Steps taken by the government:

The National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD): In order to prevent and control major NCDs, it was launched in 2010 with a focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral.
The programme envisaged the provision of promotive, preventive, and curative care from the primary to tertiary institutes, thus providing health services delivery across the continuum of care.

National Programme for Palliative Care (NPPC): It was launched in 2012, NCD Cells are being established at National, State and District levels for programme management, and NCD Clinics are being set up at District and CHC levels, to provide services for early diagnosis, treatment and follow-up for common NCDs. Provision has been made under the programme to provide free diagnostic facilities and drugs for patients attending the NCD clinics.
National Programme for Health Care for the Elderly: To provide accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an Ageing population.
NGOs like Pallium India, Karunashraya, and CanSupport are trying to fill the gap in palliative care in India.

Gaps in the guidelines

Per the Global Atlas of Palliative Care, in 2020, the need for palliative care was higher for non-cancer illnesses. However, the revised NP-NCD operational guidelines, mention palliative care in synonymy with cancer only. Cancer is just one of 20 common health conditions that require palliative care.
Since most patients who need palliative care are suffering from debilitating diseases, home-based care forms the ideal mode of healthcare delivery. Previously, the programme guidelines mentioned providing support for home-based palliative care services. However, palliative care service delivery starts only from the district hospital in the revised guidelines, with no mention of home-based care.
No mention of home-based palliative care services: Since most patients who need palliative care are suffering from debilitating diseases, home-based care forms the ideal mode of healthcare delivery.
However, palliative care service delivery starts only from the district hospital in the revised guidelines.
No mention of paediatric palliative care: An estimated 98% of children facing moderate to severe suffering during their end of life reside in lower and middle-income countries like India.
Linking of 11 programmes (including NPPC) to promote convergence: The mechanisms of the linkage with a programme (NPPC) that has not yet been fully implemented are unclear.

Way Forward:

Access to palliative care will be assessed by estimating morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer. Including an indicator to assess morphine access is a welcome move, but an indicator focusing only on patients with cancer might lead to an inaccurate assessment of coverage of services.
The recommendations of the World Health Assembly in 2014:

Palliative care to be integrated into health systems at all levels.
Including palliative care along with curative treatment

It is high time for India to realise the ongoing pandemic of non-communicable diseases and strengthen its palliative care services.

Women’s reproductive autonomy is the new catchword

Context: This year’s World Population Day theme, i.e., ‘Unleashing the power of gender equality: Uplifting the voices of women and girls to unlock our world’s infinite possibilities’, could not be more apt for India. When we unlock the full potential of women and girls, encouraging and nurturing their desires for their families and themselves, we galvanise half the leadership, ideas, innovation, and creativity available to societies.

India’s Progress on Population Front

On World Population Day (July 11), India deserves to be commended for its family planning initiatives, where despite the many challenges, the aim is to provide an increasingly comprehensive package of reproductive health services to every potential beneficiary — with a focus on the provision of modern short and long-acting reversible contraceptives, permanent methods, information, counselling, and services, including emergency contraception.
India’s commitment towards the Family Planning 2030 partnership includes expanding its contraceptive basket.
The inclusion of new contraceptive options advances women’s rights and autonomy, leading to a spike in modern contraceptive prevalence.
Access to timely, quality and affordable family planning services is crucial because unspaced pregnancies may have a detrimental influence on the newborn’s health as well as major effects on maternal mortality, morbidity, and healthcare expenditure.
The Indian government’s health, population and development programmes have shown steady progress.
Life expectancy at birth has significantly increased in the country over the years. Compared to the 1990s, Indians are currently living a decade longer. In terms of maternal health, India has made impressive strides.
The current maternal mortality rate is 97 (per 100,000 live births in a year), down from 254 in 2004.
Another triumph of these programmes is gender empowerment.
Since the beginning of 2000, India has cut the number of child marriages by half.
Teen pregnancies, too, have dramatically decreased.
Access to vital services, including health, education, and nutrition, has also improved.

Issue of Lack of Physical/Reproductive Autonomy

According to the most recent National Family Health Survey (NFHS-5), just 10% of women in India can independently decide about their health, and 11% of women believe that marital violence is acceptable if a woman refuses to have sex with her husband.
Nearly half of all pregnancies in India are unplanned.

Advantages of Physical/Reproductive Autonomy

Advancing gender equality is not just about women but also populations as a whole.
In ageing societies that worry about labour productivity, achieving gender parity in the workforce is the most effective way to improve output and income growth.
In countries experiencing rapid population growth, women’s empowerment through education and family planning can bring enormous benefits by way of human capital and inclusive economic development.
More importantly, the focus on gender equality helps shift the focus away from the notion of ‘population stabilisation’ to ‘population dynamics’ based on reproductive choices people make.
India has a significant opportunity to advance gender equality and grow its economy. Raising the women’s labour force participation by 10 percentage points might account for more than 70% of the potential GDP growth opportunity ($770 billion in additional GDP by 2025).

The way forward

Focusing on gender equality-centred growth, rights, and choices promises to help all achieve their aspirations.
Gender equality can be ensured by making investments in a woman’s life at every stage, from childbirth to adolescence to maturity.
Engaging with women, girls and other marginalised people and formulating legislation and policies that empower them to assert their rights and take life-changing personal decisions are the first steps in this direction.
Gender-just approaches and solutions are the fundamental building blocks of a more prosperous India, and indeed the world.

How the Performance Grading Index assesses states in school education

Context: The Education Ministry released Sunday's latest Performance Grading Index (PGI) edition. This relatively new index measures the performance of states in school education.

How is PGI worked out?

It assesses states’ performance in school education based on data drawn from several sources, including the Unified District Information System for Education Plus, National Achievement Survey, and Mid-Day Meal.
States are scored on a total of 1,000 points across 70 parameters, which are grouped under five broad categories:

Access (e.g. enrolment ratio, transition rate and retention rate);
Governance and management;
Infrastructure;
Equity (difference in performance between scheduled caste students and general category students) and
Learning outcomes (average score in mathematics, science, languages and social science).

States are graded and not ranked to discourage the practice of one improving only at the cost of others, “thereby casting a stigma of underperformance on the latter”.
According to the government, the objective is to help the states prioritise areas for intervention in school education.
The Education Ministry released the first PGI in 2019 for the reference year 2017-18.

What does the grading system reflect?

The PGI grading system has 10 levels.
Level 1 indicates top-notch performance and a score between 951 and 1,000 points.
Level II, or Grade 1++, indicates a score between 901 and 950.
Those with Grade 1+ (or Level III) have scored between 851 and 900.
The lowest is Grade VII, which means a score between 0 and 550 points.

How have states performed this time?

In PGI 2019-20, no state or Union Territory could achieve the highest grade, that is Level I.
Even in the 2017-18 and 2018-19 editions, no state had reached Level 1 and Grade 1++.
Chandigarh, Punjab, Tamil Nadu, Andaman, Nicobar, and Kerala scored more than 90% and obtained Grade 1++ (or Level II), making them the best-performing states.
This is the first time that any state has reached Level II.
The top-performing states of Gujarat, Chandigarh, and Kerala in 2018-19 were given Grade 1+ (or Level III), which is a score between 851 and 900 points.
Only the UT of Ladakh has been placed in the lowest grade, Grade VII, but that’s because it was the first time it was assessed after it was carved out of Jammu and Kashmir in 2019.

What are the areas where the states still have to improve?

According to the report, states and UTs mainly need to improve their performance in terms of governance processes.
This domain carries several parameters, including teacher availability, teachers’ training, regular inspection, and availability of finances.
In the domain of Governance Processes, there are 24 States/UTs which have scored less than 288 (80% of the maximum possible score). It implies that this is the area many States and UTs must focus on.
The PGI too accords the highest importance to this Domain because compliance with the indicators here will lead to critical structural reforms in areas ranging from monitoring the attendance of teachers to ensuring transparent recruitment of teachers and principals.
The second area that requires attention is the Domain for Infrastructure and Facilities, where twenty States/UTs have scored less than 120 (80% of the maximum possible score in this domain).
Two States, Bihar (81) and Meghalaya (87) recorded the lowest scores in this domain.
This is a cause for concern as a proper school building with adequate facilities is a must to improve the overall quality of school education.

National Sickle Cell Anaemia Elimination Mission

Context: Prime Minister will attend a public programme in Shahdol on 5^th July, where he will launch the National Sickle Cell Anaemia Elimination Mission. He will also distribute sickle cell genetic status cards to the beneficiaries.

What is Sickle Cell Disease (SCD)?

Sickle cell disease is a group of inherited red blood cell disorders that affect hemoglobin, the protein that carries oxygen through the body.

Normally, red blood cells are disc-shaped and flexible enough to move easily through the blood vessels.
If you have sickle cell disease, your red blood cells are crescent- or “sickle”-shaped. These cells do not bend or move easily and can block blood flow to the rest of your body.

The blocked blood flow through the body can lead to serious problems, including stroke, eye problems, infections, and episodes of pain called pain crises. which significantly impacts their quality of life.

About SCDs:

Sickle cell disease is a lifelong illness.
There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin.
If the sickle cell is inherited from one parent, it is called sickle cell trait or sickle cell carrier. If inherited from both the parents, it is called sickle cell disease or sickle cell anemia (homozygous sickle cell).
Sickle cell disease exists in two forms within the human body.
- One is the Sickle Cell trait, in which the individual does not exhibit any disease or symptoms and lives a normal life.
- The second form is characterized by the presence of symptoms related to sickle cell disease.
If two individuals with Sickle Cell trait marry each other, there is a high probability that their child will have Sickle Cell disease.
- By screening individuals for Sickle Cell trait before marriage, the spread of the disease can be prevented.

Do You Know 💡

The United Nations recognises June 19 as World Sickle Cell Day to promote awareness on sickle cell anemia and other sickle cell disorders, which are rare diseases affecting people across the world.

SCDs in Tribal: A serious health challenge for India

As per Census 2011, India has an 8.6% tribal population which is 67.8 million across the Indian states. The MoHFW tribal health expert committee report has listed sickle cell disease as one of the 10 special problems in tribal heath that affect the tribal people disproportionately.

In 13 states of the country, namely Rajasthan, Gujarat, Madhya Pradesh, Chhattisgarh, Jharkhand, West Bengal, Odisha, Telangana, Andhra Pradesh, Tamil Nadu, Kerala, Karnataka, and Maharashtra, there is a high prevalence of this disease, and in four states of the country, namely Bihar, Assam, Uttarakhand, and Uttar Pradesh, there is a partial prevalence of sickle cell disease.
The prevalence of sickle cell carriers among different tribal groups varies from 1 to 40 per cent. Madhya Pradesh has the highest load.
In Maharashtra, the sickle gene is widespread in all the eastern districts, also known as the Vidarbha region, in the Satpura ranges in the north and in some parts of Marathawada. The prevalence of sickle cell carriers in different tribes varies from 0 to 35 per cent. The tribal groups with a high prevalence include the Bhils, Madias, Pawaras, Pardhans and Otkars.
In Gujarat, the Dhodia, Dubla, Gamit, and Naika tribes have a high prevalence of SCDs.
Tribal population in the Wayanad district of Kerala was screened, followed by genetic counselling where carriers were advised not to marry carriers.

Approaches to Tackle SCDs

Efforts are being made to eliminate Sickle Cell Anaemia through two approaches:

The first approach focuses on prevention, ensuring that new cases are not born.
The second approach involves managing the treatment and providing adequate healthcare facilities for individuals already affected by the disease.

Government efforts to tackle the problem of SCDs

Ministry of health under NHM initiated the work on hemoglobinopathies (Thalassemia & Sickle Cell Disease) in 2016 wherein comprehensive guidelines on prevention and management of heamoglobinopathies were released and provision of funds towards screening and management of Sickle cell disease were made.
The Ministry of Health, in collaboration with the Ministry of Tribal Affairs and the states, has formulated a plan to screen approximately 70 million individuals aged 0-40 years belonging to tribal and other groups residing in nearly 200 districts of 17 states within the next few years.

Sickle Cell Anaemia Elimination Mission 2047

Prime Minister, in the central Budget for the financial year 2023-24, announced the launch of the national campaign “Sickle Cell Anaemia Elimination Mission 2047” to eradicate the challenge of sickle cell.
The government has allocated a sufficient budget, utilised advanced technology, provided training to healthcare workers, ensured necessary infrastructure, and made efforts in social awareness and participation to combat this disease.
To implement this entire programme, monitoring mechanisms will be established at various levels to ensure participation and bring awareness on a large scale. Individuals identified with the disease through screening will undergo regular testing, receive treatment and medication, vaccinations for other diseases, get dietary support, and have access to timely counselling services.
A comprehensive ecosystem is being developed to ensure access to proper healthcare and management for Sickle Cell Anaemia patients.
A web portal has been created using digital technology to track and maintain a complete record of sickle cell patients.

Role of Ayushman Bharat in controlling SCDs

Through the Ayushman Bharat scheme, the country has established a network of 1.6 lakh Health and Wellness Centres since 2018, which has played a crucial role in combating epidemics like Covid19.

These centres will also play a significant role in eradicating sickle cell disease along with other diseases. Trained healthcare workers in these centers will provide better treatment for sickle cell patients.

The challenge of SCDs can also be addressed by:

Increasing awareness about the disease in the community.
Implementation of mass screening activities for early identification.
Building a strong network of diagnosis and linkages.
Implementing robust monitoring system.
Strengthening the existing primary health care mechanism to incorporate SCD related strategies.
Capacity building of primary, secondary and tertiary health care teams.
Building cost-effective intensive interventions at higher care facilities.

Conclusion

SCDs are commonly found among tribal communities in India. Indigenous Peoples help protect our environment, fight climate change, and build resilience to natural disasters, yet their rights aren’t always protected. SCDs pose a significant threat to the future and existence of our indigenous populations, and it is imperative to prevent the spread of this disease in a timely manner.

Rajasthan Govt: Policy for Denotified Tribes

Context: The Congress government in Rajasthan has initiated a move to prepare a policy for the denotified tribes ahead of this year’s Assembly election despite the fact that very few among them are registered as voters in the absence of any residential proof because of their nomadic lifestyle.

Aim of the government of Rajasthan

The policy will identify the modalities for extending the benefits of development and welfare schemes to these tribes.

'De-notified Tribes'

The term 'De-notified Tribes' stands for all those communities which were once notified under the Criminal Tribes Acts, enforced by the British government between 1871 and 1971. These Acts were repealed by the independent Indian Government in 1952, and these communities were "Denotified". A few of these communities which were listed as de-notified were also nomadic.
A National Commission for De-notified, Nomadic and Semi-Nomadic Tribes (NCDNT) was constituted in 2006 by the then government. It was headed by Balkrishna Sidram Renke and submitted its report in June 2008.
The Renke commission estimated their population at around 10.74 crore based on Census 2001. A new Commission constituted in February 2014 to prepare a state-wise list, which submitted its report on January 8, 2018, identified 1,262 communities as de-notified, nomadic and semi-nomadic.
Not all of these tribes are categorised under SC, ST and OBC. The standing committee report in Parliament has cited that 269 DNT communities are not covered under any reserved categories.

Issues / Challenges

Though the notified communities were often described as "Criminal Tribes", they were often treated as castes in traditional rural society. There were restrictions placed on marriage, access to village facilities and dining. While there are significant overlaps with the Scheduled Castes or Scheduled Tribes, these communities ore often treated differently by police and other authorities when it comes to crime. Despite 65 years elapsing since the repeal of the colonial era Criminal Tribes Act, the authorities still view many of these communities with suspicion.

ln independent India, despite attempts by previous governments to provide them with some avenues of growth and development by placing them in the same category as scheduled tribes, schedule castes and other backward communities, it has been incomplete at best and inadequate at worst.
They remain, in most cases, firmly placed of the lowest rung of the social hierarchy, often forcing the prejudices thot were created during Colonial rule.

Features

As is the case with most of the communities in lndia, large majority of De-notified and nomadic communities ore primarily patriarchal.
The De-notified, nomadic and semi-nomadic communities hove o very strong caste or tribal panchayat. The decisions pertaining to their domestic and social life ore negotiated in their Kulpanchayat (Caste Councils). The panchayat comprises of the village elders. Their laws (unwritten) ore respected and obeyed by everyone. Any violation of these conventions is dealt with seriously.
Being subdued in the social stratum, they were never treated with dignity. Likewise, their languages too were not recognized. Every subgroup of these communities has its own distinct language for intro-group communication.
The DNTs and NTs show great pride in their past. They try to survive on traditional patterns of livelihood. They have been into supply of goods and services to people in villages and towns, some were pastoral nomads while others were involved in a variety of occupations like entertaining people, fortune telling and practice of crafts.
The nomadic communities have been forced to adopt new means of livelihood abandoning their traditional occupations. Most of them become daily wage labourers; some migrated to cities like Delhi in search of work. Communities with traditional occupations of singing and playing instruments got opportunities to work in hotels and cafes in tourist places. But the fight for livelihood, land and shelter is common across all nomadic communities.
Behrupia, Banjara, Sapera, Van Gujjar and Birhors are some of the commonly known Denotified, Nomadic and Semi-nomadic communities.

Schemes for DNT

The Ministry of Social Justice and Empowerment is implementing the following schemes for the welfare of the DNTs.

Dr. Ambedkar Pre-Matric and Post-Matric Scholarship for DNTs : This Centrally Sponsored Scheme was launched for the welfare of those DNT students who are not covered under SC, ST or OBC.
Nanaji Deshmukh Scheme of Construction of Hostels for DNT Boys and Girls. This Centrally Sponsored Scheme is implemented through State Governments/ UT Administrations/ Central Universities. The aim of the scheme is to provide hostel facilities to those DNT students; who are not covered under SC, ST or OBC; to enable them to pursue higher education.
From the year 2017-18, the scheme "Assistance to Voluntary Organization working for the Welfare of Other Backward Classes (OBCs)" has been extended for DNTs and EBCs as "Central Sector Scheme of Assistance for Skill Development of Backward Classes (OBCs)/ De-notified, Nomadic and Semi-Nomadic Tribes (DNTs)/ Economic Backward Classes (EBCs).

Integrated Child Development Scheme(ICDS)

About ICDS

Launched in 1975, Integrated Child Development Scheme (ICDS) is a unique early childhood development programme.
It aims to address malnutrition, health and development needs of children (0 to 6 years), and pregnant and lactating mothers.
The Centrally Sponsored Scheme is anchored by the Ministry of Women and Child Development (MoWCD).
ICDS consists of 4 different components as shown in the following figure

hVETAOwg2tsSv6KPFI88bdHioVhzIPB5qYwplrGL7GRlAaYyBu51L9owIclV1PjYuV4AX4hDqNAJqIB1P fywAHn0828PRChMD0QMe1NEOyyPkm0P1yQIbYUkvYHGUKVuq94UhLecFtv BmVJODrFpY

The Anganwadi Services (under ICDS) is a Centrally Sponsored Scheme and the Government of India releases grants-in-aid to the States / UTs s presently on the following cost-sharing ratio between Centre and States/UTs:

EaOSG2Osvs nRUSfVBfPcJoyPc ZjjDwHdRg4JLQEn5WGrx

Objectives of the Scheme

Institutionalise essential services and strengthen structures at all levels:
- Implementing ICDS in Mission mode to prevent undernutrition
- Strengthen ICDS- AWC as the first village post for health, nutrition and early learning
- Focusing on children under 3 years
- Focusing on early child care and learning environment
- Moving from outlays to child-related outcomes
- Fostering decentralisation and community based locally responsive childcare approaches –
Enhance capacities at all levels:
- Vertical integration of training of all functionaries to strengthen field-based joint action and teamwork to achieve desired results and objectives
- Establish national training resources centres at Central & State levels
Ensure appropriate inter-sectoral response at all levels:
- Ensure convergence at the grassroots level by strengthening partnerships with PRIs, Communities, and Civil Societies to improve Child development services
- Coordinate and network with all Government & Non- Government Organisations providing services for children
Raise public awareness and participation:
- Strengthen maternal and child care, nutrition and health education
- Raise public awareness at all levels about the vulnerabilities of children
- Inform beneficiary groups and the public about the availability of core services
- Promote social mobilisation and voluntary action
Create a database and knowledge base for Child development services:
- Strengthen ICDS Management Information System (MIS)
- Use Information, Communication Technology (ICT) to strengthen the information base and share & disseminate information
- Undertake Research and Documentation

Convergence of Different Ministries & Schemes

The Ministries involved in convergence with ICDS are given in the figure below

mVMvgUBd4gblH7Aaz4EJaHwjCaSUZ6X3q0SzSCBJ1EnuT y7gtg7oCkOFUEJLUXvILIN7aW0waUhRgKKzsSjO4Vez0AwPrgY0cYHPIQiNNS5MG0T Q8MYf9 KujFZfft

Issues associated with ICDS

Poor Utilisation of Services: as per NFHS 3, only 32.9% of children used any AWC services. Only 26.5% of children had received Supplementary Nutrition and only 12% regularly received it.
Inadequate Anganwadi workers: most of the Anganwadi centres are being handled by only one Anganwadi worker
Pooer infrastructure: A disconcerting 2.5 lakh centres operate without functional sanitation facilities and 1.5 lakh centres lack access to potable water. Approximately 4.15 lakh Anganwadi centres do not possess their own pucca building.

Way forward

Two worker norm for each Anganwadi centre
Improve reporting mechanism
Abn packaged food for the 3-6 year group
Increase the involvement of Panchayats/mothers’ group
Grading AWCs
Learn from the international experience of Thailand which succeeded in improving child nutrition between 1980 and 1988 and reduced child malnutrition (underweight) from 50 per cent to 25per cent.

Life Style Disorders

Context: Recently the medical journal Lancet launched its study on Diabetes and Endocrinology that reveals that more than a tenth of the people in the country have diabetes, 35 per cent have hypertension and 28 per cent have high cholesterol levels.

What is a lifestyle disorder?

Lifestyle diseases can be defined as diseases linked to one's lifestyle. These diseases are non-communicable diseases.

Causes of Lifestyle Disorder

They are caused by lack of physical activity, unhealthy eating, alcohol, substance use disorders and smoking tobacco, which can lead to heart disease, stroke, obesity, type II diabetes and lung cancer.
These studies have pointed out that lifestyle-related disease is aggravated by poor awareness, especially in rural areas.

Who is more affected by Lifestyle disorders?

Several studies have shown that close to 20 per cent of diabetics in the country are below the age of 45 and nearly 45 per cent of the people with the disease are not senior citizens.
The burden of these disorders is higher in urban areas. But people in rural centres are increasingly becoming vulnerable to metabolic diseases, especially diabetes.
There is, for instance, almost no rural-urban divide when it comes to pre-diabetes — more than 60 per cent of pre-diabetic people in India end up having the disease.
The study’s warning that the country’s already serious diabetes burden could take a turn for the worst in the next five years should be taken seriously by the country’s healthcare sector.

Consequences of lifestyle disorder

In 2005, the World Health Organization (WHO) estimated that 61 per cent of all deaths -35 million and 49 per cent of the global burden of disease were attributable to chronic diseases.
By 2030, the proportion of total global deaths due to chronic diseases is expected to increase to 70 per cent and the global burden of disease to 56 per cent.
The Havard School of public health estimated that NCDs are responsible for a loss of 6.2 trillion US dollars between the period 2012-30.

Nutrition of adolescent girls in India

Context: The findings of the National Family Health Survey-5 (2019-21) show that 59.1% of adolescent girls were anaemic. The NFHS-4 numbers also reported over 41.9% of school-going girls as underweight, numbers showcase a worrying trend.

Health of adolescent girls

Adolescence is the phase of life between childhood and adulthood, from ages 10 to 19.
It is a pivotal period of rapid physical, cognitive and psychosocial growth. This affects how they feel, think, make decisions, and interact with the world around them.
It is a significant indicator of women’s labour force participation in India in the long term, as better nutrition improves every young girl’s prospect to participate in productive activities
Adolescent girls are particularly vulnerable to undernutrition and anaemia due to the onset of menstruation.
Growth retardation is one of the most important health concerns for adolescents.

Recommended dietary allowances of nutrients for adolescents in India:

OzNG1UQWfIDmOKl72V1KBVEfIlO1w3Ly8HTf01Sx86Dp8LIUb5aJTHVUvVt8 GY 5cPqep1ZPdeghZbuqFB3PuPwcujCM4Z8nNtXw1GSlX7VU7yaTCrLIolBkL9p7Fr ORnH8n1yJKn4RISCnKogpw

Reason for nutritional deficiencies in adolescent girls

Gender Discrimination: Environmental conditions to cultural norms that lack a gender-neutral environment within a household, affect the nutrition uptake in adolescent girls.
Poverty: Families with limited financial resources may struggle to provide an adequate diet for all family members, and girls may be disproportionately affected.
Limited Access to Healthcare: Lack of access to quality healthcare services, including prenatal care and postnatal support, can contribute to nutritional deficiencies in girls. Malnourished mothers are more likely to give birth to undernourished babies, perpetuating the cycle of malnutrition.
Early Marriage and Pregnancy: In some parts of India, girls are married off at a young age, which can lead to early pregnancies. Adolescent girls who become mothers before their bodies are fully developed are at a higher risk of malnutrition, as their bodies may not be able to adequately support both their own growth and the growth of their infants.
Social and Cultural Factors: Traditional beliefs and practices, such as restrictions on food intake for girls and women, can further exacerbate nutritional deficiencies. For example, the practice of excluding certain foods from women's diets during menstruation may result in inadequate nutrient intake.
Lack of Nutritional Knowledge: Lack of education and information about balanced diets, food preparation, and utilization of available resources can hinder the improvement of nutritional status. For example, bad cooking habits like over boiling vegetables and straining water, removing the husk from wheat, eating polished rice and straining rice water, etc.
Hookworm infestation: It is a parasitic infection and resides in the small intestine. It can cause significant nutritional deficiencies. They attach to the intestinal lining and consume blood, leading to chronic blood loss and iron deficiency anaemia. This can impair the body's ability to absorb nutrients, resulting in malnutrition and stunted growth, particularly in children.

Consequences of nutritional deficiencies in adolescent girls

Malnutrition: It can lead to stunted growth, weakened immune system, increased susceptibility to infections, and higher mortality rates.
Impaired Cognitive Development: Essential nutrients like iron, iodine, vitamin A, and zinc, can impair cognitive development and lead to learning disabilities, reduced attention span, and decreased intellectual capabilities. This can have long-term effects on educational attainment and economic productivity.
Increased Disease Burden: Nutritional deficiencies weaken the immune system and make adolescents more vulnerable to various diseases and infections. For example, vitamin A deficiency increases the risk of blindness and susceptibility to infectious diseases like measles. Iron deficiency can lead to anaemia.
Reproductive Health Problems: Nutrient deficiencies, particularly of iron and folate, can increase the risk of menstrual irregularities, and heavy or prolonged periods, and even affect fertility in the long term.
Economic Implications: Undernourished adolescent girls are also at a higher risk of chronic diseases and pregnancy complications, which can lead to a higher healthcare burden on both families and communities, potentially leading to financial instability and increased poverty.

Government initiatives to address nutritional deficiencies

Scheme for Adolescent Girls (SAG): This scheme is for adolescent girls of the age group 11-14 years to facilitate, educate and empower Adolescent Girls and to break the intergenerational life cycle of nutritional and gender disadvantage.
Rashtriya Kishor Swasthya Karyakram (RKSK): For adolescent participation and leadership, equity and inclusion, gender equity, and strategic partnerships with other sectors and stakeholders. The programme envisions enabling all adolescents in India to realise their full potential by making informed and responsible decisions related to their health and well-being.
Targeted and regionally contextualised Social and Behaviour Change Communication (SBCC) efforts around adolescent girls’ nutrition are sure to generate greater demand and the adoption of good practices of foods.
Integrated Child Development Services (ICDS): The ICDS is a centrally sponsored scheme that aims to provide a package of services, including supplementary nutrition, immunization, health check-ups, and referral services, to pregnant women, lactating mothers, and children up to 6 years of age. Adolescent girls are also included in the program to ensure adequate nutrition during this critical stage.
National Nutritional Anaemia Prophylaxis Program (NNAPP): This program focuses on preventing and controlling iron-deficiency anemia among vulnerable groups, including adolescent girls. It provides weekly iron and folic acid supplementation to girls aged 10-19 years, along with health and nutrition education.
National Deworming Day: The National Deworming Day on February 10 is an initiative aimed at deworming all children and adolescents in the country to prevent worm infestation and improve overall health. Adolescent girls are an important target group for this program.

Way forward

Routine training of health workers for effective implementation and monitoring of various schemes.
Implement comprehensive nutrition education programs in schools and communities that specifically target adolescent girls. Teach them about balanced diets, essential nutrients, and healthy eating habits. This can be integrated into the school curriculum or delivered through community health workers.
Nutritious school meals: Enhance the quality of mid-day meals provided in schools to ensure they meet the nutritional needs of adolescent girls. Include a variety of nutrient-rich foods like fruits, vegetables, pulses, and whole grains.
Conduct nutrition-focused workshops, cooking demonstrations, and awareness campaigns to empower families and communities to make informed choices regarding their nutrition.
Focus on addressing gender disparities that affect nutrition, such as unequal access to food, resources, and education.
Regular data collection and analysis can help track progress, identify gaps, and inform evidence-based decision-making for future interventions.

Investing in girls’ nutrition is not only a moral obligation of the state but also an economic one, with potential returns in the form of greater and more sustainable economic growth of the nation. The strength of a nation is measured by its ability to nurture its future generations. There is a need for effective convergence and collaboration among all the relevant departments, to sow the seeds of a healthier, stronger India, where every girl can reach her full potential.

Minimum Income Guarantee Bill

Provision of the bill

MGNREGA as a Right based approach of entitlement

Benefits of MGNREGA over Cash transfer

Global Cases of social welfare programme

Way Forward

Different types of Poverty

Absolute Poverty

Relative Poverty

Situational Poverty

Generational Poverty

Subjective Poverty

Different Methods of measuring Poverty

Head Count Ratio or Poverty Ratio

Multi-dimensional Poverty

Causes of improvement

Current status of MPI in India

Way Forward

Demographic transition

India’s Demographic transition

Dynamics of Male Child in India

Impact of declining fertility on Women’s life

How early marriage and aging impacts Women’s empowerment?

Practical strategies to harness Gender Dividend:

About Palliative care

Need for palliative care

Steps taken by the government:

Gaps in the guidelines

Way Forward:

India’s Progress on Population Front

Issue of Lack of Physical/Reproductive Autonomy

Advantages of Physical/Reproductive Autonomy

The way forward

How is PGI worked out?

What does the grading system reflect?

How have states performed this time?

What are the areas where the states still have to improve?

What is Sickle Cell Disease (SCD)?

About SCDs:

SCDs in Tribal: A serious health challenge for India

Approaches to Tackle SCDs

Government efforts to tackle the problem of SCDs

Sickle Cell Anaemia Elimination Mission 2047

Role of Ayushman Bharat in controlling SCDs

Conclusion

About the scheme

Aim of the government of Rajasthan

'De-notified Tribes'

Issues / Challenges

Features

Schemes for DNT

About ICDS

Objectives of the Scheme

Convergence of Different Ministries & Schemes

Issues associated with ICDS

Way forward

What is a lifestyle disorder?

Causes of Lifestyle Disorder

Who is more affected by Lifestyle disorders?

Consequences of lifestyle disorder

Health of adolescent girls

Recommended dietary allowances of nutrients for adolescents in India:

Reason for nutritional deficiencies in adolescent girls

Consequences of nutritional deficiencies in adolescent girls

Government initiatives to address nutritional deficiencies

Way forward

Trending now