TAG: GS 3: SCIENCE AND TECHNOLOGY

THE CONTEXT: Twenty-three States have consented to participate in the BCG revaccination study in adults that will be undertaken in a “programme implementation study mode” to evaluate the effectiveness of the vaccine in reducing TB disease incidence.

EXPLANATION:

• The initiative to conduct a BCG (Bacille Calmette-Guérin) revaccination study in adults has stirred considerable discussion and debate due to the absence of comprehensive clinical trials in the country.
• The study aims to assess the effectiveness of the BCG vaccine in reducing Tuberculosis (TB) disease incidence, primarily targeting high-risk groups such as individuals older than 50 years, those with prior TB disease, underweight adults, diabetics, smokers, and alcohol consumers.

Lack of Prior Clinical Trials in India:

• India has not conducted clinical trials to ascertain the efficacy of BCG revaccination in adults for preventing TB disease.
• However, two clinical investigation studies by St. John’s Research Institute in Bengaluru have indicated the significant immunogenicity of BCG revaccination in adults.

Expert Committee Recommendations and Government Approach:

• An expert committee, including formerly of the WHO, recommended a comprehensive trial before implementation at the population level.
• Nevertheless, the Indian government has chosen a program implementation study over a clinical trial due to concerns regarding the lengthy trial process.
• This approach involves using some districts as intervention arms and others as control arms to capture TB incidence over a couple of years.

WHO’s Standpoint on BCG Revaccination:

• The WHO currently does not advocate for programmatic or pilot BCG revaccination, even in high TB burden countries like India.
• Their 2018 BCG vaccine position paper emphasizes that repeat BCG vaccination shows minimal or no additional benefit against TB or leprosy.

Challenges and Limitations of Previous Studies:

• The protective effect of a single dose of BCG vaccine given to infants in India wanes within a short time.
• The Chingleput BCG revaccination study in 1968, involving a small sub-group, indicated a 36% efficacy in reducing TB incidence after 15 years, but this study had limitations in sample size and knowledge gaps about confounding factors.

Proposed Methodology and Participating States:

• The study intends to follow a phase 4-like pragmatic evaluation by earmarking districts in participating states as intervention and control arms.
• States such as Uttar Pradesh, Madhya Pradesh, and Tamil Nadu have agreed to participate.
• Tamil Nadu planned to study lakhs of consenting participants and closely monitor a few thousand individuals for vaccine efficacy over two to three years.

Challenges Faced by Non-Participating States:

• Some states like Kerala, Bihar, Chhattisgarh, West Bengal, and Uttarakhand have chosen not to participate in the study due to field constraints and existing gaps in their immunization programs, which could overburden the staff involved.
• In essence, the BCG revaccination study in adults across various Indian states represents a shift from the usual clinical trial method to a program implementation study mode.
• This approach aims to evaluate the effectiveness of BCG revaccination in high-risk groups despite the reservations and recommendations from global health authorities like the WHO.

BCG VACCINE:

• Bacillus Calmette-Guerin (BCG) is the live attenuated vaccine form of Mycobacterium bovis used to prevent tuberculosis and other mycobacterial infections.
• The vaccine was developed by Calmette and Guerin and was first administered to human beings in 1921.
• BCG is the only vaccine against tuberculosis.
• It is the most widely administered vaccine and usually a part of the routine newborn immunization schedule.
• BCG vaccine also offers protection against non-tuberculous mycobacterial infections like leprosy and Buruli ulcer.

SOURCE: https://www.thehindu.com/sci-tech/bcg-revaccination-study-in-high-risk-adults-to-begin-in-23-states/article67594580.ece/amp/

THE CONTEXT: The Covid-19 pandemic has shown the inadequacies of the healthcare provisions in India which once again created a debate on Universal Health Care (UHC). There are many approaches to providing the UHC to the people of a country and Healthcare as an optional public service (HOPS) is one of them. This article examines the benefits and challenges of HOPS in providing a UHC.

NOTE: For the purpose of our discussion, Universal Health Coverage and Universal Health Care are used interchangeably.

ALL YOU NEED TO KNOW ABOUT UNIVERSAL HEALTH CARE?

DEFINITION: 

• According to WHO, Universal Health Coverage means that all people have access to the health services they need, when and where they need them, without financial hardship.
• It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
• The basic idea of UHC is that no one should be deprived of quality health care for the lack of ability to pay.

NEED:

• Currently, at least half of the people in the world do not receive the health services they need.
• About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health.
• This must change.

THE INDIAN SCENARIO:

• India has one-of-the highest levels of Out-Of-Pocket Expenditures (OOPE) contributing directly to the high incidence of catastrophic expenditures and poverty, notes the Economic Survey.
• It suggested an increase in public spending from 1% to 2.5-3% of GDP — as envisaged in the National Health Policy 2017 — can decrease the OOPE from 65% to 30% of overall healthcare spending.
• The Survey observes that the health of a nation depends critically on its citizens having access to an equitable, affordable, and accountable healthcare system.
• Public and private expenditures on healthcare in India do not exceed 5.5% of its GDP.

MODES OF UHC:

• UHC generally relies on one or both of two basic approaches: public service and social insurance. But there is another approach that aims to leverage the strength of both while minimising the limitations. (Read Ahead).

TEN PRINCIPLES OF UHC IN INDIA

THE PREVAILING ROUTES TO THE UHC

PUBLIC SERVICE:

• Health care, like the services of a fire department or a public library, is offered as a free public service.
• Surprisingly, this socialist vision has been successful not only in communist countries like Cuba but also in capitalist ones (well beyond the United Kingdom).
• Britain’s National Health Service (NHS) which is the best example of this genre, is free at the point of use for anyone who is a UK resident.
• Healthcare is provided by a single-payer – the British government – and is funded by the taxpayer although there are multiple providers.
• All appointments and treatments are free to the patient (though paid for through taxes), as are almost all prescription drugs.
• Responsibility for health services is devolved to local boards or trusts.
• These local units directly manage or contract services in their communities. Britain spends 9.9% of its GDP on the NHS.

SOCIAL INSURANCE:

• This method provides for both private and public health care.
• But the expenses are borne mostly by the social insurance fund(s), rather than the patient.
• Everyone has access to high-quality health care.
• A social insurance market is not the same as a private insurance market.
• The most basic version is one in which insurance is mandatory and universal.
• It is funded mostly by general taxation and administered by a single public-interest non-profit organisation.
• That’s how it works in Canada (at least in some provinces) and to varying degrees in other nations with “national health insurance” (e.g., Australia and Taiwan).
• This single-payer system makes it easier for the state to negotiate with healthcare providers for a decent price.
• However, various countries have different social models.

WHAT ARE THE CHALLENGES IN BOTH THE APPROACHES?

PUBLIC SERVICE:

• Providing free public health care to all will put a huge financial burden on the exchequer.
• The capacity of public health infrastructure in the country is hugely inadequate.
• There is a severe shortage of human resources in the health sector including medical, paramedical, and other staff as pointed out by the National Health Policy-2017.
• The profit-private healthcare system is highly developed and too entrenched in India. And hence, it is too costly to displace it.

SOCIAL INSURANCE:

• In the absence of public health centers, there is a danger of patients rushing to expensive hospitals every other day.
• This would make the system wasteful and expensive.
• Containing costs is a major challenge with social insurance because patients and healthcare providers have a joint interest inexpensive care — one to get better, the other to earn.
• Expanding social insurance to commercial healthcare providers is especially dangerous given their power and influence
• Another challenge with social insurance is to regulate for-profit private healthcare providers.

WHAT IS INDIA’S APPROACH TO UHC AS OF NOW?

Ayushman Bharat is National Health Protection Scheme, which covers over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization the most important strategy for a UHC.  Ayushman Bharat – National Health Protection Mission subsumes the ongoing centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private impaneled hospitals across the country. It is an entitlement-based scheme with entitlement decided based on deprivation criteria in the SECC database. Also, there is a Primary Health Infrastructure system in place that caters to a wide range of medical health needs although there is a huge state-wide disparity in its reach and quality. There are also state-level medical insurance schemes and departmental medical facilities including defence, railways, etc.

HEALTHCARE AS AN OPTIONAL PUBLIC SERVICE(HOPS)- THE WAY FORWARD FOR THE UHC IN INDIA

WHAT ARE HOPS?: 

• It is a framework for UHC that is based primarily on health care as a public service, with the potential to eventually converge toward some kind of NHS.
• Everyone would have the legal right to access free, high-quality health care at a public facility if they so desired. It would not restrict someone from seeking private health care on their own expenses.
• The public sector, on the other hand, would provide adequate health care to everyone as a matter of right and at no expense.

HAS IT BEEN PRACTICED IN INDIA?:

• This is something that some Indian states are already attempting. Most ailments can be properly treated in the public sector in Kerala and Tamil Nadu, for example, at a low cost to the patient.
• A vibrant private sector exists as well, which needs better regulation.
• However, as an optional public service, everyone has access to adequate health care.

ARE HOPS TRULY EGALITARIAN?:

• HOPS is not as egalitarian as the NHS and the National Health Insurance model as those with the means can access private healthcare. However, it will still be a big step toward UHC.
• Moreover, as the public sector offers an increasingly wide range of medical services, it can become more egalitarian over time.
• If quality medical care is available free of charge in the public sector, most patients have little reason to rely on the private sector.

ROLE OF SOCIAL INSURANCE IN HOPS: 

• It can cover medical procedures that are not readily available in the public sector and thus can play a limited role in this framework.
• Social insurance needs to be built around public and non-profit private healthcare.

WHAT ARE THE DIFFICULTIES WITH HOPS?:

• Difficult to specify the scope of the proposed healthcare guarantee, including quality standards.
• UHC does not mean unlimited health care: there are always limits to what can be guaranteed to everyone.
• Not only does HOPS need health standards, but it also needs a reliable way to revise those standards over time.
• Some useful items are already available like the Indian Public Health Standards.
• But a major challenge is administrative and operational which do not have easy answers.

RIGHT TO HEALTH BILL- THE TAMIL NADU WAY FOR HOPS

Tamil Nadu is in a good position to achieve HOPS under the proposed Health Rights Bill. Tamil Nadu can already effectively provide most public-sector medical services.

According to the 4th National Family Health Survey, the majority of households in Tamil Nadu are going to the public sector for medical care in the event of illness. The scope and quality of these services have steadily improved over time. The proposed Health law is very supportive of the state’s commitment to quality medical care for all. The Bill seeks to cover all age groups and include people with disabilities and mental illnesses. It enables patients and their families to demand quality service and helps further improve the system. It will serve as a model and inspiration for all Indian states.

THE CONCLUSION: Healthcare provision in India faces many challenges and it requires multiple interventions. A good beginning can be ensuring a legal right to health in the nature of HOPS. Although not devoid of challenges, HOPS can provide “hopes” to the millions who are outside the formal medical care system.

QUESTIONS:

1. What do you understand by Healthcare as an Optional Public Service? Explain.
2. No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means. Hence, a fully publicly funded healthcare system is required. Elaborate

THE CONTEXT: Recently in March 2022, the concerns have been raised that consumers may have to pay more for medicines and medical devices if the National Pharmaceutical Pricing Authority (NPPA) allows a price hike of over 10% in the drugs and devices listed under the National List of Essential Medicines (NLEM). The following article explains everything about the pricing of essential drugs in India.

WORKING OF PRICING MECHANISM

• All medicines under the NLEM are under price regulation. The NLEM lists drugs used to treat fever, infection, heart disease, hypertension, anemia, etc, and includes commonly used medicines like paracetamol, azithromycin, Cardiac Stents, Knee implants, etc.
• The Health Ministry prepares a list of drugs eligible for price regulation, following which the Department of Pharmaceuticals incorporates them into Schedule 1 of DPCO.
• The Standing Committee on Affordable Medicines and Health Products (SCAMHP) will advise the drug price regulator the National Pharmaceutical Pricing Authority (NPPA) on vetting the list. The NPPA then fixes the prices of drugs in this Schedule.
• As per the Drugs (Prices) Control Order 2013, scheduled drugs, about 15% of the pharma market, are allowed an increase by the government as per the WPI (Wholesale Price Index) while the rest 85% are allowed an automatic increase of 10% every year.
• The annual change in prices of scheduled drugs is controlled and rarely crosses 5%.
• Under the Drugs and Cosmetics Act 1940, the drugs are classified in schedules, and regulations are laid down for their storage, display, sale, dispensing, leveling, prescribing, etc.

Essential Medicines List:

• As per the World Health Organisation (WHO), Essential Medicines are those that satisfy the priority health care needs of the population. The list is made with consideration of disease prevalence, efficacy, safety, and comparative cost-effectiveness of the medicines.
• Such medicines are intended to be available in adequate amounts, inappropriate dosage forms, and strengths with assured quality. They should be available in such a way that an individual or community can afford them.

National List of Essential Medicines of India:

• The WHO EML is a model list, the decision about which medicines are essential and remains a national responsibility based on the country’s disease burden, priority health concerns, affordability concerns, etc.
• Ministry of Health and Family Welfare, Government of India hence prepared and released the first National List of Essential Medicines of India in 1996 consisting of 279 medicines. This list was subsequently revised in 2003, 2011, and 2021.

ABOUT THE NATIONAL PHARMACEUTICAL PRICING AUTHORITY

The National Pharmaceutical Pricing Authority (NPPA) is a government regulatory agency that controls the prices of pharmaceutical drugs in India. It was constituted by a Government of India Resolution dated 29th August 1997 as an attached office of the Department of Pharmaceuticals (DoP), Ministry of Chemicals and Fertilizers as an independent regulator for pricing of drugs and to ensure availability and accessibility of medicines at affordable prices with Headquarter at New Delhi, India.

Drugs (Prices) Control Order 2013:

• The Drugs Prices Control Order is an order issued by the Government of India under Sec. 3 of Essential Commodities Act, 1955 to regulate the prices of drugs.
• The Order provides the list of price-controlled drugs, procedures for fixation of prices of drugs, method of implementation of prices fixed by Govt., penalties for contravention of provisions, etc.
• For the purpose of implementing provisions of DPCO, powers of Govt. have been vested in NPPA.
• The DPCO 2013 contains more than 600 scheduled drug formulations spread across 27 therapeutic groups. However, the prices of other drugs can be regulated, if warranted in the public interest.

KEY FUNCTIONS OF NPPA

NPPA INITIATIVES

• The National Pharmaceutical Pricing Authority (NPPA) is headquartered in New Delhi and to increase its reach across the country, NPPA has set up a Price Monitoring and Resource Unit (PMRU) in the various Indian States and Union Territories.
• These PMRUs have been set up under the Consumer Awareness, Publicity, and Price Monitoring (CAPPM) scheme.
• As of March 2022, there are 23 states/UTs with the most recent addition of Himachal Pradesh on 23^rd March 2022 as the 23rd Price Monitoring and Resource Unit (PMRU). The pharmaceutical authority aims to set up a price monitoring unit in each and every state and union territory across India.

SIGNIFICANCE OF NPPA

• It is important to fix the prices of certain important drugs so that they are affordable and accessible to every citizen of the county and the National Pharmaceutical Pricing Authority ensures the same.
• It mandates that no supplier can sell a drug for more than its Maximum Retail Price (MRP).
• NPPA also played a crucial role during the pandemic time in the country by either fixing or regulating the prices of essential drugs and devices.

 AN ANALYSIS OF THE ISSUE

• The pharma lobby is asking for at least a 10% increase for scheduled drugs too rather than going by the WPI. Over the past few years, input costs have flared up and one of the reasons being 60%-70% of the country’s medical needs, are dependent on China.
• NPPA has been receiving applications for upward price revision under para 19 of DPCO, 2013, for the last two years citing reasons like “increase in Active Pharmaceutical Ingredient – API (key ingredient) cost, increase in the cost of production, exchange rates, etc. resulting in unavailability in sustainable production and marketing of the drugs.
• India is dependent on China for over 60% of its API requirement; higher API costs for price-controlled medicines reduce profits and sometimes even make the production of these drugs unviable in India.

THE WAY FORWARD

• We all are aware of the shortage of Remdevisir injections in May 2021 and black marketing and hoarding which led to skyrocketing prices. In this context, Bombay HC has asked the Centre to include Remdesivir in the list of Scheduled Drugs and regulate its price. Such steps should be proactively taken by the government with the foresight of emerging situations.
• The interests of pharmaceutical companies shall not be put ahead of the lives of ordinary citizens. As of 23^rd March 2022, only 14% of people in low-income countries have received at least one vaccine dose against COVID-19. India and South Africa have thus, taken a firm position that when lives are at stake, such essential products should be treated as global public goods and IPRs under TRIPS Agreement must be waived.
• NPPA shall also revise the list of essential medicines at short and regular intervals to have a positive impact on the availability and rational use of medicines.
• In the longer term, India needs to build capabilities to manufacture the key ingredients for these medicines.

THE CONCLUSION: Having an Essential Medicines List (EML) results in a better quality of medical care, better management of medicines, and cost-effective use of health care resources. This is especially important for a resource-limited country like India. The decision is to ensure, that life-saving essential drugs remain available to the general public at all times. To avoid a situation where drugs become unavailable in the market and the public is forced to switch to costly alternatives this is the first time the NPPA, known to slash prices of essential and life-saving medicines, is increasing prices in the public interest.

MAINS QUESTIONS:

1. Elaborate on the role of the National Pharmaceutical Pricing Authority (NPPA) in ensuring the availability of life-saving essential drugs to the general public at all times.

THE INTRODUCTION: The need for a strong and resilient social infrastructure became even more important during the ongoing COVID-19 pandemic that brought into focus the vulnerabilities in social infrastructure across countries. Specifically, the pandemics posed the challenge of balancing livelihoods while saving lives. To save lives and livelihoods amidst the COVID crisis, countries have adopted various strategies. India, the country with the second-largest population and a large elderly population, adopted a multi-pronged approach. The government’s response through ‘Aatmanirbhar Bharat Abhiyan’ packages and other sector-specific initiatives have provided the necessary support to mitigate the adverse impact of a pandemic. This chapter gives a brief account of India’s response to Social Infrastructure and Employment.

INDIA’S HEALTH RESPONSE TO THE COVID-19

Like most other countries, India also faced two COVID-19 waves: the first in 2020 and the second in 2021. To save lives, the Government adopted a multi-pronged approach viz.

1. Restrictions/partial lockdowns,
2. Building capacity in health infrastructure,
3. COVID-19 appropriate behavior, testing, tracing, treatment
4. Vaccination drive.

COVID VACCINATION STRATEGY

• Guided by scientific and epidemiological evidence, World Health Organisation (WHO) guidelines, and global best practices, India’s National COVID Vaccination Program has been one of the world’s largest vaccination programs.
• Government of India procured 75 percent of monthly vaccine production and provided it free to States and UTs, while the rest could be procured by private hospitals.
• Availability of Vaccine: The ICMR funded the clinical trials of the COVISHIELD vaccine developed in collaboration with Oxford – Astra Zeneca. COVISHIELD and COVAXIN have been widely used vaccines in India. Every month about 250- 275 million doses of COVISHIELD and 50-60 million doses of COVAXIN have been produced.
• Pricing and equity: At all Government COVID-19 Vaccination Centres (CVCs), the COVID-19 vaccine was made available free of cost for all eligible citizens.
• Coverage: From 1st May 2021, all 94 crore persons of age 18 years and above, were made eligible for COVID vaccination. From 3rd January 2022, COVID-19 vaccine coverage has been extended to the age group of 15-18 years. Till 19th January 2022, 3.73 crore youngsters between 15-18 age group have been vaccinated with 1st dose of COVID-19 vaccine covering more than 50 percent of youngsters.
• Vaccine hesitancy: To reduce vaccine hesitancy, the Government made efforts that include awareness by identified experts. From 3rd November 2021, a campaign, ‘Har Ghar Dastak’, has been initiated to identify and vaccinate those who missed 1st dose and are due for 2nd dose through house-to-house mobilization activity.
• Technology-driven: Arogya Setu mobile app was launched to enable people to assess the risk of their catching the COVID-19 infection.
• Vaccination Progress: As of 16th January 2022, a total of 156.76 crore doses of COVID-19 vaccines have been administered: 90.75 crores first dose and 65.58 crores second dose.

Population vaccinated by country (in percent)

TRENDS IN SOCIAL SECTOR EXPENDITURE

• Government’s spending on social services increased significantly during the pandemic. In 2021-22 (BE), Centre and State governments earmarked an aggregate of ` 71.61 lakh crore for spending on the social service sector; an increase of 9.8 percent over 2020-21.
• Last year’s (2020-21) revised expenditure has also gone up by ` 54,000 crores from the budgeted amount. In 2021-22 (BE), funds to the sector increased to 8.6 percent of Gross Domestic Product (GDP) (8.3 percent in 2020-21).
• During the last five years, social services accounted for about 25 percent of the total Government expenditure (Centre and States taken together). In 2021-22 (BE), it was 26.6 percent.
• Expenditure in the health sector increased from ` 2.73 lakh crore in 2019-20 (pre-COVID-19) to ` 4.72 lakh crore in 2021-22 (BE), an increase of nearly 73 percent.
• Union Budget 2021-22, announced Ayushman Bharat Health Infrastructure Mission, a new Centrally Sponsored Scheme, with an outlay of about ` 64,180 crores in the next five years to develop capacities of primary, secondary, and tertiary care Health Systems
• Union Budget 2021-22 provided an outlay of Rs 35,000 crore towards COVID-19 vaccination.
• The National Health Policy, 2017 envisaged increasing the government’s health expenditure to 2.5 percent of GDP by 2025.

EDUCATION

• During initial COVID-19 restrictions, as a precautionary measure to protect the students from COVID-19, schools, and colleges were closed across India. This posed a new challenge for the Government in terms of continuity of education.
• School Infrastructure An assessment for the pre-pandemic year of 2019-20 for which data is available reveals that the number of recognized schools & colleges continued to increase between 2018-19 and 2019-20, except for primary & upper primary schools.

SCHOOL INFRASTRUCTURE

• An assessment for the pre-pandemic year of 2019-20 for which data is available reveals that the number of recognized schools & colleges continued to increase between 2018-19 and 2019-20, except for primary & upper primary schools.

• Toilets (girls or boys), drinking water, and hand-washing facilities are now available in most Government schools (10.32 lakh).
• Priority to drinking water and sanitation in schools under Jal Jeevan Mission, Swachh Bharat Mission as well as under Samagra Shiksha Scheme has been instrumental in providing required resources and creating these assets in schools.
• As of 19.01.2022, under Jal Jeevan Mission 8,39,443 schools were provided a tap water supply.
• Availability of teachers, measured by Pupil-Teacher Ratio, an indicator whose decrease signals improvement in quality of education, has improved at all levels continuously from 2012-13 to 2019-20: from 34 to 26 at primary, 23 to 18 at upper primary, 30 to 18 at secondary, and 39 to 26 at the higher secondary level.

Schools with Basic Facilities

SCHOOL ENROLMENT

• In 2019-20, 26.45 crore children were enrolled in schools. During the year, schools enrolled about 42 lakh, additional children, out of which 26 lakh were in primary to higher secondary levels and 16 lakh were in pre-primary as per the Unified District Information System for Education plus (UDISE+) database.
• The enrollments increased across all levels viz., upper-primary, secondary, and higher secondary, except for the primary level. At the primary level, enrollment reduced from 13.5 crores in 2012-13 to 12.2 crores in 2019-20. This decline in enrollment was because of a decline in the total number of children in the age group 6-10 years.

 School Gross Enrollment Ratios in India (in percent)

SCHOOL DROP-OUT

• the years 2019-20 saw a decline in dropout rates at primary, upper-primary, and secondary levels. In 2019-20, the school dropout rate at the primary level declined to 1.45 percent from 4.45 percent in 2018-19.
• ASER found that despite the pandemic, enrollment in the age cohort of 15-16 years continued to improve as the number of not enrolled children in this age group declined from 12.1 percent in 2018 to 6.6 percent in 2021.

Major Initiatives for Students during the COVID-19 pandemic

PM e-VIDYA: Major components

• One Nation, One Digital Education (DIKSHA) Platform
• One Class, One TV channel through Swayam Prabha TV Channels
• Extensive use of Radio, Community Radio, and Podcasts
• One DTH channel is being operated specifically for hearing impaired students in sign language.

National Digital Education Architecture (NDEAR): A digital infrastructure for Education, was launched on 29th July 2021.

Vidyanjali: To connect the Government and Government aided schools through a community/ volunteer management program.

Major Schemes for School Education during 2021-22

1. Samagra Shiksha Scheme has been continued for a period of five years, from 2021-22 to 2025-26.
2. NIPUN Bharat Mission: On 5th July 2021, the government launched a National Mission on Foundational Literacy and Numeracy called “National Initiative for Proficiency in Reading with Understanding and Numeracy (NIPUN Bharat)”.
3. Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) Scheme: The Scheme, earlier known as the ‘National Programme for Mid-Day Meal in Schools”, covers all school children studying in Balvatika (just before class I) and Classes I-VIII in Government and Government-Aided Schools.

HIGHER EDUCATION

• Gross enrollment ratio in higher education was recorded at 27.1 percent in 2019-20, slightly higher than 26.3 percent in 2018-19. For males, it has also increased from 26.3 percent in 2018-19 to 26.9 percent in 2019-20 while for females it has increased from 26.4 percent to 27.3 percent respectively.

Gross Enrollment Ratios in Higher Education for age 18-23 years (in percent)

SKILL DEVELOPMENT

• To unlock the demographic dividend, several steps have been taken to increase the skill levels in the population. Periodic Labour Force Survey (PLFS) 2019-20 shows that formal vocational/technical training among youth (age 15-29 years) and working population (age 15-59 years) have improved in 2019-20 over 2018-19.
• The improvement in skills has also been for males and females, both in rural and urban sectors. However, formal training for males and females is lower in rural than in urban areas.
• As per the report of the first quarter (April-June, 2021) of the Quarterly Employment Survey (QES) in respect of establishments employing at least 10 workers in major nine sectors, 17.9 percent of estimated establishments were imparting formal skill training.

SKILL INDIA MISSION

• Launched in 2015, Skill India Mission focuses on re-skilling and up-skilling in prominent trades. Under the Mission, the government implements Pradhan Mantri Kaushal Vikas Yojana (PMKVY), Jan Shikshan Sansthan (JSS) Scheme, and National Apprenticeship Promotion Scheme (NAPS), for providing short term Skill Development training and Craftsman Training Scheme (CTS), for long term training, to the youth.

Pradhan Mantri Kaushal Vikas Yojana (PMKVY)

• PMKVY has two training components, viz., Short Term Training (STT) and Recognition of Prior Learning (RPL). Between 2016-17 and 2021-22 (as of 15 January 2022 ), under PMKVY 2.0 about 1.10 crore persons were trained (inclusive of the placement-linked and non-placement-linked components of the PMKVY).

Jan Shikshan Sansthan (JSS) Scheme

• JSS aims to provide vocational skills to non-literate, neo-literates, persons with a rudimentary level of education up to 8th and school dropouts up to 12th standard in the age group of 15-45 years. The priority groups are women, SC, ST, minorities, Divya Gyan, and other backward sections of the society.

National Apprenticeship Promotion Scheme (NAPS)

• This Scheme promotes apprenticeship training and the engagement of apprentices by providing financial support to industrial establishments undertaking apprenticeship programs under The Apprentices Act, 1961. As of 31 October 2021, 4.3 lakh apprentices are engaged under the scheme.

Craftsmen Training Scheme (CTS)

• CTS is for providing long-term training in 137 trades through 14,604 Industrial Training Institutes (ITIs) across the country. For session 2020, 13.36 lakh trainees were enrolled.

 TRENDS OF EMPLOYMENT

In the absence of high-frequency data on labour market indicators, other proxies such as subscriptions to the EPFO scheme and demand for work under MGNREGA, have been used to analyze the more recent trends in employment in urban and rural sectors.

Trends in Urban employment using Quarterly PLFS data

• In the first quarter of 2020-21, the unemployment rate for the urban sector rose to 20.8 percent. The LFPR and WPR in the urban sector also declined significantly during this quarter.

• The UR gradually declined during this period to reach 9.3 percent in Q4 of 2020-21. The UR for males as well as females, aged 15 & above, recovered to the pre-pandemic levels.

TRENDS IN DATA ON DEMAND FOR WORK UNDER MGNREGS

• During the nationwide lockdown, the aggregate demand for MGNREGS work peaked in June 2020, and has thereafter stabilized.
• During the second COVID wave, demand for MGNREGS employment reached the maximum level of 4.59 crore persons in June 2021. Nonetheless, after accounting for seasonality, the demand at an aggregate level still seems to be above the pre-pandemic levels of 2019.
• For some states like Andhra Pradesh and Bihar, the demand for work under MGNREGS has reduced to below the pre-pandemic levels during the last few months.
• Intuitively, one may expect that higher MGNREGS demand may be directly related to the movement of migrant labouri. e. source states would be more impacted. Nevertheless, state-level analysis shows that for many migrant source states like West Bengal, Madhya Pradesh, Odisha, Bihar, the MGNREGS employment in most months of 2021 has been slower than the corresponding levels in 2020.
• In contrast, the demand for MGNREGS employment has been higher for migrant recipient states like Punjab, Maharashtra, Karnataka, and Tamil Nadu for most months in 2021 over 2020.

Long-term trends in employment using annual PLFS data

• During the Periodic Labour Force Survey (PLFS) 2019-20 (survey period from July 2019 to June 2020), employment at its usual status continued to expand. Between 2018-19 and 2019-20, about 4.75 crore additional persons joined the workforce.
• This is about three times more than the employment created between 2017-18 and 2018-19.

POLICY RESPONSES TO BOOST RURAL LIVELIHOOD

Incentives for job creation: Aatmanirbhar Bharat Rojgar Yojana (ABRY) was announced as a part of the Aatmanirbhar Bharat 3.0 package to boost the economy, increase the employment generation in the post-Covid recovery phase, and incentivize the creation of new employment along with social security benefits and restoration of loss of employment during COVID-19 pandemic.

Wage employment: To boost employment and livelihood opportunities for returnee migrant workers, Garib Kalyan Rojgar Abhiyaan was launched in June 2020. It focused on 25 target-driven works to provide employment and create infrastructure in the rural areas of 116 districts of 6 States with a resource envelope of Rs 50,000 crore.

Boosting Self-employment:

• The program targets to mobilize about 9-10 crore households into Self Help Groups (SHGs).
• Till December 2021, 8.07 crore households are mobilized into SHGs.

Social protection:

• Pradhan Mantri Shram Yogi Maan-Dhan (PM-SYM) Yojana, launched on 05.03.2019, is a voluntary and contributory pension scheme for providing a monthly minimum assured pension of ` 3000 upon attaining the age of 60 years.
• As of 17.01.2022, the enrollment under the PMSYM scheme is 46.09 lakh persons, out of which female enrollment was 23.89 lakh and male enrollment was 22.20 lakh.

e-SHRAM Portal

• e-SHRAM portal has been launched to create a National Database of Unorganized Workers (UWs). One of the main objectives of this portal is to facilitate the delivery of Social Security Schemes to the workers. This database is seeded with Aadhaar and for the age group between 16-59 years.
• It includes construction workers, migrant workers, gig workers, platform workers, agricultural workers, MGNREGA workers, fishermen, milkmen, ASHA workers, Anganwadi workers, street vendors, domestic workers, rickshaws pullers, and other workers engaged in similar other occupations in the unorganized sector.

Status of Labour Reforms

• In 2019 and 2020, 29 Central Labour laws were amalgamated, rationalized, and simplified into four labor codes, viz., the Code on Wages, 2019 (August 2019), the Industrial Relations Code, 2020, the Code on Social Security, 2020, and the Occupational Safety, Health & Working Conditions Code, 2020 (September 2020).
• The new laws were in tune with the changing labour market trends and at the same time accommodated the minimum wage requirement and welfare needs of the unorganized sector workers.

HEALTH

PROGRAMMES AND SCHEMES FOR THE HEALTH SECTOR

• Ayushman Bharat Health and Wellness Centres (AB-HWCs): The vision of Ayushman Bharat is to achieve universal health coverage. It adopts a continuum of care approach, comprising two inter-related components. The first component is the creation of 1,50,000 Health and Wellness Centres (HWCs) which cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): The scheme provides a health cover of ` 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores of poor and vulnerable families in the bottom 40 percent of the Indian population.
• PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) is a mission to develop the capacities of primary, secondary, and tertiary care health systems, strengthen existing national institutions, and create new institutions, to cater to the detection and cure of new and emerging diseases. It is the largest pan-India scheme for public health infrastructure since 2005.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) is being implemented to correct regional imbalances in the availability of affordable reliable tertiary healthcare services and to augment facilities for quality medical education in the country.
• Ayushman Bharat Digital Mission (ABDM), erstwhile National Digital Health Mission (NDHM), announced on 27th September 2021 to develop the backbone necessary to support the integrated digital health infrastructure of the country.
• e-Sanjeevani: In wake of the COVID-19 pandemic, the Ministry of Health and Family Welfare upgraded the thee-Sanjeevani application to enable patient-to-doctor teleconsultation to ensure a continuum of care and facilitate health services to all citizens in the confine of their homes free of cost.

HEALTH OUTCOME INDICATORS

As per the latest National Family Health Survey (NFHS)-5, social indicators such as total fertility rate, sex ratio, and health outcome indicators viz., infant mortality rate, under-five mortality rate, institutional birth rates have improved over the year 2015-16.

CHILD HEALTH INDICATORS

• All child nutrition indicators have also improved at all Indian levels. Under Five Mortality Rate (U5MR) has declined from 49.7 in 2015-16 to 41.9 in 2019-21. Infant Mortality Rate (IMR) has declined from 40.7 per 1000 live births in 2015-16 to 35.2 per 1000 live births in 2019-21.
• Stunting has declined from 38 percent in 2015-16 to 36 percent in 2019-21. Wasting has also declined from 21 percent in 2015-16 to 19 percent in 2019-21. And, underweight declined from 36 percent in 2015-16 to 32 percent in 2019-21.

LIFE EXPECTANCY

• Life expectancy at birth was 69.4 years for the period 2014-18; it has increased by 0.4 years from 2013-17. It varies widely across states; ranging from the lowest at 65.2 years in Chhattisgarh to the highest at 75.3 years in Kerala and Delhi. It is higher in urban areas (72.6 years) than in rural areas (68.0 years).

DRINKING WATER AND SANITATION

JAL JEEVAN MISSION (JJM)

• In 2019, out of about 18.93 crore families in rural areas, about 3.23 crore (17 percent) rural families had tap water connections in their homes. As of 2 January 2022, 5,51,93,885 households have been provided with a tap water supply since the start of the mission.
• Six states/ Uts have achieved the coveted status of 100 percent households with tap water supply, namely Goa, Telangana, A & N Islands, Puducherry, Dadra, Nagar Haveli, Daman and Diu, and Haryana.

SWACHH BHARAT MISSION (GRAMEEN) [SBM-G]

• During 2021-22 (as of 25.10.2021) a total of 7.16 lakh Individual household latrines for new emerging households and 19,061 Community Sanitary Complexes have been constructed. Also, 2,194 villages have been declared as ODF Plus.
• As per the recently released findings of the fifth round of the National Family Health Survey, 2019-21 (NFHS-5), the population living in households that use an improved sanitation facility has increased from 48.5 percent in 2015-16 to 70.2 percent in 2019-21.

ELECTRICITY AND CLEAN COOKING FUEL

• As per NFHS-5, 58.6 percent of households were using clean fuel for cooking in 2019-21, a significant increase from 43.8 percent in 2015-16.

RURAL DEVELOPMENT

PRADHAN MANTRI AWAAS YOJANA-GRAMIN (PMAY-G)

• In the first phase from 2016-17 to 2018-19, one crore houses were taken up. Under phase II, assistance is being provided for the construction of the remaining 1.95 crore houses from 2019-20 to 2021-22.
• As of 18th January 2022, 2.17 crore houses have been sanctioned and 1.69 crore houses completed against a target of 2.63 crore houses till 2021-22.

PRADHAN MANTRI GRAM SADAK YOJANA (PMGSY)

• As of 18.01.2022, a total of 1,82,506 roads measuring 7,82,844 km and 9,456 Long Span Bridges (LSBs) have been sanctioned and 1,66,798 roads measuring 6,84,994 km and 6,404 LSBs have been completed.
• World Bank (2019) in an evaluation of the scheme found that PMGSY roads had a positive impact on human capital formation in rural India.

MULTIDIMENSIONAL POVERTY (MPI)

• Using the NFHS-4 (2015-16) report, in line with the global Multidimensional Poverty Index (MPI), NITI Aayog prepared Multidimensional Poverty Index at the national, for all states and districts of India.
• It will enable measuring deprivation across twelve indicators at the national, state, and districts level. In 2015-16, 25 percent of households were found to be multidimensional poor in India.
• Among states, Bihar had the largest (51.91%) multidimensional poor households, followed by Jharkhand (42.16%), Uttar Pradesh (37.79%), Madhya Pradesh (36.65%), Assam (32.67%), and Rajasthan (39.46%).
• Since the MPI index is based on NFHS-4 data of 2014-15, it may serve as the baseline for measuring deprivation in future studies.