Given its continent-like diversity, India’s epidemiological, nutritional, and demographic transitions are occurring in a staggered fashion, with high state-level variances. In many parts of the country, high rates of undernutrition co-exist with equally high and increasing rates of overweight and obesity. Further, the incidence of non-communicable diseases (NCDs) as a leading cause of mortality is increasing, even as the communicable, maternal, neonatal and nutritional causes (or the “Millennium Development Goals (MDG) conditions”) are coming down. Indeed, India has witnessed inconsistent progress towards the MDGs, and even in states where absolute levels of “MDG conditions” are still high, the NCD proportion is growing rapidly. The imperative is for a realignment of policy responding to fast-changing subnational realities, through greater integration between health and nutrition policy at every level of governance.
The COVID-19 pandemic presented unique global health, economic, and social challenges that required urgent and coordinated action by countries and international organisations worldwide. The G20 countries, for instance, supported initiatives for equitable vaccine access, strengthened their respective healthcare systems, and promoted pandemic preparedness on a global scale. Not all the G20 economies are equal, however, and there were disparities in their COVID-19 responses and the outcomes. Indeed, the challenges they faced during the pandemic were unique, to begin with, given the differences in the structures and workings of their healthcare systems. In this post-COVID-19 era characterised by greater awareness that health security is of paramount importance to the overall security of nations, it is imperative to evaluate, through a comprehensive lens, the efficiency and effectiveness of healthcare systems.
India’s COVID-19 battle will be told and retold in the coming years, inspiring both praise for what the country has achieved, and critique for its shortfalls. As India’s story continues to unfold, two strands will mould the various assessments. First is India’s aggregate performance as a developing economy: It marshalled its meagre resources to respond to the exponential threat of the virus, and was determined, too, to be part of global solutions to this scourge, such as the manufacture and supply of life-saving vaccines. The second, and perhaps even more important story is on ground-zero: In its cities and villages, India’s success or failure would be a factor of the leadership and stewardship of Prime Minister Narendra Modi and his team in responding to the crisis, and the commitment of the chief ministers and state functionaries to beef up their health systems and save lives. Whichever way the India story is told, there are certain truths that cannot be hidden: We need to invest more in our health systems, and acknowledge the stellar role of our frontline workers and formal and informal health sector personnel, as well as India’s prowess in certain segments of the medical and health industry. In this context, it becomes interesting to see how in the country’s federal structure (where health is a State subject), the sub-national units—i.e., states and union territories (UTs)—have performed. The present work, Health Systems Resilience Index: A Sub-National Analysis of India’s COVID-19 Response, provides answers to that question. It builds on an earlier report published by the Observer Research Foundation in May 2020. That report, State of the States: Two Months of the Pandemic, evaluated India’s initial response to the pandemic shortly after the crisis was officially named by the World Health Organization (WHO). Two years since then, this report attempts a more ambitious goal: to devise a unique Resilience Index for the health systems of India’s states and UTs.
This report analyses the use of child labour[1] in the textiles and allied industries in India, and the drivers that lead to its prevalence. India, home to one-fifth of the world’s children, has the highest rates of child labour: an estimated 33 million children under the age of 18 are engaged in work in various sectors across the country, from domestic service and agriculture, to textiles and mining. The textiles and allied industries are the second largest employers in India after agriculture, with 40 million direct and 60 million indirect employees. As a traditionally labour-intensive industry—where flexible and low-cost labour has driven growth and pushed India’s global competitiveness in the sector—the textiles sector is enabled by the massive use of child labour. The continuing practice of child labour has the potential to jeopardise India’s push for incentivising foreign investments into the sector and integrating into global supply chains. This report seeks to address key facets of the issue and provide holistic policy solutions. It is divided into three sections: Chapter 1 reviews key literature about child labour in India, particularly its causes and impacts. The second chapter provides an analysis of child labour in India within the garment and textile industry, using data from 88 sub-state regions (a collection of districts) covered by the National Sample Survey (NSS) of 2011-2012. The final chapter tests the hypothesis that labour costs are the main drivers of global competitiveness in the textiles and allied industries. This is done through an analysis of NSSO unit-level data from the Enterprises Survey 2015-16, of ten sub-state regions.[a]
Today’s India is bold and ambitious, seeing eye-to-eye with the Global North. It is a nation that has big dreams and works hard to achieve those dreams. This volume is a tribute to the India that has traversed a long way over the last 75 years and aspires to reach even greater milestones. It is also a tribute to the millennial India that understands its priorities for the next 25 years and is gearing up to face and overcome its challenges. Azadi Ka Amrit Mahotsav is the government’s initiative to celebrate and commemorate 75 years of India’s independence and the glorious history of its people, cultures, and achievements. Yet, it is not merely a celebration of the India of yore, but of the aspirational and ambitious India of the present and future. It is in this context that this compendium discusses the 10 policies that will shape the future sustainable India. During the 2021 Independence Day celebration, Prime Minister Narendra Modi used the term Amrit Kaal to delineate India’s development pathway over the next 25 years. “The fulfilment of our resolutions in this Amrit period will take us to the hundredth anniversary of Indian independence with pride,” he stated.[1] This compendium, Amrit Mahotsav: 10 Policies Shaping a Sustainable India, aims to celebrate the 75 years of Indian independence (the Amrit Mahotsav) and is a tribute to the India that will traverse the next 25 years of its development armed with crucial policies that will address enduring challenges and shape a more sustainable future for the country and its people.
Charitable Trust Hospitals get various benefits from the government such as land, electricity at subsidised rates, concessions on import duty and income tax, in return for which they are expected to provide free treatment to a certain number of indigent patients. In 2005, a scheme was instituted by the high court formalising that 20 per cent beds set aside for free and concessional treatment at these hospitals. In Mumbai, these hospitals have a combined capacity of more than 1600 beds. However, it has been brought to light both by the government and the media that these hospitals routinely flout their legal obligations. Considering that charitable hospitals are key resources for provisioning of health services to an already strained public health system it is vital to ensure their accountability.This study by CEHAT intended to look at the literature on the history of state aided charitable hospitals in Mumbai, and appraise the nature of engagement between the private sector and the state aided hospitals. It critically reviewed the data submitted by the state aided charitable hospitals of Mumbai to the Charity Commissioner on free and subsidised patients, to estimate the degree of compliance to by the hospitals and also to monitor them. The study found that a substantial number of state aided charitable hospitals do not comply with the scheme, and the degree of non compliance is quite high. Most state aided charitable hospitals never allotted the mandatory 20% beds for treating the poor and instead complained that they were treating too many patients. Data reported to the Charity Commission by the state aided charitable hospitals is inadequate, inconsistent and unsystematic. Charitable hospitals predominantly treat indigent or weaker section patients at the outpatient level because outpatient (OP) admissions can be passed off as in patient (IP) admissions in the current scheme of things and frees an extra bed that can earn thousands of rupees per day. State aided charitable hospitals invariably underreported donations and bed numbers at the office of the Charity Commissioner. No matter how serious the allegations were, no kind of penalties were levied on the offending hospitals. There was not a single instance where disciplinary action was taken against an offending hospital in Mumbai. We hope that the findings of the study would be useful in making key recommendations for effective implementation of the high court scheme, especially for guaranteeing access to the poor to the 20% beds that are set aside.
The present Maharashtra Human Development Report (MHDR) 2012 keeps the spirit of the Eleventh and Twelfth Five Year Plans of ‘faster, sustainable and more inclusive growth’ at the core of its analysis. MHDR 2002 was the state’s first effort in focusing on the prevailing human development scenario in the spheres of growth, poverty, equity, education, health and nutrition. Since then the state has come a long way in the last decade, achieving near-complete enrolments at the primary school level, a wide coverage of health infrastructure and initiation of new incentives, to name a few. The 2012 Report goes beyond being just a situation-analysis of the current human development scenario to a more analytical exercise in facilitating a deeper understanding of what and where the inequalities are, how capabilities can be enhanced, what has been the progress, where the shortfalls are and where the thrust of efforts to promote human development should be. Recognizing the centrality of inclusive growth processes to human development, the need to study human development outcomes disaggregated by gender, rural–urban, regional and social groups is the focal point of this Report. The outcome would be the identification of specific human development goals, evidence-based policy recommendations and directions to how those excluded from the growth and human development processes can be included to reap the benefits of the same.
Even as India achieved statistical elimination of leprosy at the national level in 2005, the target continues to be part of the country’s policy documents. But what is “elimination”, to begin with? The policy documents are unclear of its operational definition, of whether it is at the national level, the state level or the district level. Despite lack of clarity, the political leadership has not failed to indulge in the rhetoric of “leprosy elimination”. In 2018, India was supposed to have achieved national level elimination—yet again. This paper argues that these declarations are devoid of any positive public health significance, and the country is a long way from eliminating leprosy at the state or district levels. As witnessed in 2005, the declaration only served to make officials complacent, shifting resources away from the programme itself. Meanwhile, the data show worrying new trends: Leprosy is becoming highly concentrated amongst the Adivasis (Scheduled Tribes); and the number and proportion of states and districts with elimination-level prevalence is fast decreasing. The paper makes a case for Ayushman Bharat to be the opportunity for streamlining case detection and treatment.
Even as India achieved statistical elimination of leprosy at the national level in 2005, the target continues to be part of the country’s policy documents. But what is “elimination”, to begin with? The policy documents are unclear of its operational definition, of whether it is at the national level, the state level or the district level. Despite lack of clarity, the political leadership has not failed to indulge in the rhetoric of “leprosy elimination”. In 2018, India was supposed to have achieved national level elimination—yet again. This paper argues that these declarations are devoid of any positive public health significance, and the country is a long way from eliminating leprosy at the state or district levels. As witnessed in 2005, the declaration only served to make officials complacent, shifting resources away from the programme itself. Meanwhile, the data show worrying new trends: Leprosy is becoming highly concentrated amongst the Adivasis (Scheduled Tribes); and the number and proportion of states and districts with elimination-level prevalence is fast decreasing. The paper makes a case for Ayushman Bharat to be the opportunity for streamlining case detection and treatment.
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