1. NHPS

About NHPS

• National Health Protection Scheme (NHPS) was announced under Ayushman Bharat programme for a New India 2022. Health Infrastructure in country

• Aim- To provide medical cover up to Rs5 lakh per year per household for secondary and tertiary health care. Coverage- An estimated 10 crore households across the country, constituting 40% of total population on the basis of “deprivation and occupational criteria” as per Socio-Economic and Caste Census (SECC) data, 2011.

• Using JAM- It would be a cashless and Aadhaar enabled for better targeting of beneficiary.

• Finance- It is a Centrally Sponsored Scheme with ratio of contribution towards premium will be o 60: 40 ratio Share between Centre and State in all states and UTs with legislature.

• 90: 10 ratio between Centre and northeastern states & 3 Himalayan states.

• 100% Centre’s contribution in case of union territories (UTs) without legislature.

• Central funding: Initial corpus of Rs 2000 crore was announced and rest will be funded from 1% additional cess (Budget-2018).

• NHPS scheme will subsume Rashtriya Swasthiya Bima Yojana (RSBY) under it.

• National Health Agency (NHA)- It will be set up to manage NHPS. 72   Significance

• It would be the world’s largest government-funded health programme.

• It is expected to help in building New India 2022 by enhancing productivity, avert wage losses and impoverishment.

• Consolidating Fragmented Healthcare Insurance facility available in different states.

• It might help in achieving National Health Policy target of health expenditure to reach 2.5 per cent of the GDP by 2025 and will lead to Universal Healthcare Coverage.

• It might promote equal distribution of patients in private and government hospitals as scheme will be delivered by a network of public and private hospitals.

• It will operate around the insurance principle of risk pooling. When a large number of people subscribe to an insurance scheme, only a small fraction of them will be hospitalised in any given year.

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Challenges:

• Identification of Beneficiary will be extremely challenging as criteria, other than family income, will cause a huge discontent.

• Ignoring Primary Healthcare- Rural Health Statistics 2016 shows the number of primary and community health centers have stagnated over the last three decades and scheme might further promote unnecessary tertiarization of healthcare, leading to a cost spiral.

• Past experience (Evaluation of RSBY) shows that India lacks the institutional expertise and capacity to implement public health insurance effectively.

• International Experience has also shown that insurance-based health care provision, is an expensive model of financing health care for the government.

• Poor health infrastructure like hospital beds, doctors (mainly specialists), healthcare staff, diagnostic facilities, pharmacies, etc are not enough to meet the needs of the population.

• Against Federalism- It curtails states’ autonomy to design their own policies that is constitutionally mandated to be in their domain.

• Unethical medical practices under previous scheme for quick monetary gains through unnecessary hospitalization, extension of hospital stay, etc.

• Instances of Frauds- Hospital and Insurance company were found in unholy nexus by charging extra for registration, diagnostics & treatment and claiming false insurance claims by floating ghost beneficiaries under government insurance schemes.

• Structural Issues remain as India fares poorly on both disease surveillance and funds utilization on health. Way Forward

• Expanding scope to achieve Ayushman Bharat by sharing expenditure on outpatient services for long-duration chronic disease.

• Diverse disease profile- Each state must be given the flexibility to curate its own list of medical procedures. Integrating primary healthcare into NHPS to make the scheme viable and sustainable.

• Preventive healthcare be made an integral part of NHPS to reduce the burden of hospitalization caused by disease progression and improving nutritional status, awareness, and maintaining efficient health surveillance systems.

• Leveraging Technology- Blockchain technology can be used to develop a seamless patient electronic medical record (EMRs) for insurance-based NHPS to prevent fraud and ensure accountability and traceability. Checks and Balances mechanism at the ends of both the patient and the providers to measure outcomes and tackle abuse of the scheme.

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1.1. Urban Nutrition In India

• The Urban HUNGaMA (Hunger and Malnutrition)

• Report on Urban Nutrition was released based on the survey that was conducted in 2014 by Citizens Alliance against Malnutrition.

• Details The URBAN HUNGaMA Survey 2014 was conducted to capture essential nutrition data of children aged 0-59 months in the 10 largest cities of India.

• Situation in India At 6,40,000 newborn child deaths in 2016, India has the largest number of babies dying in the world. The number of annual under-five deaths in India has gone below one million for the first time in 2016. The under-five mortality rate for girls was 11 per cent higher at 41 per 1,000 as against 37 per 1,000 for boys. India’s current under-five mortality rate is 39/1000. With the current rate of decline, India is back on track to meet the Sustainable Development Goals (SDG) target for the under-five mortality of 25 per 1,000 live births by 2030. India’s neonatal mortality rate (2016) is 25.4/1000.

• Related info - India Newborn Action Plan (2014) It is India’s committed response to the ENAP to advance the Global Strategy for Women s and Children’s Health. Its goal is to attain Single Digit Neonatal Mortality and Stillbirth Rates by 2030. It is to be implemented within the existing

• Reproductive, Maternal, Newborn, Child and Adolescent health (RMNCH+A) framework of the National Health Mission (NHM). Six pillars of intervention include: o Preconception and antenatal care o Care during labour and child birth o Immediate newborn care o Care of healthy newborn o Care of small and sick newborn Care beyond newborn survival Every year, an estimated 2.6 million babies are stillborn, the vast majority in low- and middle-income countries.

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1.2. Healthy States, Progressive India Report

About the Report

It is an annual report which will rank States and UTs on incremental changes in health outcomes and overall performance with respect to others. It has been developed by NITI Aayog in consultation with Technical Assistance Agency of World Bank, Ministry of Health and Family Welfare (MoHFW), States and Union Territories, domestic and international sector experts and other development partners. It aims to promote a cooperative and competitive spirit among States and UTs to rapidly bring about transformative action in achieving the desired health outcomes. The Health Index is based on three main domains which focus on outcomes, governance and information, and critical inputs–

• Health Outcomes – 10 indicators weighing 70% of the total index score has been given the highest importance. Key indicators under this domain are Neonatal Mortality, Under Five Mortality Rate, Total Fertility Rate, and Sex Ratio at Birth etc.

• Governance and Information - 3 indicators which weigh12% are Data integrity measure, average occupancy of an officer (signifying stability in organization) and average occupancy of a full-time officer for all districts.

• Key Inputs and Processes – 10 indicators weighing 18%are proportion of vacant healthcare, proportion of total staff for which an e-pay slip can be generated etc.

• The states have been categorised based on the availability of data and the fact that similar states should be compared amongst themselves. Therefore the states have been categorised as Larger states, Smaller States and UTs.

• Based on the above categories the states are grouped into three categories – Aspirants (bottom one third states with score below 48), Achievers (middle one third state with score between 48 and 63) and Front runners with scores above 63.

• The composite score of the index is calculated for a base year i.e. 2014-15 and a reference year i.e. 2016-16.The incremental ranks are measure of the difference in performance between these two periods

• The data sources for the index are Sample Registration System, Health Management Information System,Central MoHFW data, State Report, National Family Health Survey, Civil Registration System etc.

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1.2.1 The objective of the index is –

• To develop a composite health index based on key health outcomes, healthsystem and service delivery indicators.

• To ensure State and UTs partnership and ownership through Health Index data submission on web based portals

• Build transparency through independent validation by independent agencies.

• Generate Health Index scores and ranking of States and UTs based on year to year overall performance.

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1.3. INDIA HEALTH FUND

Why in news?

• The India Health Fund (IHF), an initiative by Tata Trusts, in collaboration with the Global Fund has come forward to financially support innovations and technologies designed to combat tuberculosis and malaria.

Key facts

• TB and malaria pose longstanding health challenges for India. The two diseases account for over 4.23 lakh deaths and around 15 million lab-confirmed cases every year.

• Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable. TB is spread from person to person through the air.

• Malaria is a disease of the blood that is caused by the Plasmodium parasite, which is transmitted from person to person by mosquitoes. Human malaria is transmitted only by females of the genus Anopheles. Of the approximately 430 Anopheles species, only 30-40 transmit malaria.

• It is aligned with the country’s goal of eliminating TB by 2025 and malaria by 2030. The IHF aims to support individuals and organisations with already germinated innovative strategies, services, products. It is not a fellowship to do research from scratch. The Global Fund is designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. Founded in 2002, it is a partnership between governments, civil society, the private sector and people affected by the diseases.

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1.4. Institute Of Eminence (Ioe)

News Highlight

Government constituted a panel, headed by N Gopalaswami, for identification of top 20 best higher education institutions. Features of such institutions include It should preferably be multidisciplinary and have both teaching and research focus of an exceptionally high quality. Apart from the regular courses, it should also offer various interdisciplinary courses, including in areas of emerging technology and interest as well as those of relevance to the development concerns of countries like India. There should be a reasonably good mix of domestic and foreign students. There should be a transparent merit based selection in admissions, so that the focus remains on getting meritorious students. The faculty student ratio should not be less than 1:10 after three years of declaration as a World Class Institution. The Institution should have a world-class library with subscriptions to reputed journals in the areas of its course offerings. It should have student amenities comparable with that of globally reputed institutions. The Institution should have reasonably large owned campus with adequate space for expansion etc. Issue Involved On Institutes

• Non-applicability of reservation system would face resentment from particular section of society. o In the absence of supervisory support from UGC, in the long run these institutes could fall under political influence and might lose its quality of research.

• Socio-Economic incentives for the researcher should be provided in order to avoid brain-drain. On ranking methodology

• A heavy emphasis is placed on subjective perception-based metrics estimated using independently conducted surveys.

• The participation of India in general and academicians/researchers in international ranking surveys have historically been very low – thereby pulling down India’s average performance.

• Complex classification of Institutions of National Importance, Central, State, State Private, and Deemed to Be Universities and overregulation by various bodies such as UGC, AICTE, NBA, NAAC father hampers the ranking prospect for India Universities.

• Institutions of eminence The UGC (Institutions of Eminence Deemed to be Universities) regulations, 2017 will govern all such institutions that are conferred with this status, ensuring their complete academic, administrative and financial autonomy. These regulations will override all other UGC regulations and free the institutions of UGC’s restrictive inspection regime, the regulatory control over fee and curriculum. Benefits to IoE The IoE will enjoy administrative and financial autonomy in a wide range of matters, including faculty and staff salaries, student fees, course offerings and content, among others. Status of IoE would bring greater reputation which would attracts greater funding and increased collaborations with world-class

• Reason for dismal performance on Higher education Low numbers of PhD-qualified researchers, hampered research productivity and Innovation ideas. Inadequate faculty/student ratio in some universities. Less integration with world class technology enabled education. Old curriculum and less practical work in engineering colleges etc. Inadequate infrastructure coupled with non-availability of fund to run the institutes.

• About RISE It is a new initiative to step up investments in centrally funded institutions like IITs, Central Universities and others such institutes Funding will be provided through Higher Education Financing Agency (HEFA).

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1.5. Education Development Impact Bond

News Highlight

• The British Asian Trust created a 10-million-dollar Education Development Impact Bond (EDIB) for India. About the Bond It is intended as an innovative and sustainable social impact investment tool which will be tied in with performance and outcomes of educational initiatives in India. It will provide funding for delivering a range of activities including principal and teacher training, direct school management, and supplementary programmes. The concept of Development Impact Bonds is intended as a result-oriented way to attract new capital into development, with a strong emphasis on data and evidence. The focus is to improve literacy and numeracy learning levels for over 200,000 primary school students from marginalized communities in Delhi, Gujarat and Rajasthan. The bond has been described as a step towards a greater focus on social impact financing as a transformational tool for philanthropy. The UK government’s Department for International Development (DfID) will contribute technical assistance and insights to the project as part of a wider partnership.

• About RISE It is a new initiative to step up investments in centrally funded institutions like IITs, Central Universities and others such institutes Funding will be provided through Higher Education Financing Agency (HEFA).

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1.6. Education Development Impact Bond

News Highlight

• The British Asian Trust created a 10-million-dollar Education Development Impact Bond (EDIB) for India. About the Bond It is intended as an innovative and sustainable social impact investment tool which will be tied in with performance and outcomes of educational initiatives in India. It will provide funding for delivering a range of activities including principal and teacher training, direct school management, and supplementary programmes.

• The concept of Development Impact Bonds is intended as a result-oriented way to attract new capital into development, with a strong emphasis on data and evidence. The focus is to improve literacy and numeracy learning levels for over 200,000 primary school students from marginalized communities in Delhi, Gujarat and Rajasthan. The bond has been described as a step towards a greater focus on social impact financing as a transformational tool for philanthropy. The UK government’s Department for International Development (DfID) will contribute technical assistance and insights to the project as part of a wider partnership.

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1.7 National Achievement Survey  

News Hightlight

• Recently, National Achievement Survey (NAS) was released by the HRD Ministry. About National Achievement Survey It assesses performance of students in five major subjects-English, Mathematics, Science, Social Science and Modern Indian Languages. Comparison between National Achievement Survey and ASER National Achievement Survey ASER This is a school based survey It is household based survey Conducted by NCERT for students in class 3rd, 5th and 8th Conducted by ASER Centre (Pratham) It is based on a pen-paper test One-on-one assessment It takes into account the children enrolled in government schools. All children irrespective of whether they are school going or not Based on wide variety of skills Based on foundational skills such as reading and math For both urban and rural areas For rural areas Findings of the Survey The performance of students declined in environmental science, language and maths as one moves from class III to class VIII. Rural students scored higher than those in cities which is contrary to the perception that the quality of education in urban areas is superior to that in rural areas. Also, in classes V and VIII, OBC students outscored the general category. At all levels, average scores were lowest for ST students while SC students scored a tad higher. Female students performed better than male students.

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1.8. Khap Panchayats

News Hightlight

• The Supreme Court recently said any attack against an adult man and woman opting for an inter-caste marriage by khap panchayats or associations is “absolutely illegal”.

• About Khap panchayats They are the traditional social institutions engaged in dispute resolution in village communities. They are formally distinct from the lawfully elected village panchayats and their rulings have no legal sanctity in the eyes of court. They are most prevalent in Haryana and Western UP, however they exists in whole of North India in different forms. It is generally an all-male organization and its leaders are unelected but based on their social clout. Controversial aspects of Khap Khap Panchayats functions as extra-constitutional authorities, often delivering pronouncements amounting to violation of human rights fundamental rights like right to life and liberty, right to privacy , freedom of expression, right of association, movement and bodily integrity among others.

• They have been linked to honour killings, forced marriages, female foeticide, excommunication of individuals and families and whimsical ways of delivering justice. They promote a Culture of Silence by inculcating fear among people. The inherent weakness of Panchayati Raj System gives them more strength. They have strong political hold in the region of their operation, hence no political parties could dare to go against their decisions. Even the state machinery like police don't act against them They are extremely patriarchal organisation and most of the times young women are at the receiving end of their pronouncements. They recommend special kind of dress code for them, put restrictions in their going out, employment choices, and also restricts their right to choose partner of choice. Their continued prevalence hinders social mobility, growth and development, familial bond and trust and shows general lack of empathy, compassion, brotherhood in the society.

• Other related aspects They are not illegal organisations per se, they are age-old, social institutions based on the kinship feeling or cultural relativism that gives them strength. They sort out a plethora of social and legal issues in villages starting from minor disagreements to grazing land, playground, water and fodder distribution in villages, land disputes, marital disputes, division of ancestral property, and common-resource management in villages. They deliver justice quickly than regular courts. The rural-folk lacks money and expertise to handle these situations in a court of law. People readily stand as witness in a Panchayat full of their peers, and speak truth, while they would feel uncomfortable in a court. 80   In many cases, especially land dispute, there are no documentary evidence, all the evidence exists is the elders and their witness to the past. These panchayats have also frequently made pronouncements on social issues in an attempt to combat problems like female abortions, alcohol abuse, dowry, and to promote education.

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1.9. Pradhan Mantri Kaushal Vikas Yojana 2.0: An Assessment

News Hightlight

• The government’s flagship skilling scheme — Pradhan Mantri Kaushal Vikas Yojana (PMKVY) is facing issues in providing placement to the skilled candidates. Pradhan Mantri Kaushal Vikas Yojana (PMKVY) is the flagship scheme of the Ministry of Skill Development & Entrepreneurship (MSDE). The objective of this Skill Certification Scheme is to enable a large number of Indian youth to take up industry-relevant skill training that will help them in securing a better livelihood. Individuals with prior learning experience or skills will also be assessed and certified under Recognition of Prior Learning (RPL). PMKVY was launched on on 15 July, 2015 to provide training and skilling to 24 lakh youths. The scheme was reviewed and PMKVY 2.0 was launched in October 2016. It aims to spend Rs 12,000 crore on skill training 10 million youth between 2016 and 2020. Changes from PMKVY to PMKVY 2.0 Placement tracking has been made mandatory. setting up Model Skill Centres called Pradhan Mantri Kaushal Kendras (PMKKs), in districts. Focus has been shifted to getting greater participation of states, bringing district collectors into the picture to ensure delivery at the district level District-level data-crunching exercise to know the specific demand-supply conditions for each district Involvement of industry especially the MSME sector under cluster-based model such as training candidates in a group in a specific region.

• Details According to latest data from the Ministry of Skill Development and Entrepreneurship an average of just over one out of six people trained under the scheme having found a job. The performance has improved since launch of PMKVY 2 in October 2016. As per the Union skill development ministry data, it had placed around 318,000 youth in jobs or self-employment over the last 17 months out of 612,000 candidates who completed training under the PMKVY-2. However, the number fell short of its 70% placement target under the PMKVY-2.

• Why shortfall? PMKVY scheme is struggling because of lack of quality training and information asymmetry regarding the demand-supply dynamics of skilled candidates.

• Why success of PMKVY important? In India, about 12 million people enter the labour market every year. Providing gainful employment to such huge workforce is important for reaping demographic dividend, maintain social harmony and political stability. India’s jobs problem has also attracted international attention. Both the World Bank and the International Labour Organization have flagged the need for quality salaried jobs in the country. India needs to create regular, salaried jobs with growing earnings rather than self-employed ones in order to join the ranks of the global middle class by 2047.

• Way forward The problem with PMKVY is not its poor job placement record. The government should focus on making candidates employable. The government should not only be focusing on formal skilling but also on providing decent education, labour reforms and improving the ease of doing business. (Note: For details of PMKVY refer Current Affairs notes of September 2017) 81   Broadcasts Engineering Consultants India Limited It is a Government of India Enterprise under the Ministry of Information and Broadcasting It is a Mini Ratna company established in 1995. It provides project consultancy services and turnkey solutions encompassing the entire gamut of radio and television broadcast engineering. Pradhan Mantri Ujjwala Yojana was launched in May 2016 through which cash assistance is given to the beneficiaries to get a deposit-free new LPG connection. Initially, PMUY envisaged a target of 5 crore connections with an allocation of Rs. 8000 crore over a period of 3 years starting from FY 2016-17. Earlier Eligibility: Any Below Poverty Line (BPL) family, whose information is included in the district BPL list prepared by the State government.

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1.10. Swajal Yojana

About Swajal Project

• It is a community owned drinking water programme which will not only ensure round-the-year availability of clean drinking water but also generate employment. Besides ensuring the availability of clean drinking water to every household round the year, the project would also generate employment. It is the second project under the Swajal Yojana. Prior to this, it has been launched in Uttarkashi district of Uttarakhand. 90% of the project cost will be taken care of by the government while the rest 10% of the project cost which will be contributed by the community. The project derives its name from an old Swajal project, a World Bank project dedicated to rural water and environmental sanitation launched in 1996 in UP.

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1.11. Social Media Centres

News Hightlight

• The Ministry of Information and Broadcasting has approved the hiring of social media executives for sharper delivery of the government’s message to the voters. More about the News The social media wing will be setup the Broadcasts Engineering Consultants India Limited. One executive will be hired from each district. A new media wing is being set up by the Broadcast Engineering Consultants India Limited (BECIL) for the work. Purpose These social media executive will analyse local news and help the government adapt to these responses. They will also analyze whether the government’s message is taken positively or negatively. Significance It will give the government an opportunity to know the ground level responses of the people beyond the capital which earlier sketched a skewed picture.

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1.11.1 Pradhan Mantri Ujjwala Yojana

News Hightlight

• The Cabinet Committee on Economic Affairs, chaired by the Prime Minister Shri Narendra Modi, has approved to enhance of the target of Pradhan Mantri Ujjwala Yojana (PMUY) from five crore to eight crore. Details The revised target of Pradhan Mantri Ujjwala Yojana (PMUY) will be achieved by 2020 with additional financial allocation of Rs 4800 crore. 82   The earlier scheme excluded genuinely poor households whose name was not included in Socio Economic Caste Survey (SECC) list. Now the Scheme will cover all SC/ST households, beneficiaries of PMAY (Gramin), Antyoday Anna Yojana (AAY), Forest dwellers, Most Backward Classes (MBC), Tea and Ex-Tea Garden Tribes, people residing in Islands and rivers etc. in addition to SECC identified households. Present status Under the PMUY, the original target was to release 3 crore connections by the end of FY 2017-18, but as a result of efficient scheme implementation and monitoring, more than 3.35 crore connections have been made