19/11/2019 : The Hindu Editorials Notes : Mains Sure Shot 

No.1.

Question – Critically analyze status of maternity benefit in India and assess the implementation of PMVVY of maternity benefit.(250 words)

Context – The reach of maternity benefits in India.

Data and facts:

  1. As per Jaccha Baccha Survey ( JABS), conducted with student volunteers in six States of north India — Chhattisgarh, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha and Uttar Pradesh to understand the fulfillment of special needs of maternity.Among women who had delivered a baby in the preceding six months, only 31% said that they had eaten more nutritious food than usual during their pregnancy. Their average weight gain during pregnancy was just seven kg on average, compared with a norm of 13 kg to 18 kg for women with a low body mass index.

Steps taken by India:

  1. Under the National Food Security Act, 2013, all pregnant women except those already receiving similar benefits under other laws) are entitled to maternity benefits of ₹6,000 per child. For more than three years, the Central government simply ignored its duty to act on this.
  2. In 2017 the Pradhan Mantri Matru Vandana Yojana (PMMVY):- benefits are restricted to the first living child, and to ₹5,000 per woman. A budget provision of ₹2,700 crore was made for it in the 2017- 18 budget. 

Issues in implementation:

  1. Budgeted amount of FY 2017-18 is mere fraction of 15000 crore required for the full implementation of the maternity benefit as per NFSA norms. Actually expenditure against the budgeted year 2017-18 was nearly 2000 cr. In the FY 2018-19 budgeted allocation reduced to 2000 crore from 2700 crore. 
  2. Poor coverage – As per  statistics released by the ministry of women and child development about coverage of scheme,  in 2018-19 only around 22% of all pregnant women received any PMMVY money, and around 14% received the full benefits. Coverage and benefits amount got reduced vis a vis NFSA. Further As per the researchers who extrapolated data obtained under RTI , PMVVY benefited only 31% of eligible beneficiary. 
  3. Procedural hiccups – The application process is tedious. Aside from filling a long form for each installment, women have to submit a series of documents, including their ‘mother and child  protection card, bank passbook, Aadhaar card and husband’s Aadhaar card. Essential details in different documents have to match, and the bank account needs to be linked with Aadhaar.
  4. Issues in digitization – There are frequent technical glitches in the online application and payment process. When an application is rejected, or returned with queries, the applicant may or may not get to know about it. Grievance redressal facilities are virtually nonexistent.
  5. Rejection of payments due to minor mismatch between the Aadhar’s name and Bank account name.  More than 20% respondents in the survey mentioned that they had faced difficulties due to difference in address of Maika on Aadhar and his Sasuraal address.  

Other issues:

  1. Opposition insensitivity towards the maternity benefit issues and not setting accountability for the same.
  2. Vast majority of women not employed in the formal sector are deprived of many maternity benefits. 

Significance of Maternity Benefits in India:

  • Maternity benefits could help to relieve the hardships faced by pregnant women and give babies a chance of good health.
  • The announcement assumes significance as India accounts for 17% of all maternal deaths in the world. The country’s maternal mortality rate is pegged at 130 per 100,000 live births, whereas infant mortality is estimated at 43 per 1,000 live births. Among the primary causes of high maternal and infant mortality are poor nutrition and inadequate medical care during pregnancy and childbirth.
  • Undernutrition continues to adversely affect the majority of women in India. In India, every third woman is undernourished and every second woman is anaemic. An undernourished mother almost inevitably gives birth to a low birth weight baby. When poor nutrition starts in – utero, it extends throughout the life cycle since the changes are largely irreversible.
  • Owing to economic and social distress many women continue to work to earn a living for their family right up to the last days of their pregnancy. Furthermore, they resume working soon after childbirth, even though their bodies might not permit it, thus preventing their bodies from fully recovering on one hand, and also impeding their ability to exclusively breastfeed their young infant in the first six months.

Jaccha-Bachcha Survey:

  • Jaccha-Bachcha Survey (JABS) conducted in six States of north India — Chhattisgarh, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, and Uttar Pradesh has revealed the hardships faced by pregnant women.
    • For lack of knowledge or power, most of the sample households were unable to take care of the special needs of pregnancy, whether it was food, rest or health care.
    • Among women who had delivered a baby in the preceding six months, only 31% said that they had eaten more nutritious food than usual during their pregnancy.
    • Their average weight gain during pregnancy was just seven kg on average, compared with a norm of 13 kg to 18 kg for women with a low body-mass index.
    • In Uttar Pradesh, 39% of the respondents had no clue whether they had gained weight during pregnancy, and 36% had gone through it without a health check-up.
    • It is only in Himachal Pradesh, where rural women are relatively well-off, well-educated and self-confident, that the special needs of pregnancy received significant attention.

State best example:

  1. Under the Dr. Muthulakshmi Reddy Maternity Benefit Scheme, pregnant women in Tamil Nadu receive financial assistance of ₹18,000 per child for the first two births, including a nutrition kit.
  2. Odisha’s Mamata scheme also covers two births, albeit with lower entitlements — ₹5,000 per child, as with the PMMVY. The JABS survey suggests that the Mamata scheme is working reasonably well: among women who had delivered in the last six months, 88% of those eligible for Mamata benefits had applied, and 75% had received at least one of the two instalments.

Way forward:

  • The templates of the successful state schemes need to be extended and consolidated on a national basis.
  • The Maternity entitlements need the political attention it deserves given the wide impact their successful implementation can have.

 

No. 2.

 

Question – Despite the health outcomes greatly improved, why are the tribal areas still lacking behind?Explain( 250 words)

Context – The condition of health in tribal areas.

What is National Nutrition Mission?

  • It was launched by the PM in 2018 with the objective of accelerating improvements in nutrition levels in India, for which annual targets have been set for reduction in levels of stunting, undernutrition, anaemia and low birth weight, to be achieved by the year 2022.

Why in news?

  • It is news because Odisha, which is one of the Empowered Action Group States, or eight socio economically backward States of India, has done remarkably well in health and nutrition outcomes over the past two decades.
  • Its infant mortality rate has significantly declined. Its under-five mortality rate almost halved in the National Family Health Survey (NFHS)-4 from NFHS-3.
  • It has seen a steep decline in stunting in children under five. Anaemia in children and pregnant women has also decreased since NFHS-3.
  • Antenatal care and institutional deliveries have shown good improvement.

The other side: condition of the tribals:

  1. Even though so much has been achieved,  the nutrition status of the most nutritionally-deprived communities – the Scheduled Tribes (STs) has not improved.
  2. The recently released NFHS-4 highlighted that despite improvements, the undernutrition among STs has remained poor, and much higher than that for all groups taken together.
  3. As per the report, in India, 44% of tribal children under five years of age are stunted (low height for age), 45% are underweight (low weight for age) and 27% are wasted (low weight for height).
  4. The high levels of hunger and malnutrition among tribal people received considerable attention after reports of malnutrition deaths among children in pockets inhabited by tribal people, specifically in states like Odisha, Maharashtra and Madhya Pradesh.
  5. It is widely accepted that undernutrition results from multiple causes, which can be categorised as immediate (inadequate diet and disease), underlying (household food insecurity, poverty, poor access to health and WASH services) and basic causes (overall social, political and economic environment).
  6. In case of tribal people, additional factors like discrimination, geographical isolation, limited access to public services, cultural differences, among others, add to the existing deprivations faced by them across sectors.
  7. In the last decade or so, initiatives have been taken by the government to reach out to tribal people and increase their access to public health and nutrition services, which are crucial for addressing immediate causes of undernutrition. These include relaxing population norms in tribal habitations for setting up of anganwadi and mini-anganwadi centres under Integrated Child Development Services scheme; or setting up of the health centres under the National Health Mission (NHM), taking into account the scattered and sparse population in a number of tribal habitations.
  8. In addition, some states have introduced state-specific schemes specifically for tribal people; such as Maharashtra’s APJ Abdul Kalam Amrut Aadhar Yojna, a full-meal scheme for pregnant and lactating women and Village Child Development Centre for severely undernourished children.
  9. However, shortage of basic infrastructure as well as human resources for delivery of these schemes, constrain the quality as well as outreach of these services in tribal areas.
  10. As per the Rural Health Survey 2017, there is an overall shortfall (difference between required and in-position) of 21%, 26% and 23% respectively for sub-centres, Primary Health Centres (PHCs) and Community Health Centres (CHCs) in tribal areas at the all-India level. This shortfall is much higher in tribal-dominated states; for example, the shortfall for PHCs is 52% in Rajasthan, 53% in Madhya Pradesh, 58% in Jharkhand, 36% in Telangana and 30% in Maharashtra.
  11. Along with this is the acute and persistent shortage of personnel to deliver these services in tribal areas. For example, the same survey reveals that in tribal areas, the vacancy of doctors in PHCs is as high as 28%, and for nursing staff at PHC and CHC levels it is 22% at the all-India level.
  12. These shortages are compounded by high rates of non-functionality of the health centres, absenteeism of personnel for delivery of services, as well as unavailability of basic drugs and equipment. For example, NFHS-4 revealed that 57% of STs expressed concern that no drugs would be available at the health centres, and 42% felt that distance from health facilities restricts their access to medical advice or treatment.

What can be done? / Way ahead:

  1. Firstly, more attention should be paid on allotment of enough budgetary resources in the form of a targeted policy driven budgets for STs. for example, the government of India initiated a strategy of Tribal Sub Plan (TSP) in 1974.
  2. As per the TSP strategy, the Union and state governments had to earmark plan funds for tribal people at least in proportion to their share in the total population of India (8.6% as per Census 2011) or of respective states. The objective was to ensure separate funding to address specific development deficits in tribal areas.
  3. However, the allocations for TSP never met the mandate and TSP allocations remained much below the prescribed norm. For example, analysis of TSP outlays for nutrition-related ministries show that between 2014-15 to 2016-17, the Union government was allocating only around 4.4% of its plan budget under TSP (against the norm of 8.6%). So implementation needs to be regulated and monitored too.
  4. As a policy, TSP can be used to address challenges in access to food, potable water, sanitation facilities, quality health services and other facilities in tribal areas which together lead to poor nutrition among tribal women and children. TSP can be used to fill in the critical gaps in resources to ensure quality and outreach of interventions across nutrition-related sectors, and thus address the multiple causes of undernutrition.
  5. Despite tribal undernutrition being a persisting concern over the years, there is as yet no specific policy to address the issue and streamline the government’s efforts across sectors. Some states have shown initiative to introduce specific schemes, the approach remains limited to tackling immediate issues relating to diet and disease, and does not sufficiently address the larger issues of poverty, food insecurity at household level, landlessness and shrinking livelihoods, among others.
  6. In this context, the government needs to play a more proactive role and form a policy for coordinated action across ministries, such as tribal affairs, women and child development, agriculture, rural development, drinking water and sanitation, and human resource development (education), to inform and strengthen their efforts towards tackling tribal undernutrition.

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