Editorials/Opinions Analysis For UPSC 10 June 2022
- The Jal Jeevan and Swachh Bharat Missions are improving people’s well-being
- Healthcare in India is ailing
The Jal Jeevan and Swachh Bharat Missions are Improving People’s Well-Being
The performance of the Jal Jeevan and Swachh Bharat Missions highlights the importance of convergence as an operating principle of the government.
GS-II: Welfare Schemes for Vulnerable Sections of the population by the Centre and States and the Performance of these Schemes
Dimensions of the Article
- Jal Jeevan Mission: Progress made so far
- Achievements of Swachh Bharat Mission
- How convergence between SBM and JJM enabled each other
- Impact on Growth and Economy
- Way Forward
Jal Jeevan Mission: Progress made so far
- Jal Jeevan Mission (JJM) is a flagship programme of the Government of India, launched by Hon’ble Prime Minister on 15th August 2019.
- Jal Jeevan Mission, is envisioned to provide safe and adequate drinking water through individual household tap connections by 2024 to all households in rural India.
- Community approach: The Jal Jeevan Mission is based on a community approach to water and will include extensive Information, Education and communication as a key component of the mission.
- Over 9.6 crore rural households get tap water supply; notably, more than 6.36 crore households have been provided tap water connections since the programme was announced in August 2019.
Achievements of Swachh Bharat Mission
- Universal sanitation coverage: To accelerate the efforts to achieve universal sanitation coverage and to put the focus on sanitation, the Prime Minister of India had launched the Swachh Bharat Mission on 2nd October 2014.
- Under the mission, all villages, Gram Panchayats, Districts, States and Union Territories in India declared themselves “open-defecation free” (ODF) by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi.
- To ensure that the open defecation free behaviours are sustained, no one is left behind, and that solid and liquid waste management facilities are accessible, the Mission is moving towards the next Phase II of SBMG i.e ODF-Plus.
- Swachh Bharat Mission Phase-2: The government has launched Swachh Bharat Mission Phase 2 with a focus on plastic waste management, biodegradable solid waste management, grey water management and fecal sludge management.
- Under Swachh Bharat Mission Phase-2, arrangements for solid and liquid waste management have been made in 41,450 villages; nearly 4 lakh villages have minimal stagnant water.
- ODF Plus: Nearly 22,000 villages have been named “model village” under the ODF Plus scheme, and another 51,000 villages are on their way to achieving this tag.
- Sludge treatment and plastic waste management: Before the government embarked on Swachh Bharat Mission, nearly 1,20,000 tonnes of fecal sludge was left untreated as two-thirds of all toilets were not connected to the main sewer lines
- The scale of India’s plastic waste pollution is staggering.
- Both these problems find themselves on the agenda of Swachh Bharat Mission’s Phase 2.
- In a short time, 3.5 lakh villages have become plastic dump free and nearly 4.23 lakh villages have minimal litter.
- Nearly 178 fecal sludge treatment plants and nearly 90,000 km of drains have been constructed.
How convergence between SBM and JJM enabled each other
- Principle of convergence: The late Arun Jaitley introduced convergence as one of the primary operating principles of the government in his first budget speech.
- One enabling the other: The best exhibition of this can be found in the ways in which the Jal Jeevan Mission and Swachh Bharat Mission work in tandem, one enabling the other.
- More than 10 crore toilets were built under SBM but this accomplishment could have been difficult had the government not had the foresight to build the toilets on a twin-pit design that has in-situ treatment of fecal sludge.
- Now, providing tap water connections through the Jal Jeevan Mission is among the government’s top priorities.
- Managing grey water discharge: The Jal Jeevan Mission faces a challenge similar to that faced by the Swachh Bharat Mission — managing grey water discharge.
- Holistic sanitation: When household tap connections were provided, the Jal Jeevan Mission converged with the Swachh Bharat Mission to achieve holistic sanitation in which the treatment of grey water became a vital component.
- Focus on women: The Jal Jeevan mission intends to relieve women of the drudgery of travelling long distances to fetch water.
- The Swachh Bharat Mission too is centered around the dignity of women.
- A joint study by the Bill and Melinda Gates Foundation and UNICEF revealed that an overwhelming number (80 per cent) of the respondents stated that safety and security were the main drivers of their decision to construct toilets.
- The Jal Jeevan Mission is catalyzing change at the grass roots level by reserving 50 per cent seats for women in village and water sanitation committees.
- In every village, at least five women have been entrusted with water quality surveillance and many of them have been trained as plumbers, mechanics and pump operators.
Impact on Growth and Economy
- In 2006, a joint study by WSP, Asian Development Bank and UKAID revealed that inadequate sanitation cost India Rs 2.4 trillion — 6 per cent of India’s GDP at that time.
- The Swachh Bharat Mission, apart from preventing GDP loss, provides annual benefits worth Rs 53,000 per household.
The success of Jal Jeevan Mission and Swachh Bharat Mission is a good example of convergence, one of the primary operating principles of the government.
Source – The Indian Express
Healthcare in India is Ailing
The lesson emerging from the pandemic experience is that if India does not want a repeat of the immeasurable suffering and the social and economic loss, we need to make public health a central focus.
GS-II: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources
Dimensions of the Article
- Need for Institutional Reforms in the Health Sector
- About National Health Mission (NHM)
- Learning from the failure of National Health Mission (NHM)
- Way Forward
Need for Institutional Reforms in the Health Sector
- The importance of public health has been known for decades with every expert committee underscoring it.
- Ideas ranged from instituting a central public health management cadre like the IAS to adopting an institutionalised approach to diverse public health concerns — from healthy cities, enforcing road safety to immunising newborns, treating infectious diseases and promoting wellness.
- Covid has shifted the policy dialogue from health budgets and medical colleges towards much-needed institutional reform.
About National Health Mission (NHM)
- The National Health Mission (NHM) seeks to provide universal access to equitable, affordable and quality health care which is accountable, at the same time responsive, to the needs of the people, reduction of child and maternal deaths as well as population stabilization, gender and demographic balance.
- The Framework for Implementation of NUHM has been approved by the Cabinet on May 1, 2013.
- NHM encompasses two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
- The National Rural Health Mission (NRHM) was launched in 2005 with a view to bringing about dramatic improvement in the health system and the health status of the people, especially those who live in the rural areas of the country.
Learning from the failure of National Health Mission (NHM)
- The National Health Mission (NHM) has been in existence for about 15 years now and the health budget has trebled— though not as a proportion of the GDP.
- Despite this less than 10 per cent of the health facilities below the district level can attain the grossly minimal Indian public health standards.
- Clearly, the three-tier model of subcentres with paramedics, primary health centres with MBBS doctors and community health centres (CHC) with four to six specialists has failed.
- Lack of accountability framework: The model’s weakness is the absence of an accountability framework.
- The facilities are designed to be passive — treating those seeking care.
- FHT: Instead of passive design of NHM, we need Family Health Teams (FHT) like in Brazil, accountable for the health and wellbeing of a dedicated population, say 2,000 families.
- The FHTs must consist of a doctor with a diploma in family medicine and a dozen trained personnel to reflect the skill base required for the 12 guaranteed services under the Ayushman Bharat scheme.
- A baseline survey of these families will provide information about those needing attention.
- Family as a unit: The team ensures a continuum of care by taking the family as a unit and ensuring its well-being over a period.
- Nudging these families to adopt lifestyle changes, following up on referrals for medical interventions and post-operative care through home visits for nursing and physiotherapy services would be their mandate.
- Health cadre: The implication of and central to the success of such a reset lies in creating appropriate cadres.
- Clarity to nomenclatures: There is also a need to declutter policy dialogue and provide clarity to the nomenclatures.
- Currently, public health, family medicine and public health management are used interchangeably.
- While the family doctor cures one who is sick, the public health expert prevents one from falling sick.
- The public health management specialist holds specialization in health economics, procurement systems, inventory control, electronic data analysis and monitoring, motivational skills and team-building capabilities, public communication and time management, besides, coordinating with the various stakeholders in the field.
- Move beyond doctor-led systems: India needs to move beyond the doctor-led system and paramedicalise several functions.
- Instead of wasting gynaecologists in CHCs midwives (nurses with a BSc degree and two years of training in midwifery) can provide equally good services except surgical, and can be positioned in all CHCs and PHCs.
- This will help reduce C Sections, maternal and infant mortality and out of pocket expenses.
- Counsellors and physiotherapists at PHC: Lay counsellors for mental health, physiotherapists and public health nurses are critically required for addressing the multiple needs of primary health care at the family and community levels.
- Review of existing system: Bringing such a transformative health system will require a comprehensive review of the existing training institutions, standardizing curricula and the qualifying criteria.
- Increase spending on training: Spending on pre-service and in-service training needs to increase from the current level of about 1 per cent.
- Redefining of functions: A comprehensive redefinition of functions of all personnel is required to weed out redundancies and redeploy the rewired ones.
Resetting the system to current day realities requires strong political leadership to go beyond the inertia of the techno-administrative status quoist structures. We can.
Source – The Indian Express