Economic Survey 2018 - Vol. 2, Ch. 10: Social Infrastructure, Employment and Human Development (Download PDF)

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As India is poised to grow as one of the leading knowledge economies, education, skill development and health will remain priorities for the Government. Trends in social sector expenditure - Public investment in social infrastructure like education and health is critical in the development of an economy.

  • The data of 29 States, sourced from ‘State Finances: A Study of Budgets of 2016 - 17 (RBI) ’ have shown upward movement in expenditure on social services.

Education for All

  • The Government of India is committed to achieving the Sustainable Development Goal (SDG- 4) for education – “Ensure inclusive and quality education for all and promote lifelong learning” by 2030.
  • India has made significant progress in quantitative indicators such as enrolment levels, completion rates and other physical infrastructure like construction of school buildings/class rooms, drinking water facilities, toilet facilities and appointment of teachers etc. at elementary school levels.
  • Towards improving the learning outcomes at elementary school level, Central Rules under the RTE Act have been amended in February, 2017 to include the defined class-wise, subject-wise learning outcomes.

Student Classroom Ratio (SCR)

  • SCR is defined as average number of pupils (students) per classroom in a school in a given school-year. The ideal size should be at 30 students per classroom.
  • At all India level, percentage of schools with SCR greater than 30 students declined from 43 % in 2009 - 10 to 25.7 % in 2015 - 16. Though, SCR improved in almost all of the States, there are variations in the improvement across States

Pupil Teacher Ratio

  • As per Unified District Information System for Education (UDISE), the PTR at national level for primary schools is 23: 1 in 2015 - 16. Globally, there are variations in the optimum number of students taught in a particular class and as such the data is not uniformly comparable.
  • Data from the UNESCO Institute of Statistics on PTR in primary schools shows that India has a national PTR comparable to countries with similar socio-economic indicators.
  • States like Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh have higher percentage of schools with PTR > 30 compared to other States. There is a need to assess whether higher number of schools having PTR > 30 in above 4 States is owing to the shortage of teachers or deployment.
  • The Central Government through the flagship programs of Sarva Shiksha Abhiyan (SSA) at elementary level and Rashtriya Madhyamik Shiksha Abhiyan (RMSA-Integrated) at secondary level provides assistance to the State Governments and UTs for additional teachers to maintain appropriate PTR as per the prescribed norms for various levels of schooling.
  • The Central Government has been consistently pursuing the matter for expeditious recruitment and redeployment of teachers with States and UTs at various fora.

Gender Parity Index (GPI)

  • Gender Parity Index (GPI) in education is a valuable indicator which reflects the discrimination against girls in access to educational opportunities.
  • In higher education, gender disparities still prevail in enrolment for which continuous efforts are being made by the Government to improve net intake rate for women in higher education.
  • Beti Bachao Beti Padhao (BBBP) scheme has been introduced for promoting survival, protection and education of girl child. It aims to address the issue of declining Child Sex Ratio.
  • The scheme launched in 2015 is a tri-ministerial, convergent effort of Ministries of Women and Child Development, Health & Family Welfare and Human Resource Development with focus on awareness and advocacy campaign.
  • Multi-sectoral action in select 161 districts (100 districts in Phase-1 & 61 districts in Phase-II) was taken, enabling girls’ education and effective enforcement of Pre-Conception & Pre Natal Diagnostic Techniques (PC&PNDT) Act.
  • The Scheme has been approved for expansion to cover all 640 districts in the country.

Progress in Labour Reforms

  • The Government is in the process of rationalizing 38 Central Labour Acts by framing relevant provisions of existing laws into 4 labour codes viz. , Code on Wages, Code on Safety and Working Conditions, Code on Industrial Relations, and Code on Social Security and Welfare.
  • The codification of the labour laws is expected to remove the multiplicity of definitions and authorities leading to ease of compliance without compromising wage security and social security to the workers.
  • The Government has undertaken numerous technology enabled transformative initiatives such as Shram Suvidha Portal, Ease of Compliance to maintain registers under various Labour Laws/Rules.
  • The Universal Account Number have been effected in order to reduce the complexity in compliance and to bring transparency and accountability for better enforcement of the labour laws.
  • The Government initiated the National Career Service portal (www.ncs.gov.in) by linking all employment exchanges of the country to facilitate online registration and posting of jobs for job-seekers and to provide employment related services like career counselling, vocational guidance, information on skill development courses and internships.
  • Further, the Employee’s State Insurance (ESI), Act has been extended to all 325 complete districts as well as 93 district headquarters area. The scheme is also partially available in centers in 85 districts. Arrangements are being made for further extension of the scheme across the country by 2022.
  • Under the scheme, insured persons are entitled to various cash benefits in the event of abstention from work due to sickness, temporary disablement, permanent disablement, dependent benefit, unemployment allowance, maternity benefit etc. The family members of the insured persons are also entitled to medical benefit.
  • ESI has a network of 152 hospitals, 1467 dispensaries, 628 branch offices and 62 regional/sub regional offices across the country.

Gender gap in Labor Force Participation Rate and Earnings: Global Comparison

  • In the case of India, the gender gap in labor force participation rate is more than 50 % points. The lower participation of women in economic activities adversely affects the growth potential of the economy.
  • Government has been taking measures to increase the participation of women in productive economic activities by schemes to provide support services to working women and also through legislative measures to enhance maternity benefit.

📝 Some of the initiatives taken by the government are

  • Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) is one of the important schemes which ensures participation by women in the economic activity by stipulating minimum 33 % participation by women. The scheme has been converged with ICDS scheme for construction of AWCs.
  • For economic empowerment of women through promoting the spirit of creating self-employment ventures, Mahila E-Haat, an initiative for meeting aspirations and needs of women entrepreneurs has been launched This is impacting directly and indirectly over 26000 SHGs and 3.75 lakh beneficiaries
  • As per the Maternity Benefit (Amendment) Act, 2017, the women are entitled to enhanced maternity leave for a period of 26 weeks (6 months) working in registered establishment under any Central or State law. It has been made mandatory for the establishments employing 50 or more employees to provide creche facility, either separately or along with common facilities within a prescribed distance.

📝 Political empowerment of women

  • The representation of women in Parliament and in decision making roles in public sphere is one of the key indicators of empowerment.
  • There are developing countries like Rwanda which has more than 60 % women representatives in Parliament in 2017 while countries like Egypt, India, Brazil, Malaysia, Japan, Sri Lanka and Thailand have less than 15 % representation of women in Parliament.
  • Recognizing the significance of roles of women in decision making process in the society is critical to strengthen women’s agencies for building a progressive society.
  • Article 243D (3) of the Constitution of India provides that not less than one third of the total number of seats be reserved for women.
  • Article 243 D (4) of the Constitution of India provides that not less than one third of the total offices of Chairpersons in Panchayats at each level shall be reserved for women.
  • Women sarpanchs (chairperson) accounted for 43 percent of total gram panchayats (GPs) across the country, exhibiting active leadership of women in local governments
  • Further, for leadership development and to address women’s issues at village levels, Mahila Shakti Kendra scheme has been launched at the village level.
  • District Level Centres for Women are also being set up in 640 districts under this scheme, which will provide convergence at the district level for all initiatives related to women.
  • Besides, Nai Roshni, a leadership development program, is also operational for benefiting the women belonging to minority communities.

Health for All

  • Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development (SDG-3).
  • India’s commitment to achieve the targets under SDG-3 with some of them also aligned with the National Health Policy 2017, will help in strengthening health delivery systems and in achieving universal health coverage.

Expenditure on Health

  • In a developing country like India, incurring higher levels of Out of Pocket Expenditure (OoPE) on health adversely impacts the poorer sections and widens inequalities. Although, OoPE has declined approximately 7 % points during the period 2004 - 05 to 2014 - 15
  • Limited affordability and access to quality medical services are among the major challenges contributing to delayed or inappropriate responses to disease control and patient management.
  • There is a need to prioritize standardization of rates by devising appropriate quality assurance framework and regulatory mechanism.
  • Government has already enacted Clinical Establishments (Registration and Regulation) Act 2010 and notified the Clinical Establishments (Central Government) Rules, 2012 to regulate the clinical establishments across the country, the Act at present is applicable in 10 States/UTs, which needs to be taken up by remaining States while ensuring strict compliance as well.

📝 Steps taken by the government to regulate drug prices

  • Under National Health Mission (NHM), Government is supporting States through National Free Diagnostic Service Initiative to provide essential diagnostic services in public health facilities. Government of India has brought out guidelines in July 2015 to provide states with a broad framework for implementing free drug initiatives

  • National Free Drug Initiative under NHM aims at expanding the availability of free drug provision in all public health facilities.

  • Under Clinical Establishments (Registration and Regulation) Act, 2010 and Clinical Establishments (Central Government) Rules, 2012, the clinical establishments (in the States/Union Territories where the Act is applicable) shall charge the rates for each type of procedure and services within the range of rates determined by the Central Government from time to time in consultation with the State Governments.

  • Medical Council of India (MCI) has amended the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 vide notification dated 21.09. 2016, which stipulates that ‘every physician should prescribe drugs with generic names legibly and preferably in capital letters’.

Burden of Diseases: India and States

📝 The concept of Disability Adjusted Life Years (DALYs) provides a framework for analyzing the disease burden and risk factors. DALYs is the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability.

One DALY represents the loss of the equivalent of one year of full health.

Using DALYs, the burden of diseases that cause premature death but little disability can be compared to that of diseases that do not cause death but do cause disability.

The information and data base about changing disease patterns and the use of DALYs to quickly compare the impact caused by very different conditions, such as cancer and depression, in a single, comparable metric are crucial inputs for decision-making, effective resource allocation and policy planning.

The significance of DALYs as a critical health policy indicator is reflected by the inverse relationship between life expectancy and DALYs rates.

The per person disease burden measured as DALYs rate dropped by 36 % from 1990 to 2016 in India.

Of the total disease burden in India measured as DALYs, 61 % was due to communicable, maternal, neonatal, and nutritional diseases (CMNNDs) in 1990, which dropped to 33 % in 2016.

The risk factors are drivers of diseases and injuries causing premature death and disability. The leading risk factors for health loss.

The use of DALYs to track disease burden has also been recommended by India’s National Health Policy of 2017. The disease burden in India can be reduced substantially, if the risk factors related to health loss are addressed effectively.

Malnutrition still remains the most important risk factor (14.6 percent) that results in disease burden in the country though the disease burden due to it has dropped in India.

📝 The Government is implementing several programs and has also initiated new policy interventions to improve the health and nutritional status of women and children. Some of the initiatives include

  1. Integrated Child Development Services (ICDS): ICDS scheme aims at the holistic development of children upto 6 years of age and to meet nutritional needs of pregnant women and lactating mothers. Recently, rationalization, restructuring and continuation of four child centric schemes such as

    • Anganwadi Services (in place of ICDS);

    • Scheme for Adolescent Girls (SAG) (in place of SABLA);

    • Child Protection Services (in place of Integrated Child Protection Scheme)

    • National Creche Scheme (in place of Rajiv Gandhi National Creche Scheme)

  2. Pradhan Mantri Matru Vandana Yojana (PMMVY): It is a Centrally Sponsored Scheme, in January, 2017 for providing partial compensation for the wage loss in terms of cash incentive so that the woman can take adequate rest before and after delivery of the first child.

  3. National Nutrition Mission (NNM): The Government of India has approved setting up of National Nutrition Mission (NNM) commencing from 2017 - 18 The NNM, as an apex body, will monitor, supervise, fix targets and guide the nutrition related interventions across the Ministries.

  4. Pradhan Mantri Ujjwala Yojana (PMUY): PMUY was launched in May 2016, for providing LPG connections to 5 crore women belonging to the BPL families over a period of 3 years from 2016 - 17. The scheme aims to safeguard the health of women & children by providing them with a clean cooking fuel – LPG

Air pollution causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.

The behavioural and metabolic risk factors associated with the rising burden of Non Communicable Diseases (NCDs) have become quite prominent in India.

the dietary risks, which include diets low in fruit, vegetables, and whole grains, but high in salt and fat, were India’s third leading risk factor, followed closely by high blood pressure and high blood sugar.

Unsafe water, sanitation, and handwashing (WaSH) was the second leading risk factor in 1990, but its ranking has dropped to seventh position in 2016.

States with higher life expectancy are reflecting lower DALYs rates means lower incidence of diseases and vice-versa. Though, there have been dramatic fall in CMNNDs, however, States with high DALYs rates are indicating relatively greater increase in NCDs.

Despite improvements in overall life expectancy in India over the years, inequalities still persist among states

Public Health Expenditure by States and DALYs

  • The National Health Policy, 2017 has recommended increasing State sector health spending to more than 8 % of the State government budget by 2020.
  • There is a need to understand the efficiency of the public spending with respect to DALYs behavior across the major States and to assess whether high spending by States on health results in better health outcomes.
  • The efficiency in the use of resources along with measures for preventive and curative health care is necessary to translate enhanced expenditure into improved health outcomes.
  • The health of the population is closely related to the quality of life indicators like access to sanitation, safe drinking water and the like which can decrease the disease burden of the population. Therefore, focus of the Government on improving access to sanitation through Swachh Bharat Mission (SBM) gains special significance.

Swachh Bharat Mission (Gramin)

  • 296 districts and 307, 349 villages all over the India have been declared as Open Defecation Free (ODF).
  • Eight States and two Union Territories i. e. Sikkim, Himachal Pradesh, Kerala, Haryana, Uttarakhand, Chhattisgarh, Arunachal Pradesh, Gujarat, Daman & Diu and Chandigarh have been declared as ODF completely.

Health and Economic Impact of Sanitation

  • The quality of hygiene and sanitation has significant impact on improving the health outcomes which is a well-established fact.
  • To assess the impact of sanitation program on health status, a pilot study was undertaken by the Bill & Melinda Gates Foundation (BMGF) in selected ODF and non-ODF districts.
  • BMGF estimated that households in ODF villages in India have significantly better health indicators.
  • The non-ODF districts have lower percentage of population with secondary education, reflect higher levels of diarrhea, stunting, wasting and BMI owing to behavioral inertia.
  • In ODF areas, with higher percentage of population with secondary education, there has been a clear cut evidence of behavioral shift of the individuals due to larger presence and proactive work undertaken by village health and sanitation committees (VHSC).
  • Studies have documented that in addition to the health benefits, there are also economic gains on becoming ODF areas. UNICEF estimated that a household in an ODF village in rural India saves `50, 000/- ( $800) every year.

The way forward

  • Towards inclusive development, India has been implementing programs for social sectors like education and health to include women and the marginalized sections of the people to bridge the gaps in educational attainments, health outcomes and employment opportunities.
  • Though macroeconomic growth and efficient markets are essential, it is necessary to equally ensure that the benefits of growth are equitably accessible to all citizens to make growth broad based.

Conclusion

  • The policies and institutional systems for inclusive growth are progressively being built by the Government of India in the form of digitalization to transform governance and achieve social inclusion through financial inclusion initiatives, gender mainstreaming and measures to reduce all forms of social inequalities inherent in Indian society.

- Published/Last Modified on: March 28, 2018

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