Gist of EPW May Week 3, 2019

The Economic and Political Weekly (EPW) is an important source of study material for IAS, especially for the current affairs segment. In this section, we give you the gist of the EPW magazine every week. The important topics covered in the weekly are analysed and explained in a simple language, all from a UPSC perspective.

1. Toeing the US Line on Iran

Context

  • The Indian position on the recent sanctions imposed by the United States (US) on Iran confirms India’s reluctance to protest these unilateral sanctions and demonstrates its eagerness to play a junior partner of the US in world politics.

Analysis of the issue

  • The official position of India, so far, is quite vague as there are two different versions floating around.
    • The minister of petroleum and natural gas responded with a tweet that India is fully prepared to deal with the situation arising out of it.
    • The second version was announced by India’s foreign minister, during the meeting with her Iranian counterpart expressed India’s inability to take any major decision on the issue during the ongoing national elections.
  • Indian companies, on the other hand, have already stopped buying Iranian oil and are looking for alternative suppliers.
  • At the moment, India intends complete compliance with the American sanctions.

About US Sanctions

  • The current set of sanctions imposed on Iran by the Donald Trump administration is in defiance of any established international legal regime.
  • The US sanctions are unilateral and have no legal justifications.
  • They are the result of diplomatic and military calculations of Israel, Saudi Arabia and American trio, and India has nothing to gain from it.

Advantages of importing Iranian oil

  • 10% of its total oil imports was from Iran, which was India’s third largest supplier of oil after Saudi Arabia and Iraq.
  • The Iranian oil was not only cheaper but also came with a longer credit period.
  • India paid most of the price in euros, and the rest in rupees, which reduced dependency on the US dollar.
  • A part of the rupee payment was also in kind. India got to pay a part of the cost in kind through the supply of rice, medicines and other commodities.

Significance of the issue

  • India imports 84% of its oil requirements and hence domestic prices are dependent on the international market.
  • Rising trade deficit, and huge oil and gas bills make it necessary for India to look for cheaper and more reliable oil supplies.
  • Now, Indian refineries will have to negotiate for additional supplies from Saudi Arabia or the United Arab Emirates. It is a double blow for the Indian oil market.
  • Some refineries are already under US pressure to stop buying oil from Venezuela. The crude oil from Iran and Venezuela provides wider margins to Indian refiners.
  • The end of imports from these countries will increase the costs, which will eventually be transferred to the consumers.
  • Indian consumers should expect a steep rise in the prices of oil and other petroleum products post the elections.

Other Issues

  • Compliance with the sanctions may also mean that India will lose the chance of getting stakes in the Farzad B gas fields.
  • It has already lost the opportunity in the last decade to build a land pipeline from Iran to supply gas due to its attempts to please the US.
  • This makes India vulnerable to any hostility in the Persian Gulf region from where it imports the majority of its energy requirements through the sea routes.
  • Though the impact of India’s compliance with the US sanctions on other areas of cooperation with Iran is not yet clear, the hostile effects cannot be denied.
  • The fate of India’s ambitious North–South Corridor that will provide land routes to Afghanistan, Central Asia and Europe is uncertain.
  • India has invested heavily in the Iranian port of Chabahar in the Arabian Sea. Iran is also important in Indian attempts to create an alternative market in West Asia for its exports.

Conclusion

  • Arguments in favour of India complying with the US sanctions are motivated by the so-called realist calculations, according to which aligning with the US is far more rewarding.
  • According to this view, the US needs India to balance China’s rise in the region. This so-called strategic thinking, however, ignores the costs altogether.
  • Respect for sovereignty of a country and upholding the sanctity of international laws have always guided Indian responses in world politics.
  • However, it seems this time it chose to move away from its established principles in order to appease the US.
  • It is obvious that India’s compliance with the sanctions does not even guarantee a minimum of its foreign policy objectives. Rather, it compromises its strategic autonomy.
  • The appeasement of the sole superpower could be an endless pit where India’s standing in the regional and world politics becomes contingent on imperialist calculations.

2. Delivering Nutrition to Pregnant Women

Context

  • To reduce the burden of maternal undernutrition in India, select nutrition interventions are delivered to pregnant women at scale through the National Health Mission.
  • But, delivery is constrained by poor planning and budgeting, delayed fund flow, and shortage of infrastructure and human resources; and funds are underutilised.

Significance of Maternal nutrition

  • Maternal nutrition is important due to its critical and complex association with women’s well-being and implications for child development.
  • Deficiencies in both macronutrients and micronutrients can cause severe maternal morbidity and mortality.
  • During pregnancy, an inverse relationship exists between calcium intake and development of hypertension and iron deficiency anaemia in pregnancy increases the risk of haemorrhage and maternal mortality.
  • A woman’s nutritional status before and during pregnancy also impacts foetal development and child malnutrition.

Implications of Maternal undernutrition

  • intra-uterine growth retardation
  • low-birth-weight babies
  • preterm birth
  • childhood stunting
  • emergence of chronic diseases
  • Also results in low energy reserves in mothers and affects their functional outcomes.

Government Intervention

  • Health-related nutrition interventions are delivered through the National Health Mission (NHM), a centrally sponsored scheme.
  • The NHM is an umbrella programme delivering a range of maternal and child health (MCH) services, within which delivery of most nutrition interventions for pregnant women are included.
  • The interventions for pregnant women include supplementation with iron and folic acid (IFA), calcium, and other micronutrients; salt iodisation; and balanced energy and protein supplementation.
  • In India, some of the nutrition interventions for pregnant women are included in the basic Attendance and Utilization of Antenatal Care (ANC) Services provided to pregnant women through the NHM.
  • Village Health Nutrition Days (VHNDs) are organised every month at anganwadi centres (AWCs), where micronutrient supplements such as IFA and calcium are distributed to pregnant women.
  • The Supplementary Nutrition Programme for Pregnant and Lactating Women, part of the Integrated Child Development Services scheme, is implemented by the Ministry of Women and Child Development.

Gaps in Planning and Budgeting Process

  • The NHM follows a bottom-up approach for planning and budgeting.
  • The plans made at the district level (DHAP) are presented to the state government; the state’s demand for funds, or the State Programme Implementation Plan (SPIP), should be based on the DHAPs.
  • The budget demands for nutrition interventions for pregnant women are supposed to be generated using various parameters, such as
    • the number of expected pregnant women in the year (estimated through eligible couple survey conducted by ASHAs)
    • Payments to be made (such as beneficiary payment, ASHA incentives, courier services for VHND)
    • Consumables required during the year.
  • However, discussions with front-line workers (FLWs) revealed that their inputs were hardly ever taken for planning or budgeting.
  • The DHAP did not include inputs from the blocks or villages and the SPIPs did not consider DHAPs in their plans.
  • Therefore, budget allocations did not meet a district’s needs; the deficit created a backlog of requirements; health facilities functioned sub-optimally; and service delivery was poor.
  • The approval of NHM budgets and release of funds were also delayed.
  • Disbursal took time, too. It should take 15 days (NHM 2016) to transfer funds from the state treasury to the state health society, but it took 60–65 days, and it took another month or so to reach the district.
  • Delayed releases hindered the regular functioning of activities, district- and block-level NHM officials, and many activities had to be postponed.
  • That affected service and expenditure quality. When funds were delayed, the officials met current expenditure requirements by temporarily allocating funds from different NHM components or sub-programmes.

Challenges faced

  • Maternal nutrition interventions are an integrated set of services. It requires adequate physical infrastructure, well-trained staff, and regular supply of drugs and supplements.
  • However, compared to district requirements, the NHM programme has been underfunded over the years.
  • A vicious cycle of understaffing and shortage of infrastructure has led to underutilisation of even the limited resources available and, in turn, to fund allocation for the scheme in subsequent financial years
  • Low fund utilisation adversely impacts scheme implementation and reduces allocations in subsequent years. Funds have been reduced because the health sector has performed poorly or the state government lacks the capacity to spend its resources.
  • The WHO (2010) has suggested a maximum limit of nearly 435 persons per skilled health personnel (including doctors, nurses, and midwives) for delivery of essential MCH services.
  • Considering contractual and permanent ANMs, doctors, and GradeA nurses, only one health worker was employed for every 4,620 people in rural areas and one health worker was sanctioned for a population of 1,900.
  • These affected fund utilisation. Spending on some components of the scheme was irregular. For some components, funds are allocated in a given year, but utilised only in subsequent years.
  • Another issue that demands attention is the delivery of ANC services through VHND. It is dependent on the AWC set-up for implementation, but most AWCs lack basic materials
  • Unless proper infrastructure is created and minimum basic amenities provided, the services provided through AWCs would remain weak.
  • Poor resource allocation for the health sector in general, and for nutrition interventions for pregnant women in particular, has created a situation in the district where out-of-pocket expenditure on ANC services was high and dependence on private healthcare had increased.
  • There is, therefore, a need to significantly scale up health system budgets in the district.

Summary

  • During pregnancy, a woman’s physiology considerably influences the growth and development of the foetus and her own well-being.
  • Nutrition interventions during pregnancy positively impact maternal nutrition, but implementation and coverage remains low, largely due to low budgets for health interventions, weak service delivery infrastructure, and serious staff shortage.
  • Procedural issues such as delays in the approval and release of funds adversely affect fund utilisation for ANC services.
  • The delivery of maternal nutrition interventions can be improved only if the overall health delivery system is improved.
  • This would entail enhancing budgets for the NHM and the health sector overall, addressing procedural challenges, recruiting an adequate number of skilled health personnel, improving infrastructure, and providing health facilities accessible round the clock.
  • The health service delivery system is at the core of maternal nutrition interventions; strengthening them will go a long way in improving the health of women in the district.

For more EPW articles, read “Gist of EPW”.