UPSC Exam Preparation Gist Yojana May 2018 Issue Nutrition

UPSC Exam Preparation: Gist of Yojana May 2018 Issue: Nutrition

Table of Contents: NUTRITION

1. Introduction

2.Creating Mass Movement to Address Malnutrition

3.Food to Nutrition Security

4.Role of Health Services in Nutrition

5.Accountability for Nutrition Outcomes

6.Nutritional Status in India

7.Decentralised Approach to Tackling Nutrition

8.Shaping Food Consumption

9.Financial Inclusion in India: Challenges and Way Forward

10.Boosting Infrastructure to fuel Development

11. Stretching a Hand to the Vulnerable

12. Expanding Universal Health Coverage

 

Introduction

With a population of 1.2 billion as per the 2011 census, for a country like India, improvement of health and nutritional status of the population is of high priority. Article 47 of the Indian Constitution states that “the state shall regard raising the level of nutrition and standard of living of its people and improvement in public health among its primary duties”.  The government has been giving extensive importance to universal access to efficient and basic health services in both urban and rural areas. As a result, famines and severe food insecurity are no longer a threat though seasonal food insecurity continues to raise its head in different pockets of the country. There has been substantial improvement in the nutritional status of all the segments of the population with a substantial reduction in case of under-nutrition and micronutrient deficiencies.

The challenge of maternal and child undernutrition remains a national public health concern and a policy priority. India is home to over 40 million stunted and 17 million wasted children (under 5 years). Undernutrition is a condition resulting from inadequate intake of food or more essential nutrients resulting in deterioration of physical and mental health. Regional disparities in the availability of food and varying food habits lead to the differential status of undernutrition which is substantially higher in rural than in the urban areas. This demands a region-specific action plan with significant investments in human resources with critical health investments at local levels. 

The announcement of National Nutrition Mission (NNM) is a very significant development on this front. It has introduced a central nodal agency with extensive financial resources to coordinate various central and state government schemes and imbue them with additional financial resources. The core strategy of the mission is to create decentralised governance system with flexibility given to states, districts and local level with robust monitoring, accountability and incentive frameworks that will encourage local solutions. The programme, through well-defined targets, strives to reduce the level of stunting, under-nutrition, anaemia and low birth weight babies.

Creating Mass Movement to Address Malnutrition

In order to achieve its true potential and play the role as a global superpower, India will need to focus on eradication of malnutrition so as to ensure that the coming generations are healthy, enabling higher intellectual potential, leading to enhanced work productivity. This one factor will enable us to connect the dots between schemes like Make in India, Digital India, Skill India and grow to our desired potential as a nation.

On the 8th of March, 2018, POSHAN Abhiyaan – the PM’s Overarching Scheme for Holistic Nourishment was launched. The programme through the use of technology, a targeted approach and convergence strives to reduce the level of stunting, under-nutrition, anaemia and low birth weight in children, as also, focus on adolescent girls, pregnant women and lactating mothers, thus holistically addressing malnutrition. The programme aims to ensure service delivery and interventions by use of technology, behavioural change through convergence and lays down specific targets to be achieved across different monitoring parameters over the next few years.

Different Ministries/ Departments at the Centre and States/UTs deal with varied interventions required for reduction of malnutrition in a stand-alone manner. State/UT being the highest implementing agency for all such schemes, it is pertinent to achieve synergy of all interventions to effectively target malnutrition. POSHAN will provide the required convergence platform for all such schemes and thus augment a synergized approach towards nutrition.

Convergence at centre is being achieved through the formation of the National Council for Nutrition and the Executive Committee for POSHAN Abhiyaan. Both these draw members from the stake holders of the Abhiyaan. Similarly, the convergence Action Plan at State, district and block level define the implementation and monitoring mechanisms for the Abhiyaan. The Very High Speed Network (VHSN) day provides the convergence platform at village level for the participation of all the frontline functionaries.

The software application, ICDS – common application software especially developed for this enables data capture, ensures assigned service delivery and prompts for interventions whenever required. This data is then available in near real time to the supervisory staff from Block, District, State to National level through a Dashboard, for monitoring. The procurement and distribution of mobile devices is a part of the project.

The application is aimed to augment system strengthening in ICDS service delivery and looks at improving the nutrition outcomes through effective monitoring and timely intervention. The software allows the capture of data from the field on electronic devices (mobile/tablet). It enables collection of information on ICDS service delivery and its impact on nutrition outcomes in beneficiaries on a regular basis. This information is available to the States and MWCD on real time basis on web-based dashboards. It is aimed to improve the ICDS service delivery and also enable the Mission to effectively plan and take fact-based decision making.

The problem of malnutrition is inter-generational and is dependent on multiple factors which, inter-alia, include optimal Infant & Young Child Feeding (IYCF) practices, Immunization, Institutional Delivery, Early Childhood Development, Food Fortification, Deworming, access to safe drinking water and proper sanitation (WASH), Dietary diversification and other related factors. Therefore, to address the problem of stunting, under-weight and wasting, especially in children, there is a need to take up sustained efforts requiring multi-pronged approach and bring grass root synergy and convergence. The problem can finally only be addressed through a socio-behavioural change. This aspect of POSHAN looks at deploying a multi-pronged approach to mobilise the masses towards creating a nutritionally aware society. Community based events at anganwadi centres to engage the beneficiaries and their families towards nutritional awareness; sustained mass media, multi media, outdoor campaigns and synergised mobilization of all frontline functionaries, self-help groups and volunteers towards nutrition, are the methods to be adopted. The aim is to generate a Jan Andolan towards Nutrition.

Ministry of Women and Child Development is the nodal Ministry for anchoring overall implementation.

As the National Family Health Survey (NFHS-4) highlights that inter-state and inter-district variability for undernutrition is very high, so every state/district needs to develop its Convergence Action Plan which includes their specific constraints and bottlenecks and what can they address in short, mid or long term.

Food to Nutrition Security

Since 1947, achieving food security has been a major goal of our country. This was because the Bengal Famine created awareness of the need for paying priority attention to the elimination of hunger. Our Food Security Act 2013 specially mentions the need for nutritional security.

This chapter briefly indicates how this can be achieved. Both food and non-food factors will have to receive concurrent attention. Some of the steps needed for this are:

  1. Food to Nutrition Security:

There is a need for change in emphasis from food security to nutrition security. Nurition security is “physical, economic and social access to balanced diet, clean drinking water, sanitation and primary health care”. There has to be a food based approach to nutrition security and not a drug based one.

In the area of nutrition security, it is important to look at food adequacy, protein deficiency and deficiency of micro-nutrients like iron, iodine, zinc, vitamin-A etc., The Farming System for Nutrition (FSN) provides a methodology for achieving such symbiotic linkages. Above all, a global grid of genetic gardens of biofortified plants will be an important tool for fighting hidden hunger.

  1. National Nutrition Week:

It would be worthwhile to spend National Nutrition Week and other such events in generating awareness of the implications of malnutrition particularly with reference to brain development in child. It will be useful to launch a National Grid of Genetic Garden of Bio fortified Plants. It will help to provide agricultural remedies to major nutrition problems particularly affecting the poor.

  1. Making National Nutrition Mission a success:

Government has approved the National Nutrition Mission with a three year budget of 9000 crore. This is government’s response to the widespread malnutrition resulting in children with impaired cognitive abilities. The Nutrition Mission to be successful should be designed on a mission mode with symbiotic interaction among components and with a Mission Director who has the requisite authority coupled with accountability. Earlier Missions were not successful because the concept of Mission was not fully operationalized. The Nutrition Mission should have interactive components to make it a success. It should have proper monitoring tools so that the efficacy of the intervention can be judged.  

 

National Nutrition Mission:

On the occasion of the International Women’s Day on the 8th of March 2018, a pan India National Nutrition Mission covering all the 640 districts of the country was launched. To achieve the goals of the National Nutrition Mission, the following areas need concurrent attention.

  1. Overcoming calorie deficiency through the effective use of the provisions of the National Food Security Act 2013.
  2. Overcoming protein hunger through the increased production and consumption of pulses and milk and poultry products.
  3. Overcoming hidden hunger caused by micro nutrient deficiency through the establishment of genetic gardens of bio fortified plants and promoting a Farming System for Nutrition programme.
  4. Ensuring the availability of clean drinking water, sanitation and primary health care.
  5. Developing a cadre of Community Hunger Fighters who are well versed with the art and science of malnutrition eradication.

Role of Health Services in Nutrition

When India became independent, the country faced two major nutritional problems: a threat of famine and the resultant acute starvation due to low food production and the lack of an appropriate food distribution system. The other was chronic under-nutrition due to poverty, food insecurity and inadequate food intake. Famine and starvation hit the headlines because they were acute, localised, caused profound suffering and fatalities. But chronic low food intake was a widespread silent problem leading to under-nutrition, ill health and many more deaths than starvation. Mutually reinforcing adverse consequences of under-nutrition and ill health resulted in high morbidity and mortality in all age groups and the longevity at birth was only 35 years.

The country adopted multi-sectoral, multi-pronged strategies to improve the nutritional and health status of the population.

All the national nutrition and health surveys carried out over the last four decades have documented that there have been steady but a slow decline in under-nutrition and micro-nutrient deficiencies, morbidity and mortality due to severe infections. Because of the synergistic interactions between nutrition and health, some health interventions resulted in improving both health and nutrition status and vice versa. In the last two decades, there has been a slow but steady increase in the prevalence of over-nutrition and Non-Communicable Diseases (NCD).

NCDs are asymptomatic in the initial phase; only after symptoms due to complications arise do patients seek health care. It is essential to improve awareness regarding health consequences of adiposity and initiate programmes for prevention and management of adiposity (adiposity). Interventions for regaining normal nutritional status in those with NCD will have to be initiated as a part of management of NCD.

A decline of under-nutrition:

The Integrated Child Development Scheme (ICDS) was aimed at providing food supplements to children from poor and marginalized sections to bridge the gap between requirement and actual dietary intake. Though initiated in the seventies, ICDS was universalized only in the first decade of the new century.

Prevention and treatment of infections reduced energy loss due to infection and prevented deterioration in nutritional status. Thus, improved access to health care played an important role in achieving a steady reduction in the under-nutrition rates in pre-school children in the last four decades.

Optimal nutrition in childhood:

As birth weight is a major determinant to growth, low birth weight children grow along a low trajectory of growth during infancy, childhood and adolescence. Height, weight and BMI are three parameters widely used for assessing the nutritional status. Of the three, BMI which is the indicator of current energy adequacy has long been accepted as the indicator for assessment of nutritional status in adults.

A case study for a health care intervention helping in achieving the nutritional goals:

During the 1960s poverty, household food insecurity and hunger were widespread among poorer segments of the population. Dietary intake of all nutrients was low and moderate and severe under-nutrition in young children were common. Poor green and yellow vegetable intake led to widespread Vitamin A deficiency. In the urban areas, the primary health care infrastructure to treat the infections was poor and in the rural areas, it was non-existent.

Untreated severe infections, especially measles, in the already severely under-nourished young children, led to Keratomalacia; those who survived the infection were often left with nutritional blindness.

Based on the findings of the National Institute of Nutrition, Massive Dose of Vitamin A Supplementation (MDVAS) for the children of the age group 1-5, once in 6 months was initiated in 1970. But the coverage under the programme was as low as less than 10%. During the 80’s there was a steep reduction in Keratomalacia. Over the next decade, blindness due to the deficiency of Vitamin A was not reported by major hospitals.

Though the coverage under MDVAS still persisted to be low, the primary health care infrastructure in urban and rural areas had been established and access to immunisation, treatment of infections, severe grades of under nutrition had improved substantially.

Universal Salt iodization:

Iodine deficiency disorders (IDD) have been recognised as a public health problem in India since the 1920s. Iodine Deficiency affects all socio-economic groups living in defined geographic areas. IDD during pregnancy was associated with high abortion and foetal wastage rates; some infants born to these mothers suffered from cretinism and mental retardation. In adults, IDD include hypothyroidism and goitre. Universal use of iodised salt is a simple, inexpensive method of preventing IDD.

A case study :

Initially, IDD in India was thought to be a problem in the sub Himalayan region. The National Goitre Control Programme initiated in 1962, focused on supplying iodised salt to those living in the goitre belt.  Studies over the next 2 decades showed a decline in the cretinism and mental retardation in children and some reduction in the prevalence of goitre in 6-12 year old children.

Considering the fact that IDD existed in pockets in all states of India, a National Iodine Deficiency Disorders Control Programme (NIDDCP) was initiated in 1992 with the goal of ensuring universal household access to iodised salt. However, over the next fifteen years, the household access to adequately iodised salt remained below 50%. In 2007 mandatory fortification of all salt for human consumption with iodine was notified. Universal salt iodization programme is an example of a nutrition programme not only achieving nutritional goals but also preventing mental retardation in children and IDD related health problems in adults.

 

Dual Nutrition and health burden:

Over the last three decades, there has been a progressive rise in over-nutrition both in men and in women. However, the overnutrition rates were higher in women, than in men.

India’s health system was built up with a focus on early detection and effective treatment for under-nutrition, infections and maternal child health problems. Most of these health problems are symptomatic and acute. Over the years, utilization of health care had improved and this led to a sustained reduction in under-nutrition, ill health and mortality rates.

In the coming years, Indians and Indian health system have to reorient and gear themselves for successfully managing the prevention, early detection and effective management of dual nutrition and disease burden.

In the dual nutrition and health burden era, assessment of nutritional status is an important component of both public health interventions and care of individuals seeking health care.  

Promoting synergy between health and nutrition services will enable the country to successfully face the nutrition challenges and achieve rapid improvement in health and nutritional status of the population.

Accountability for Nutrition Outcomes

One of the most important areas that should be targeted is nutrition. It is the most basic facets of human life. The economic benefits of investing in proper nutrition are several: improving nutritional outcomes would help in controlling diseases, reduce infant and maternal mortality, empower women, break the vicious intergenerational cycle of malnutrition, improve worker productivity, and even improve learning outcomes for students.

In early years of independence, the principal challenge was to be self-sufficient in food production. Due to the green-revolution, this particular challenge was largely met.

A National Mission for nutrition is required for four reasons. First, the current efforts are fragmented. There is a need to bring together all relevant stakeholders on a single platform to enable a synergistic and holistic response to the issue.

Second, the mission sets specific targets related to nutritional outcomes and a timeline in which those are to be achieved. This brings urgency in tackling the problem of malnutrition while demonstrating political commitment towards it.

Third, the mission encompasses a targeted strategy consisting of a plan of actions and interventions. These are designed to help accelerate the improvement in nutritional outcomes.

Fourth, the nutrition mission targets behavioural change through social awareness, and by creating a mass movement through a partnership between go9vernment, the private sector and the public.

 

Aim of Nutrition Mission:

  • The nutritional outcomes have steadily improved over the last 15 years, led by the economic growth. According to the National Family Health Survey (NFHS) between 2005-06 to 2015-16
  1. Stunting in children declined from 48% to 38%
  2. Proportion of underweight children went down from 42.5% to 35.7%
  3. Proportion of women with low BMI went down from 35.5% to 22.9%
  4. Anaemia in women declined from 55.3% to 53%
  • The National Nutrition Mission aims to accelerate the progress. Decline at
  • Child stunting is aimed at 2% per annum. By 2022, it is aimed at reducing it to 25%
  • Undernutrition by 2% per annum
  • Anaemia by 3% per annum
  • Low birth weight by 2% per annum
  • All the districts will be covered in a phased manner.

Key implementation strategies:

The core strategy of the mission is to create a decentralised governance system.

  • Outcome orientation: orientation will promote accountability. It would be done through universal monitoring of parameters of the beneficiaries and real-time tracking of the progress made. Ranking based on improvement allows for competition between different villages, districts and states to do better than each other and come out on the top.
  • Incentives based on outcomes: The states, districts and Panchayats showing the largest improvements would be incentivised.
  • Data collection and monitoring: An Information and Communication Technology driven data collection system would provide real time information allowing tracking and monitoring of individual severely malnourished children.
  • Coordination between different programmes: A national council has been set up under the NITI Aayog which will be responsible for overall policy direction in relation to the nutrition mission. Another executive committee of national nutrition mission has been set up at the secretary level. The design of these institutions also promotes cooperative federalism since they include representation from 5 states on a rotation basis.
  • Geographical Convergence: In parallel to the aspirational districts programme, attempts would be made to uplift the worst performing districts. Considering the widespread disparities in nutritional outcomes, it is logical to target the worst performing districts.
  • Jan Andolan: Success in the nutrition mission demands community participation because most of the aspects of change are behavioral and the government interventions intend to nudge the communities towards right practices. This would play a role in bringing about a lasting change at the ground level.

 

Nutritional Status in India

Malnutrition indicators in India remain among the highest in the world, despite a declining trend since the early 1990s. The recent figures from NFHS 4 are encouraging, showing further improvement on most indicators.

Key Nutrition Metrics:

  • Key Centrally Sponsored Schemes (CSSs) with a focus on health have seen budgetary cuts over the last two years. Central allocations to the ICDS have declined almost by 10%.
  • A complimentary public intervention is the Mid-Day Meal programme. Field studies highlight the link between the provision of school meals and improved cognition.

Existing Policy Framework:

The most prominent government nutrition interventions include the ICDS programme led by the Ministry of Women and Child Development (MWCD), and the NHRM led by the Ministry of Health and Family Welfare (MHFW). Both CSSs prioritise the role of community level organisations – AWCs and AWWs under ICDS and Accredited Social Health Activists (ASHAs) under the NHRM – for delivery of nutrition interventions to the target groups of pregnant and lactating mothers and infants.

These programmes are supplemented by the PDS, which is used to provide subsidised food grains to large sections of the country’s poor. In addition, more than six states, including Maharashtra, Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat, Karnataka and most recently Jharkhand have also established state nutrition missions.

Policy Recommendations:

1)Strengthen and restructure ICDS and leverage PDS:

ICDS needs to be in mission mode. Last – mile delivery of ICDS interventions needs to standardise the nutritional component of supplementary food, prioritise educational outreach to pregnant and lactating mothers, improve programme targeting and streamline operations of AWCs through better infrastructure provision and training for AWWs.

2)Extend coverage of food fortification of staples:

Currently fortification of staples is limited to the mandatory iodisation of salt. Additional proposals under consideration include making the double fortification of salt (with iodine and iron), and the fortification of edible oils mandatory. The standards of hot cooked meal should also be changed to using only fortified inputs.

3)Target multiple contributing factors, for example, WASH

Swachh Bharat Abhiyan has increased access to toilets throughout the country.  However, the push for toilet construction must be combined with a strategy for behavioural change.

4)Align agricultural policy with national nutritional objectives:

Agriculture policy must be brought in tune with nutrition policy, with incentives provided for encouraging the production of nutrient rich and local crops for self-consumption. Efforts should be made to discourage the cultivation of resource rich cash crops with no nutrient value such as sugar cane and cotton.

5)Boost private sector engagement in nutrition intervention:

Private sector collaboration in the form of public-private partnerships (PPPs) has the potential to leverage the appropriate technology for scaling-up food fortification interventions and to develop and distribute nutrient-rich foods to improve maternal and infant nutrition. The PPPs can leverage technological solutions for scaling up food fortification initiatives and complement the government’s outreach efforts through mass awareness.

Decentralised Approach to Tackling Nutrition

According to a statement by the Ministry of Finance in 2016, “the highest economic returns to public investment in human capital in India lie in maternal and early-life health and nutrition interventions. The World Development Report published the most striking visual representation of the impact that5 poor nutrition can have on deprivation in the brain.  Focussed on the global learning crisis, the report shows significant differences in the MRI scan of brain of 2 infants, one stunted, while the other wasn’t.

Economics of Nutrition:

Several billion dollars are lost in terms of GDP due to malnutrition. These are direct losses in physical productivity due to mortality and also indirect losses from poor cognitive skills, loss of schooling or due to increased health care costs. The return on investment prevented by Malnutrition is extremely high. The Global Nutrition Report of 2016 estimates that for every dollar invested in nutrition, yields a return of 16 dollars.

On paper and policy – the recent interventions on nutrition have all the right ingredients. Funds have been set aside, the need for a comprehensive approach is specified, institutional structures such as the National Council on India’s Nutritional Challenges and Executive Committees have been set up; nutrition specific and sensitive schemes have been mapped and access to sanitation facilities has simultaneously improved.

However, given the complexity and diversity of the issue, a routine centralised, target driven approach towards implementing the programme may not work. Instead, for the mission to succeed, a decentralised approach with a focus on the first principles – namely the 3 Fs – Funds, Functions and Functionaries will be critical.

 

  1. Flexible Financing:
  • The first step in ensuring the success of the programme is to get the financing right. Analysis undertaken of the NFHS as well as Rapid Survey of Children (RSOC) has highlighted significant inter-state and intra-state variation on achievement in nutritional outcomes.
  • It will be essential to also provide essential flexibility such that the states or even the districts can choose from a basket of interventions based on their current level of nutritional development.
  • If for instance, a state or a district or even a Panchayat wants to tackle nutrition by focusing on ending open defecation, it should have the flexibility of determining its own roadmap.
  1. Clearly defined Functions:

In order to strengthen coordination across ministries and have clear lines of accountability, roles and responsibilities and accountabilities of each member within the bureaucracy will need to be clearly defined and articulated.

  1. Focus on the Functionaries:

Finally, the lower and mid-level bureaucrats and front-line workers at the last mile are critical resources in the implementation of government schemes and can make or break the state’s ability to deliver on its promises.

For many years, the government has been grappling with acute shortage of staff. In such a scenario, the short-staffed delivery systems are only able to focus on routine activities. Softer items such as innovation, counselling and training are neglected. Long-term sustainable efforts at behavioural change will require fixing these capacity constraints urgently.

Shaping Food Consumption

The National Food Security Act primarily focuses on providing food security via expansion of Public Distribution System. This move could lead to income effect or the substitution effect, which effect prevails remains an empirical question.

Income Effect: For certain households, being able to buy cheap cereals will free up money to purchase other foods such as milk, fruits, eggs, meat etc.

Substitution Effect: For the other households, having other dominating consumption needs, money saved by purchasing subsidized cereals would be devoted to those needs and would be diverted from food expenditure.

Tit-bits:

According to the Global Nutrition Report 2017, India is facing a serious burden of undernutrition, which shows that more than half the women of reproductive age in the country suffer from anaemia.

Public Distribution System

PDS in India is perhaps the largest distribution network of its type in the world. It is an Indian food Security System for the poor people established by the Government of India under the Ministry of Consumer Affairs, Food and Public Distribution. While the Central government is responsible for procurement, storage, transportation and bulk allocation of food grains, the State governments hold the responsibility for distributing the same to the consumer through the established network of Fair Price Shops. Major commodities distributed include wheat, rice, sugar and kerosene.

The PDS was envisaged as a means of dealing with nutritional deficiency. It was launched as a universal programme in the context of food shortages during the early years after Independence. Since it was widely criticised for its urban bias, it was subsequently streamlined through the launch of Targeted PDS (TDPS) in June 1997, which aimed at providing very poor families access to food grains at reasonably low costs.

Coverage of TDPS

PDS cards are ubiquitous with households that do not own any card declining from 19% to 14% of the total households between 2004-05 and 2011-12. Although BPL and AAY card holders come from the poorer sections of the society, this concordance is not perfect. The use of the consumption-based poverty line cut-off suggested by the Tendulkar Comiittee indicates that only 29% of the BPL cardholders are poor while 71% are not poor. In contrast, about 13% of the APL cardholders are poor while 87% are not poor. Thus, many non-poor have BPL cards while some of the por are excluded from the ownership of BPL cards.

Targeting Efficiency

While Exclusion Errors in PDS targeting have declined, inclusion errors have increased. However, both the errors remain high. This change could be attributed to a decrease in the poverty levels as well as a slight increase in the number of cards being distributed to the whole population.

Role of Below Poverty Line and Antyodaya Anna Yojana subsidies in Shaping Food Expenditure

Application of the Propensity Score Matching (PSM) techniques show that at any given income level, households with BPL/AAY cards are more likely to buy cereals from PDS shops than those with APL cards. Rising incomes lead to greater dietary diversification for households without BPL cards than the matched households with BPL cards.

National Food Security Act, 2013

The National Food Security Act (NFSA) was enacted by the Government in the year 2013 to provide food and nutritional security in human life cycle approach, by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity.

The Act inter alia entitles upto 75% of rural population and upto 50% of the urban population for receiving subsidized foodgrains under TDPS, thus covering about 2/3rd of the population.

Eligible household comprise of priority households and AAY households. Persons belonging to priority households are entitled to receive 5kg of foodgrains per person per month at subsidized prices. AAY households, which constitute the poorest of the poor, would continue to receive 35 kg food grains per household per month

The PDS needs to be effectively monitored and there is a need to explore the possibility of introducing innovative ideas such as smart cards, food credit/debit cards, food stamps and decentralised procurement, to eliminate hunger and make food available to the poor wherever they may be in a cost effective manner.

Financial Inclusion in India: Challenges and Way Forward

Financial inclusion is a process that enables improved and better sustainable economic and social development of the country. It focuses on raising the standard of living of the underprivileged people in the society with the objective of making them self-sufficient and well informed to make better financxial decisions. Also, it acknowledges the participation of the low-income groups based on the extent of their access to financial services in economic growth.

The aim of financial inclusion is delivery of financial services to low income groups with the provision of equal opportunities.

 

Historical Developments:

Contrary to general belief, historically, India is a pioneer in financial inclusion. The Cooperative Credit Societies Act, 1904 gave an impetus to cooperative movement in India. The objective of cooperative banks was to extend banking facilities, mainly availability of credit on easy terms compared to money lenders who were well known to charge high rates of interest.

  • Financial inclusion exercise explicitly started with the nationalization of State Bank of India in 1955.
  • Banks were nationalised in 1969 to serve the unbanked population, mainly weaker sections of the society as well as rural areas.
  • The concept of priority sector lending became important by 1974 which implied directed lending to unbanked areas, and in 1980, eight more private banks were nationalised to extend banking in rural and remote areas. Since then, there has been a considerable reorientation of bank lending to accelerate the process of development, especially of the priority sector, which had not previously received sufficient attention.
  • Since 2005, Government of India along with the Reserve Bank of India (RBI) and National Bank for Reconstruction and Development (NABARD) has been initiating a number of concerted measures to enhance financial inclusion in India. These measures include Self Help Group- bank linkage programme, use of business facilitators and correspondents, easing of ‘Know Your Customer’ (KYC) norms, electronic benefits transfer, use of mobile technology, opening ‘no-frill accounts’ and emphasis on financial literacy.
  • Opening customer service centres, credit counselling centres, Kisan Credit Card, National Pension Scheme, MGNREGS, Aadhaar scheme. The banking penetration, despite concerted efforts was low.

To ensure a banking account in every household, the Prime Minister announced the need for focused efforts. The objective of Pradhan Mantri Jan Dhan Yojana (PMJDY) was widening access to various basic financial services like savings bank account; need based credit, remittances facility and insurance and pension to excluded sections, mainly weaker sections and low-income groups. The Government continued its efforts towards achieving financial inclusion by introducing Micro Units Development Refinance Agency (MUDRA) to focus on providing credit to small entrepreneurs. In a logical and well-sequenced step, the Central government extended social security to the masses. The flagship scheme, Atal Pension Yojana (APY) aims to provide old age income security to the working poor in the unorganised sector. Jeevan Jyothi insurance scheme providing a one year cover, renewable annually, offering life insurance and Suraksha insurance scheme, renewable annually, providing insurance and Suraksha insurance scheme, renewable annually, providing insurance to cover death or disability on account of an accident.

 

Challenges:

The key challenges in extensively extending financial inclusion are:

  1. Some Accounts under PMJDY are not operative due to lack of funds with account holders. Implementing technological advancements is a matter of concern.
  2. Lack of financial literacy in the rural households.
  3. There is a need for technical and institutional infrastructure for e-payment systems to service a large number of new and existing accounts.
  4. There is a requirement of sufficient technical skill development and training for banks and institutional staff.
  5. Security of transactions is a matter of concern.
  6. Lack of ease in transaction related activities in banks is clearly demonstrated by the repetitive behaviour of rural households’ persistence in taking loans from the money lenders.
  7. There is a need for greater use of technology.
  8. Factors such as lower income or asset holdings, lack of awareness about the financial products, perceivably unaffordable products, high transaction costs, products which are not convenient, inflexible, and not customized to the rural sector income pattern are a major barrier for gaining access to the financial system.
  9. Costs in terms of increasing expenditure on IT deployment and risks in terms of monetary loss, data theft and breach of privacy are a concern.
  10. Nearly 31 crore new accounts have been opened in previous 3 years under PMJDY and nearly 80% of these are first time users. This can be a threat to cyber security especially when KYC norms have been diluted.

 

The governments, globally, have been making effort to extend financial services to large segments of the population because financial inclusion promotes economic equality and economic growth. The issue of digitization, necessary for achieving higher financial inclusion, is serious and needs analysis. The country has low level of literacy, with English literacy of not more than 10% of the population. Given the fact that all electronic devices have English numerals and all communication on digital banking is also in English, there is the natural barrier to completely digitize Indian economy during the immediate period. 

The cost of providing equipment in remote parts of the country and ensuring seamless connectivity at the affordable cost would be another challenge that would need to be addressed. In view of the success of PMJDY, a new gap clearly emerged and that is regulation of the micro and rural sector.

 

Tit-Bits:

Baseline Ranking of Aspirational Districts

The NITI Aayog launched the baseline ranking for the Aspirational Districts recently. These rankings are to be based on published data of 49 indicators across five developmental areas of Health and Nutrition, Education, Agriculture and Water Resources, Financial Inclusion and Skill Development and Basic Infrastructure.

‘Transformation of Aspirational Districts’ programme aims to quickly and effectively transform some of the most underdeveloped districts of the country. The broad contours of the programme are Convergence (of Central and State Schemes), Collaboration (of Central, State level ‘Prabhari’ Officers and District Collectors), and Competition among districts driven by a Mass Movement a Jan Andolan. With States as the main drivers, this program will focus on the strength of each district, identify low-hanging fruits for immediate improvement, measure progress, and rank districts.

Health and Nutrition, Education, Agriculture and Water Resources, Financial Inclusion and Skill Development, and Basic Infrastructure are this programme’s core areas of focus. Districts are prodded and encouraged to first catch-up with the best district within their state, and subsequently aspire to become one of the best in the country, by competing with, and learning from others in the spirit of competitive and cooperative federalism.

Boosting Infrastructure to fuel Development

The Government has announced commitments to build large infrastructure projects through significant public expenditure and with the help of private partners – including foreign investors. There are some areas in infrastructure where the externalities caused by projects cannot be captured by project revenues alone. Therefore, the government has created a Viability Gap Funding arrangement through a window in the Finance Ministry.

Urbanization is an opportunity and priority so the government ha srolled out two inter-linked programmes – Smart Cities Mission and the AMRUT.

The Smart Cities Mission aims at building 100 Smart Cities with the state-of-art amenities. These Cities have started implementing various projects like Smart Command and Control Centre, Smart Roads, Solar Rooftops, Intelligent Transport Systems, Smart Parks.

To Preserve and revitalize soul of the heritage cities in India, National Heritage City Development and Augmentation Yojana (HRIDAY) has been taken up in a major way. The AMRUT programme focuses on providing water supply to all households in 500 cities.

The government also ensured to leverage the India Infrastructure Finance Corporation Limited (IIFCL) to help finance major infrastructure projects, including investments in education and health infrastructure, on strategic and larger societal benefit considerations.

Ambitious Bharatmala Pariyojana has been approved for providing seamless connectivity of interior and backward areas and borders of the country.

Power Sector:

The PPAs would seek to cover 100% of the annual average demand of a particular state or a discom. The government’s strategy is aimed at improving India’s per capita power consumption, which is around 1000 kWh among the lowest in the world. The government also talked about a radical plan to separate the so-called carriage and content operations of existing power distribution companies. Carriage refers to the distribution aspect and content to electrify itself.

The separation will allow people and companies in India buy electricity from a power company of their choice, and have it supplied to them by the distribution network that services the neighbourhood in which they live. The result, apart from the choice of consumers, would be lower tariffs because of the competition. This will help in reduction of cross-subsidies borne by the industry, and make tariffs more competitive for businesses thereby pushing the government’s ‘Make in India’ drive. With its draft national energy policy, Government’s policy think-tank NITI Aayog has pitched for DBT in the electricity sector.

Housing:

The Housing for All Mission aims to build on Rajiv Awas Yojana (RAY) and fully address the housing shortage by 2022.

Transport:

Specific actins taken by Government include the development of inland waterways, coastal shipping, dedicated freight corridors in railways, electronic tolling system, development of public transport including metro, bus rapid common ticketing for urban treansport etc.

The strong advantages of infrastructure development in India are governed by huge demand as it has a requirement of investment worth Rs. 50 trillion in infrastructure by 2022 to have sustainable development in the country.

Interestingly strong policy support like the ‘Housing for All’ and ‘Smart Cities Mission’ the Government of India is working on reducing bottlenecks pushing growth in the infrastructure sector. With the UDAY Scheme, that will help in financial turnaround and revival of electricity distribution companies of India, the power sector has been registering strong growth. Also 100% FDI is permitted under the various infrastructure sectors. A strong momentum is also over served in the expansion of roadways.

The eight core infrastructure industries include coal, crude oil, natural gas, refinery products, fertilizers, steel, cement and electricity. The overall index grew by 4.8% during FY 2016-17. The growth drivers for infrastructure in India are Government Initiatives, Infrastructure Need, Housing Development, International Investment and Public-Private Partnerships.

Public Private Partnership:

The Government is attempting to revive and give a boost to Public-Private Partnerships. Japanese investment has played a significant role in India’s growth story. Japan has pledged investments of around US$35 billion for the period of 2014-19 to boost India’s manufacturing and infrastructure sectors. The Japanese government is constantly looking for investment opportunities in India. Asian Development Bank will provide US$ 275 million loans for a piped water supply project for rapidly urbanizing small towns, covering 3 lakh households, in Madhya Pradesh. India will need to construct 43000 houses every day until 2022 to achieve the vision of Housing for All by 2022. Hundreds of new cities need to be developed over the next decade under the smart city programme. This has the potential for catapulting India to third largest construction market globally. The sector is expected to contribute 15% to the Indian economy by 2030. The recent policy reforms such as Real Estate Act, GST, REITs, steps to reduce approval delays etc are only going to strengthen the real estate and construction sector.

Recent Budget Provisions:

The Union Budget 2018 has identified infrastructure sector as the growth drivers of Indian Economy and essential for further economic development.  

The Government has set aside Rs. 21,000 crore for building 5.1 million rural houses under the Prime Minister Awas Yojana (PMAY). Sectors including cement, steel, paints, sanitary ware and electricals could benefit from the Government’s decision to step up its affordable housing drive. The Government will create a dedicated Affordable Housing Fund in National Housing Bank. An interesting subsidy will be provided to rural households that are not covered under PMAY.

The budget also levied a Rs. 8 per liter road and infrastructure cess on imported petrol and diesel. The government and market regulators also have taken necessary measures for development of monetizing vehicles like Infrastructure Investment Trust (InvIT) and Real Estate Investment Trust (ReITS).

 

Stretching a Hand to the Vulnerable

Social Inclusion refers to access to favourable opportunities in society to enhance one’s life chances. Such opportunities comprise of education, employment, social services and social protection. The absence of these opportunities is social exclusion, which results in marginalization, poverty and material deprivation.

 

Constitutional Provisions:

The Constitution of India through its Preamble seeks to secure to all its citizens – justice, social, economic and political; liberty of thought, expression, belief, faith and worship; and equality of status and of opportunity.

  • The Indian Constitution has outlined through the Fundamental Rights and DPSPs, the state’s policies for Social Inclusion.
  • Part III of the Indian Constitution provides for 6 Fundamental Rights for Social Inclusion. These include Right to Equality, Right to Freedom, Right against Exploitation, Right to Freedom of Religion, Cultural and Educational Rights and Right to Constitutional Remedies.
  • These Rights are also available to persons with disabilities.
  • Article 15 (3) empowers the State to make special provisions for women and children in educational institutions and employment opportunities. This provision has been widely invoked by Government for providing exclusive reservation of certain categories of posts for women and for reservation of women in local bodies and educational institutions.
  • Article 15 (4) seeks to promote the educational advancement of socially and educationally backward classes of citizens, i.e, the OBCs, the Scheduled Castes and Scheduled Tribes in matters of admission of students belonging to these categories in unaided educational institutions
  • Article 17 abolishes untouchability and its practice in any form. The enforcement of any disability arising out of untouchability shall be an offence in accordance with the law.
  • The DPSPs are enshrined in Part IV of the Indian Constitution.
  • Article 38 says that the state shall strive to promote the welfare of the people by securing and protecting effectively as it may, a social order in which justice, social, economic and political shall inform all the institutions of the national life.
  • Article 39 provides for the abolition of child labour and for equal pay for equal work for both men and women.
  • Article 41provides for Right to Work, to education, to public assistance in case of unemployment, old age, sickness and disablement and in other cases of undeserved want.
  • Article 42 provides for just and humane conditions of work and for maternity relief.
  • The 11th schedule to Article 243 G says that Social Welfare including the Welfare of the handicapped and mentally retarded, and the 12th schedule to Article 243 W says that safeguarding the Interests of Weaker Sections of Society including the handicapped and the mentally retarded.

Governance Structures:

The Government of India’s Social Inclusion programmes is implemented by the Ministries of Social Justice and Empowerment, Tribal Affairs, Women and Child Development and Minority Affairs.

 

Ministry of Social Justice and Empowerment:

The Ministry of Social Justice and Empowerment implements 42 schemes for the welfare of Scheduled Castes. The Ministry seeks educational empowerment, economic empowerment and social empowerment under its various schemes. The Ministry is the custodian of 2 Acts, specifically aimed at curbing

  1. Untouchability
  2. Atrocities against Scheduled Castes and Scheduled Tribes

These are the Protection of Civil Rights Act 1955 and the Scheduled Castes and Scheduled Tribes (Prevention of Atrocities) Act 1989. The National Commission for Scheduled Castes was set up under Article 383 of Constitution in 1990.

The economic empowerment of Scheduled Castes is through the special central assistance to the scheduled castes sub-plan (SCSP). Assistance is provided by the State Scheduled Caste Development Corporations, which implement economic development schemes with the equity transferred by the central government. The State Scheduled Caste Development Corporations provide credit and inputs by way of margin money loans and subsidy. India established the National Scheduled Castes Finance and Development Corporation to provide concessional loans to Scheduled Castes families and skill cum entrepreneurial training to the youth of the target group living below double the poverty line. The National Safai Karmacharis Finance and Development Corporation has been established for economic empowerment of scavengers and manual scavengers.

 

Department for Empowerment of Persons with Disabilities (Divyangjan)

The Department for Empowerment of Persons with Disabilities deals with the legislation governing different aspects of disability and welfare and empowerment of persons with disabilities. These are the Rehabilitation Council of India Act 1992, The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1955 and the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act 1999.

There are 3 Statutory bodies under the Department.

  1. The Rehabilitation Council of India is responsible for regulating training policies and programmes for various categories of professionals in the area of rehabilitation and special education.
  2. The Chief Commissioner for Persons with Disabilities is the statutory functionary under the Act of 1955 to coordinate work of State Commissioners for persons with disabilities.
  3. The National Trust is a statutory body, which enables and empowers persons with disabilities to live independently as fully as possible and to extend support to registered organizations providing need-based services.

India has set up 6 National Institutes/ Apex Level Institutes to deal with multi-dimensional problem of disabled population in each major area of disability. The National Handicapped Finance and Development Corporation is the apex level financial institution for extending credit facilities to persons with disabilities for their economic development.

The Accessible India campaign is a nationwide flagship campaign to ensure a barrier-free and conducive environment for Divyangjans all over the country, launched by the Prime Minister in 2015 for creating universal accessibility for persons with Disabilities.

 

Ministry of Tribal Affairs

The Ministry of Tribal Affairs was established with the objective of providing a focused approach to the integrated socio-economic development of the Scheduled Tribes, in a coordinated and planned manner. The scheduled areas are notified under Article 244 (1) of the Constitution. Article 244 (2) relates to those areas in the State of Assam, Meghalaya, Tripura and Mizoram which are declared Tribal Areas and provides for District Councils/ Regional Councils for such areas.

The Ministry administers grants to states comprising of special central assistance to tribal sub-plan schemes, grants under Article 275 (1) of the Constitution of India, grants for the Ekalavya Model Residential Schools; education grants for vocational training centres in tribal areas, establishment of ashram school in Tribal Sub-Plan areas, and livelihood support grants for minimum support price for minor forest produce. The Ministry also provides equity support to the Tribal Cooperative and Marketing Federation of India and the State – Tribal Cooperative and Marketing Federation. The National Scheduled Tribes Finance and Development Corporation provides financial assistance to empower tribals for undertaking self-employment ventures. The National Commission for Scheduled Tribes was established under Article 338A of the Constitution as an independent body to safeguard the rights of tribals.

National Policy for Older Persons:

India’s National Policy for Older Persons seeks to encourage individuals to make provisions for their own as well as their spouse’s old age; to encourage families to take care of their older family members and to promote research and training facilities to train geriatric caregivers and organizers of services for the elderly. The Government has constituted the National Council for Older Persons to advise and aid the Government in developing policies for older persons.

Ministry of Women and Child Development

The Ministry of Women and Child Development was established in 2006 with the responsibility to advance the rights and concerns of women and children and to promote their survival, protection, development and participation in a holistic manner. It was also expected to bring about inter-ministerial and inter-state convergence with regard to women and child development programmes. The National Policy for Empowerment of Women lays down detailed prescriptions to address discrimination against women, strengthen existing institutions, provide better access to health care, equal opportunities for women’s participation in decision making and mainstreaming gender concerns in developmental process. The policies and programmes of government have been formulated on the lines of the broader vision laid down by the National Policy for Empowerment of Women.

The Ministry of Women and Child Development is the custodian of several Acts relating to women and children. Prominent among these is the Dowry Prohibition Act, the Prohibition of Child Marriage Act, the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, and the Juvenile Justice (Care & Protection of Children) Amendment Act 2011.

The National Commission of Women and the National Commission for Protection of Chi8ld Rights have been established under the aegis of Ministry of Women and Child Development to safeguard the rights of women and protect children’s rights respectively.

Amongst the flagship schemes implemented by the Ministry of Women and Child Development are the Umbrella ICDS, Women Empowerment Schemes like Beti Bachao Beti Padhao and a series of grant in aid schemes in the field of women and child development.

  • The umbrella ICDS comprises of 6 components namely
  1. Anganwadi Services Scheme
  2. Pradhan Mantri Matru Vandana Yojana
  3. National Creche Scheme
  4. Poshan Abhiyan
  5. Scheme for Adolescent Girls
  6. Child Protection Scheme

 

  • The ICDS is aimed at improving the nutritional and child health status of children below the age of six years and pregnant and lactating mothers as also to reduce the mortality, morbidity and malnutrition.
  • The Beti Bachao Beti Padhao scheme is to celebrate the girl child and enable her education. The main objectives of the scheme are to prevent gender-based sex-selective elimination, to ensure survival and protection of the girl child and to ensure education and participation of the girl child. The scheme seeks to improve sex ratio at birth in selected gender critical districts by 2 points a year.

Expanding Universal Health Coverage

The mandate of the Ministry of Health and Family Welfare (MoHFW) is to ensure that the health services reach the most vulnerable and the unserved populations. To fulfill this, the Ministry has taken up initiatives to ensure and expand Universal Health Coverage (UHC).

One of the significant steps has been the announcement of the National Health Policy 2017, to address the current and emerging challenges necessitated by the changing socio-economic and epidemiological landscapes of the country. While the Policy touches upon all components of healthcare in the country, it has brought focus to preventive and promotive health, primary health care and ensuring access, affordability and quality of health services. The other policy initiatives have been the Mental Healthcare Act 2017, HIV and AIDS (Prevention and Control) Act – 2017 and amendment of the Indian Medical Council Act, 1956 for a uniform entrance examination for admission to all medical seats in the country.

 

Other significant steps and initiatives by the  Ministry of Health and Family Welfare (MoHFW):

  • A landmark initiative to expand the universal health coverage across the country is – Ayushman Bharat. It has two components viz, Comprehensive Primary Health Care (CPHC) and National Health Protection Mission (NHPM).
  • The NHPM is poised to be the largest public funded health insurance scheme in the world.
  • The Health Ministry has been persistently working on ensuring accessibility, affordability and quality of health services with special focus on reducing the Out Of Pocket Expenditures (OOPE) of the beneficiary. Under the flagship programme National Health Mission (NHM) essential drugs and diagnostics are provided at all public facilities through the Free Drugs and Diagnostics program.
  • Through 124 Affordable Medicines and Reliable Implants for Treatment (AMRIT) Pharmacies, drugs and other consumables are sold at a significant discount of up to 50% on market rates.
  • The Pradhan Mantri National Dialysis Programme (PM-NDP) conducts free dialysis sessions.
  • Maternal health programs such as Janani Shishu Yojana have benefitted lakhs of mothers.
  • Pradhan Mantri Surakshit Matritva Abhiyan has helped identify more than 6 lakh high-risk pregnancies through more than 1.16 crore antenatal check-ups.
  • LaQshya – ‘Labour room Quality improvement Initiative’ is a focused and targeted approach to strengthen key processes related to the labour rooms and maternity operation theatres.
  • A singular and landmark achievement for India is that it has been validated for Maternal and Neonatal Tetanus Elimination (MNTE) in April 2015. Noteworthy is that India’s Under-five Mortality Rate and Maternal Mortality Ratio declined at a higher pace than the global average.
  • A significant accomplishment has been an expansion of the world’s biggest public health intervention i.e, Universal Immunization Program (UIP), by launching five new vaccines (Measles-Rubella, Pneumococcal, Rotavirus, Inactivated Polio and Japanese Encephalitis). Mission Indra dhanush was an important component of UIP. For achieving the target of achieving 90% full immunization, Intensified Mission Indra dhanush was launched in 2017.
  • MoHFW implements several programs to cater to each life stage of a child i.e, ante-natal to adolescent and thereunto family planning and pregnancy.
    • The MAA – Mother’s Absolute Affection has enhanced the focus on breastfeeding.
    • Intensified Diarrhoea Control Fortnight (IDFC) to combat mortality in children due to childhood diarrhoea
    • National Deworming Day (NDD) to combat Soil-Transmitted Helminth (STH) infections.
    • The Rashtriya Bal Swasthya Karyakram (RBSK) entails provision for child health screening and early intervention services through early detection and management of 4 D’s i.e, Defects at birth, Diseases, Deficiencies, Development delays.
    • With a high focus on the adolescent health, the Rashtriya Kishor Swasthya Karyakram (RKSK) was launched.
    • Mission Parivar Vikas programme was launched in 2016 for increasing access to contraceptives and family planning services. As a part of Nayi Pehel, family planning kit is provided by the ASHAs to the newlyweds.
    • Saas Bahu Sammelan are held to encourage young married women and their mothers-in-law to freely discuss matters related to family planning and reproductive health.
  • An announcement has been made by the PM for achievement of TB Free India by 2025.

 

The NHP 2017 clearly states tapping of IT for healthcare, and MoHFW has several IT initiatives including development of ‘inter-operable Electronic Health Records (HER) system, telemedicine services, public health IT solutions, Mother and Child Tracking System, Kilkari App etc. There has been a sharp focus on provision of affordable, accessible quality healthcare through various strategic interventions. The efforts are in the direction of achieving Swastha Bharat, Samruddh Bharat.

 

 

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