UPSC Mains Answer Writing (GS 2 - Day 32)

Topic: Health, Education, Human Resources, Poverty and Hunger

Q1. Discuss why development of the social sector is important and what are the issues involved in its development. (10 Marks)

Model Structure

Introduction

• Social sector includes areas like health, education, skill development, overall empowerment and fulfillment of essential needs which results in human capital formation and development.

Main Body

• Development and growth are different concepts and no country has progressed without development of the social sector. It is important to invest in social sector because-
  • Better health indicators translate into better productivity, more expenditure in development parameters and less out of pocket expenditure.
  • Women empowerment and care of old age people means active participation of more than 50% population in the development process.
  • India has lagged behind in structural transformation of the economy due to neglect of skill development. This has affected the transformation of the social sector as a whole.
  • Better access to justice and speedy disposal of cases is another area which helps overall development of the social sector.
  • Literacy rate in India is around 75% which is way less than many of the advanced economies. It doesn’t bode well for the 5^th largest economy in the world.
• India has lagged behind in development of social sector due to challenges like-
  • Share of education as a percentage of GDP has remained stagnant around 2.8% which is problematic considering high drop out ratio and poor accessibility and affordability of education for the masses.
  • Though we are food surplus, yet we face issues of hunger as recently revealed by Global Hunger Index. This is in addition to issues like malnutrition, stunting, wasting and over-weight.
  • Even in the health sector, expenditure as a percentage of GDP is very dismal around 1.6 % which is way lower than many advanced economies.
  • Unemployment levels are also very high which increases dependency ratio and has potential to turn demographic dividend into a disaster.

Conclusion

Public spending in the social sector needs to be increased as recommended by the 15^th Finance Commission. It called for increasing expenditure in the health sector to 2.1% of GDP. There can also be a combined vision of 5 years involving center and states for the social sector.

Q2. Accredited Social Health Activists (ASHAs) form a critical pillar of India's rural healthcare system. Discuss the role of ASHA workers in strengthening primary healthcare in India, especially in remote areas. Evaluate the challenges they face in executing their duties, and propose measures to improve their working conditions and effectiveness. (10 Marks)

Model Structure

Introduction 

• ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing the benefits of various healthcare schemes of the government. OR
• The World Health Organization (WHO) has recognised India's 10.4 lakh ASHA workers as 'Global Health Leaders' for their efforts in connecting the community to the government’s health programmes. (Data-based)

Main Body

Role of ASHA workers 

• They act as a bridge connecting marginalized communities with facilities such as primary health centres, sub-centres and district hospitals.
• The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.
• The aim is to have one ASHA for every 1,000 persons or per habitation in hilly, tribal or other sparsely populated areas.
• ASHA workers are also tasked with ensuring and motivating children to get immunized.

Challenges faced by ASHA workers 

• Low Remuneration: ASHAs receive performance-based incentives, often insufficient to compensate for their efforts and the risks involved.
• Overburdened with Work: Given the broad array of services they provide, they are often overworked and under-equipped.
• Lack of Professional Growth: There is a lack of clear career progression and skill development opportunities for ASHA workers. (for e.g. ASHA workers were not treated the same as doctors even though both are on the frontline in the fight against the pandemic.)
• Social Barriers: ASHAs often face social barriers, including gender-based discrimination and resistance from the community.

Measures to improve their functioning

• Improve Remuneration: Establishing a fixed salary structure, along with performance-based incentives, could enhance their financial stability.
• Capacity Building: Regular training and skill development programs should be organized to equip ASHAs with the latest healthcare knowledge and techniques.
• Career Progression: Creating a structured career progression pathway would improve their job satisfaction and motivation.
• Strengthen Infrastructure: Ensuring proper healthcare infrastructure and supplies would enhance their ability to deliver services effectively.
• Social Security: Providing ASHAs with benefits such as insurance, maternity leave, and pensions would help improve their working conditions.
• Recognition of ASHAs’ work by the government and their communities through financial and non-financial incentives.
• Development of institutional mechanisms for feeding ASHAs’ experiences, needs and class, caste and gender realities in policymaking.
• Development of support systems for ensuring the physical and mental well-being of ASHAs.
• Initiation of broader health system reforms for ASHAs, including strengthening policies for fair recruitment, retention, financial protection, leave management, protection against sexual harassment, physical and mental health protection and stigma prevention with clear accountability at all levels.

Conclusion 

ASHA workers are the backbone of India's rural healthcare system. Strengthening their role, addressing their challenges, and improving their working conditions can significantly bolster India's primary healthcare, bringing us closer to achieving universal health coverage.

Q3. The socio-economic benefits of Universal Health Coverage are plenty, but for it to be a reality the government must learn core lessons from pandemics and rebuild trust in public health. Comment. (15 Marks)

Model Structure

Introduction

• India with mass poverty, geographically distant communities, absence of healthcare infrastructure and shortage of healthcare professionals, needs a robust universal health coverage programme.

Main Body:

Socio-Economic benefits of Universal Healthcare Coverage

• Social:
  • Enhance accessibility: every individual should have access to services that address the causes of disease and death.
  • Improve health: UHC ensures that quality of health services are good enough leading to improved health of people
  • Formation of human capital: affordable and good quality health services to women, children, adolescents and people suffering from mental health issues, would enhance human capital.
• Economic:
  • Reduction of financial distress: it protects people from spending on healthcare services out of their own pockets.
  • Reduction of poverty: it will cut down the risk of people being pushed into poverty due to huge amounts of spending on unexpected diseases.
  • Economic development: In the long run, good health will allow children to learn and adults to earn.
    • Building a foundation of economic development in the country.

To provide UHC-core lessons of the pandemic

• Human Resources:
  • Shortage of healthcare professionals: especially in rural and small cities. 
    • Only 45 doctors per lakh population are available, against WHO recommendation of 100.
  • Compulsory Rural Stint: To enhance availability and accessibility.
    •  Maharashtra’s step to stop doctors avoiding rural stint after paying 10 lakhs fine.
• Affordability:
  • Price Regulation: Need to regulate rates and quality in the private sector.
  • Insurance coverage: Increase insurance penetration and also the spectrum of treatments covered and PMJAY’s hospital coverage.
  • Decrease out of pocket expenditure: Report by Pew Research Center states that the pandemic pushed 32 million out of the middle class.
• Structural changes:
  • Increase vaccination infrastructure: to tackle mass vaccination on lines of Polio eradication programme.
  • Network of laboratories: Robust testing infrastructure, with hub and spoke model.
  • WHO’s framework of six healthcare system building blocks: Study the lessons learnt post pandemic and create actionable points.
• Innovative Approach:
  • Behavioral change campaigns: On lines of Swachh Bharat Mission to instill hygiene habits like hand washing.
  • Focus on NCDs: NCD burden was highlighted by comorbid complications of COVID-19. They account for 2/3rd deaths in India.
  • Technology leverage: Tele-medicine, mobile-health, and digital platforms should be used for healthcare delivery at remote locations.

Steps to rebuild trust in healthcare:

• Increase public spending on health: By at least 3% by 2024.
• Expand healthcare workforce: multilayered, multi skilled teams that can deliver the needed services must be made available.
• Address regional disparities: incentivising rural areas for healthcare infrastructure.
• Reduce out-of-pocket expenditure: essential drugs and diagnostics at public health care facilities should be made free, especially in rural areas.

Conclusion

• In the pandemic era, it is the public system, with all its problems, that has risen to the occasion. 
• There is a need to transform the fractured healthcare to a single healthcare system for everyone involving both public and private sectors.

Q4. India’s ‘EdTech’ sector, which underwent a boom during COVID-19, is in dire need of regulation for the greater public good. Comment. (10 Marks)

Model Structure

Introduction

• According to the data provided by IBEF, the Indian EdTech industry was valued at US$ 750 million in 2020 and is expected to reach US$ 4 billion by 2025. However, in recent times, a need has been felt for its urgent regulation. (Data-based)
• EdTech, or Education Technology, refers to using the Information and Communications Technology (ICT) ecosystem to enhance teaching and learning. Some famous examples include Byju's, Unacademy, UpGrade etc. In recent times, due to many controversies and lack of regulatory clarity, a debate has been ongoing regarding its regulation. (Definition-based)

Main Body

Need for regulation

1. Standardization and Quality Control: There's a wide variation in the quality of content, teaching methodology, and assessment techniques across platforms. A regulatory framework could ensure a minimum quality standard.
2. Data Privacy: EdTech platforms collect vast amounts of data from users. Clear regulations on data protection and privacy are necessary to prevent misuse.
3. Pricing Transparency: Some EdTech platforms employ aggressive marketing strategies with hidden costs, leading to transparency issues. A pricing and refund policy framework can protect consumer rights.
4. Inclusion of Special Needs Students: Regulations could ensure that platforms make provision for special needs students, making learning accessible to all.
5. Certifications and Degrees: Clear guidelines on recognising certificates and degrees from online platforms can ensure their relevance in the job market and prevent fraudulent practices.
6. Investors over students: Many EdTech companies focus more on profit maximization to provide better returns to their investors than the welfare of students. 
7. Misleading ads: Many times, there are false claims and alluring ads that exploit parents' desires.
8. Unfair loans: Many companies, under the garb of being a benefactor, push them to take their courses on loans with intricate terms and conditions for refunds.

Possible areas of regulation:

• Quality Standards: Define and enforce minimum quality standards for EdTech platforms.
• Establish an accreditation system for EdTech platforms. (Just like regular education institutes)
• Affordability Measures: Introduce regulations to promote affordable access to EdTech services.
• Accessibility Requirements: Set guidelines to ensure that EdTech platforms are accessible to all, including students with disabilities. 
  • Eg. features like closed captions, screen readers, and compatibility with assistive technologies.
• Data Privacy and Security: Enact comprehensive data protection regulations for EdTech platforms. Define strict guidelines for the collection, storage, and usage of student data, ensuring that platforms prioritize data privacy and implement robust security measures.
• Transparency in Marketing and Advertising.
• Teacher Qualifications and Monitoring.
• Complaint Redressal Mechanisms: Develop a structured complaint redressal system for students and parents.
• Encourage collaboration between EdTech platforms and traditional educational institutions to promote integration and ensure alignment with established curriculum frameworks.
• Regulatory Oversight and Accountability: Establish a regulatory body or authority to oversee the functioning of the EdTech sector, monitor compliance with regulations, and impose penalties or sanctions for non-compliance.

Conclusion 

It's crucial to strike a balance that allows the EdTech sector to innovate and grow while ensuring it serves the larger interests of society. 

Q5. Differentiating between ‘calorie hunger’ and ‘hidden hunger’, evaluate the extent of hidden hunger in India. Further, suggest strategies to address hidden hunger effectively, aligning with India’s constitutional and policy mandates. (15 Marks)

Model Structure

Introduction 

• According to Global Hunger Index 2022, India ranked 107 among 121 countries and is in the serious hunger category. (Data-based)
• Hunger can be defined as a condition in which a person cannot eat sufficient food to meet basic nutritional needs for a sustained period. Currently, India is home to different types of hunger - calorie hunger, hidden hunger and protein hunger. (Definition-based)

Main BodyDifference between calorie hunger and hidden hunger

According to NFHS-5, nearly 35 % of children under 5 are stunted in India. Further, around 19 % of children under 5 fell in the ‘wasted’ category. 

Strategy to address hidden hunger effectively

• Food Fortification: This involves adding key vitamins and minerals to staple foods. (E.g. FSSAI - Food Fortification Resource Centre (FFRC) to promote large-scale food fortification across India). 
• Diet Diversification: Promoting the consumption of various foods, including fruits, vegetables, whole grains, and animal-sourced foods, can ensure a broader intake of necessary nutrients.
• Supplementation Programs: Providing direct supplements, especially for pregnant women, lactating mothers, and young children.
• Improving Public Health Infrastructure: Strengthening the public health infrastructure to enable regular screening, early detection, and treatment of micronutrient deficiencies.
• Policy Integration: The existing policies must integrate nutrition-sensitive and nutrition-specific interventions. 

Conclusion 

• According to UNICEF, “the ‘hidden hunger’ due to micronutrient deficiency does not produce hunger as we know it. You might not feel it in the belly, but it strikes at the core of your health and vitality.”
• Therefore, it is imperative that interventions be specifically aimed at hidden hunger and not just meeting calorie requirements. 

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