Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
General Studies 1
Population and associated issues, poverty and developmental issues
Improving maternal and newborn health
Despite the remarkable global progress made in maternal and newborn survival over the last decade, the situation remains grim:
6 million babies still die in their first year of life—nearly three million in the first 28 days.
India loses more children under age 5 each year than any other country.
Countrywide, more than half of these deaths occur in the neonatal period, most often because babies are born prematurely, suffer from birth asphyxia, or have neonatal infections.
Of the 27 million babies born in India annually, approximately 13% (3.5 million) are born preterm and 28% (7.6 million) with low birth weight, increasing their risk of dying in the neonatal period.
The maternal mortality for India continues to be high, with 167 maternal deaths per 100,000 live births.
The good news is that there is an upsurge in collective efforts in India to improve neonatal and maternal health in line with the UN’s Sustainable Development Goals.
Many state governments in India are making efforts to address public health challenges in their states. Maharashtra has a home-based newborn care programme in Gadchiroli to reach women in settings where public health infrastructure may be limited. In Odisha, the government is using self-help groups and community participation to address the equity and quality of delivery of public health programmes.
The Union government’s safety net programmes, such as the public distribution system, integrated child development services, and midday meal schemes, while challenged by inefficiency, play an important role in offering social protection and ensuring that poor families do not go hungry.
The training and posting of auxiliary nurse midwives in newly built health sub-centres, under the supervision of block medical officers, is another positive step to improve access to health services in rural areas.
The recent decline in maternal and infant mortality rates is a positive example of public health intervention in India. Several initiatives, such as the Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram, are paying increasing attention to scaling up through institutional delivery, which has a greater impact.
Efforts are under way to implement both facility-based newborn care (FBNC) and home-based newborn care (HBNC) programmes to further reduce maternal and infant mortality.
By ensuring better nutrition for mothers and newborns during the first 1,000 days after birth, we can greatly reduce malnutrition and help infants survive and stay healthy. A simple step like promoting early exclusive breastfeeding has the potential to prevent 13% of global deaths annually for children under five years. The government of India is moving in the right direction with the recent release of guidelines for comprehensive lactation management centres, kangaroo mother care, and for FBNC.
Major challenges remain, especially around ensuring that small and isolated populations, women and children in particular, in vulnerable locations can access the healthcare they need.
Addressing the complex socio-economic and environmental factors:
The complex socio-economic factors leading to ill health in children and women in India.
Neonates born to vulnerable populations, such as the urban and rural poor, and traditionally marginalized and excluded communities, such as Adivasis and Dalits, have a higher probability of being excluded from health services and are at high risk of morbidity and mortality.
As compared to males, newborn deaths among females are higher at the district level—newborn care units typically admit approximately 30% fewer female neonates than male neonates. Studies show that the average expenditure on healthcare during the neonatal period is nearly four times higher in households with male newborns than those with female newborns.
These socio-economic factors continue to persist in spite of numerous efforts by governments and civil society to address them.
To solve challenges successfully, we need urgent and more coordinated collaborative efforts:
We need better oversight and governance through the engagement of civil society organizations and information technology (IT)-enabled platforms, which can lead to the generation of real-time data for better decision making.
Addressing environmental factors: Germs are not the only cause of disease; environmental factors, such as lack of nutrition, safe water, sanitation and hygiene, can also play a role. Without addressing these environmental factors, we will be stuck forever in the reactive treatment mode. Instead, we need to adopt the more proactive and preventive mode, which requires long-term planning and commitment of resources, both human and material.
There are gaps in impact, and the interventions remain inadequate due to limited coverage, governance challenges, and the shortage of health workers in primary healthcare facilities. India’s march towards more development will be faster only if all its current and future citizens have an equal chance to lead a healthy life.
Connecting the dots:
While India has made remarkable global progress made in maternal and newborn survival over the last decade, there is much more which remains to be done. Discuss.
General Studies 2
Urbanization, their problems and their remedies.
General Studies 3
Conservation, Environmental pollution and degradation, environmental impact assessment.
Protecting Indian Lakes
Bellandur lake in Bengaluru has been much in the news in recent months for the surge of foam and froth from the polluted lake, and the rise of smoke and flames from the area surrounding it. In May 2015, the Bellandur lake itself was on fire, creating enormous fear and anxiety in the minds of the people living in the area. The Central Pollution Control Board (CPCB) submitted a report to the Union Ministry of Environment, Forests and Climate Change, highlighting the sustained inflow of untreated sewage and industrial effluents as the principal forces behind the phenomena of froth and fire. Subsequently, an expert committee set up by the state government submitted its report on rejuvenation of the lake in October 2016.
Bellandur: Only one such example
Bellandur is only one example of what we are doing to most of our lakes, streams and rivers in urban India. Out of 480 million litres per day (MLD) of wastewater discharged to the lake, only 308 MLD is treated. According to the CPCB, 75 per cent of the measured pollution in our rivers from point sources is from municipal sewage and 25 per cent is from industrial effluents.
Issues with Indian lakes:
Indian cities and towns have abused their surface water bodies.
Sewerage networks are supposed to ensure that sewage or wastewater is conveyed to a sewage treatment plant, treated and then discharged into water bodies. The sewage treatment is only 30 per cent of the sewage generated for all Indian cities and towns.
Since the “unofficial” groundwater that is used by city residents from private bore-wells is not included in the definition of water consumed by the city, wastewater or sewage (estimated as 80 per cent of the water consumed in the city) is typically under-estimated. The situation with respect to sewage treatment is therefore worse than it appears for all cities.
As the untreated wastewater or sewage finds its way to local waterbodies, it feeds the growth of water-weeds, which blankets surface water. Surfactants are clearly a cause of foam formation.
What needs to be done?
There are no short-cuts to protecting our catchments for freshwater. Waste management is critical — solid waste (garbage), liquid waste (sewage), and acquatic waste.
Urban planning in India must ensure that wetlands which are natural recharge zones are typically not disturbed.
Also, natural drains which provide a safe exit to storm-water including flood-water and also recharge ground water, should be protected from encroachment.
Removal of silt from the lake is required.
Treatment of municipal sewage which is going into the water body.
Closure of polluting industries.
Ban on dumping of municipal solid waste around the lake.
Penalty on apartment buildings in the area which are sending untreated sewage to the lake.
An environmental fine on anyone found dumping waste in and around the lake.
The problem of Eutrophication was identified when Lake Erie, on the US-Canada border, turned green and its aquatic life began dying for want of oxygen, as dying plants sank to the bottom and rotted, consuming dissolved oxygen from the water. This is called eutrophication. Both countries rapidly responded with an international treaty in 1970 which, has since 1973, limited the phosphorus content in their detergents to a maximum of 2.2 per cent. The European Union followed suit. We need similar regulations in India, that is, the surfactants in detergents must be biodegradable. It is extremely important that a lower limit closer to the global norm is placed on phosphorus content in the detergents and its labelling becomes mandatory for all detergents in the Indian market so that caring citizens can make eco-friendly purchasing choices.
The National Green Tribunal expressed extreme dissatisfaction on the unhealthy condition of the lake in its successive hearings. The NGT has asked all departments of the government to work together to prepare an Action Plan by September 7 for cleaning up the lake. This action plan must be prepared immediately and implemented effectively. This could can then act as a model for other states.
Connecting the dots:
Bellandur lake in Bengaluru was in news in recent months for the surge of foam and froth. It is only one example of what we are doing to most of our lakes, streams and rivers in urban India. Discuss the reasons behind such a grim situation of Indian lakes and what should be the way forward.
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