Poor infrastructure, staff crunch continue to plague healthcare in rural India: Centre
(GS-II: Issues Relating to Development and Management of Social Sector/Services relating to Health)
India’s rural healthcare system continues to be plagued by shortfall on two critical fronts — doctors and infrastructure. There is a shortage of 83.2 per cent of surgeons, 74.2 per cent of obstetricians and gynaecologists, 79.1 per cent of physicians and 81.6 per cent of paediatricians, according to the Rural Health Statistics 2021-2022.
The Indian healthcare system is divided into:
Sub-centres (SC): These are the first point of contact for a patient, catering to a population of 3,000-5,000.
Primary Health Centres (PHC): SC is succeeded by a PHC, which is required to look after the daily needs of 20,000-30,000 people (50,000-75,000 in urban areas).
Community Health Centres (CHC): They provide referrals and access to specialists, catering to 80,000-120,000 people (0.25-0.5 million in urban areas).
Key highlights of the Rural Health Statistics 2021-2022:
There is a shortage of 83.2% of surgeons, 74.2% of obstetricians and gynaecologists, 79.1% of physicians and 81.6% of paediatricians.
Less than half the PHC (45%) function on a 24×7 basis.
Of the 5,480 functioning CHCs, only 541 have all four specialists.
SC, PHC and CHC facilities are overburdened across the board, with SCs currently looking after more than 5,000 people, PHCs catering to 36,049 people and CHCs to 164,027 people.
This, coupled with a human resource shortage (like auxiliary nurse midwives – ANM), plagues access to adequate and quality healthcare.
Other challenges faced by the Indian rural healthcare sector and additional statistics:
Some of the government initiatives to transform rural healthcare:
Under Ayushman Bharat, the existing SCs and PHCs are being transformed into AB-Health and Wellness Centres (HWCs) to deliver preventive, curative, palliative and rehabilitative services which are universal, free and close to the community.
PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) envisages increased investments in public health to provide better access to health in rural areas by:
National Ambulance Service under National Health Mission (NHM) for free transportation to health facilities.
Contribution of the National Rural Health Mission (NRHM):
While there has been a decline in the past year, a huge improvement has been recorded as compared to 2005, when the government launched the NRHM (now subsumed under NHM).
For example, the number of allopathic doctors at PHCs has increased from 20,308 in 2005 to 30,640 in 2022, which is about a 51% increase.
The focus should be placed on improving rural healthcare infrastructure and human resources. This will ensure that Indians living in even the most remote areas have access to effective healthcare.
This would be in line with India’s commitments as a welfare state and would also aid in the achievement of SDG 3 – Health for All.
Alien plants growing together threatening tiger habitats: Study
(GS-III: Environment and Ecology)
Several alien invasive plants growing together can have a detrimental effect to the biodiversities in tiger habitats, a new study has found. The plants can put pressure on native forage plants and drive away wild herbivores — the food source for the big cats.
Invasive/introduced/alien/exotic species are any non-native species that significantly modify or disrupt the ecosystem it colonises.
Such species may arrive in new areas through natural migration, but they are often introduced by the activities of other species like Humans.
The study was conducted in Kanha Tiger Reserve (MP), comparing uninvaded native forests with old-growth invasions of single and multiple alien plants.
India’s biodiverse ecosystems are threatened by a variety of alien plants, introduced during British colonisation. Lantana alone has pervasively invaded 44% of India’s forests.
Apart from their spread in different ecosystems, little is known and even greater confusion when one asks about how alien plants impact native ecosystems.
Highlights of the study:
Co-occurring invasive plants have a magnified cumulative impact than their individual impacts, causing ecological homogenisation in invaded regions.
Multiple alien species together affected soil nutrients and the abundance of rich grasses and herbs.
Depletion of the native plant populations → Reduced forage availability for herbivores like sambar and chital → diseases in the herbivores → threaten the sustenance of tiger, leopard and dhole.
Additional Tier-1 bonds and the case against Yes Bank
The Bombay HC quashed the write-off of Additional Tier-1 (AT1) bonds worth Rs 8,400 crore issued by Yes Bank Ltd, bringing relief to investors.
Yes Bank, which was on the verge of collapse, was placed under a moratorium by the RBI in 2020 and a new management and board were appointed as part of a rescue plan worked out by the RBI.
The central bank allowed a write-off of Rs 8,400 crore on AT1 bonds issued by Yes Bank after it was rescued by the SBI.
A SEBI probe found that the bank facilitated the selling of AT1 bonds (as a ‘Super FD’ and ‘as safe as FD’) from institutional investors to individual investors, who were not informed about all the risks involved in the subscription of these bonds.
What are AT1 bonds?
These are unsecured bonds (issued by banks) that have perpetual tenor (no maturity date). These bonds are typically used by banks to bolster their core or tier-1 capital.
Tier I capital is a bank’s highest quality capital because it is fully available to cover losses and is made up primarily of share capital and disclosed reserves.
They have a call option, which can be used by the banks to buy these bonds back from investors.
AT1 bonds are subordinate to all other debt and only senior to common equity. Mutual funds (MFs) were among the largest investors in perpetual debt instruments.
Govt exempts key infra projects from wildlife fund rules
The Centre has exempted road, rail, and transmission line projects from having to deposit 2% and 0.5% of the total project cost towards the cost of the Wildlife Management Plan (WMP) and Soil and Moisture Conservation Plan (SMCP) in a move that will benefit developers, but which has been criticised by environmentalists.
The Union environment ministry under guidelines issued on June 7, 2022 made it mandatory for all projects to deposit 2% of the total project cost towards the cost of implementation of WMP and 0.5% for SMCP, as the case may be, to obtain Stage-II (final forest) clearance under the Forest Conservation Act 1980 (FCA).
Why are the changes now?
The government decided to tweak the guidelines for road and other linear projects such as rail lines, sidewalks, trails, and transmission lines after it was pointed out that these projects would end up paying for the entire length of the project even though only a small part would pass through a forest.
Now the cost of WMP and SMCP will be proportionate to extent of forest land involved instead of the total project cost.
About FCA, 1980:
FCA regulated deforestation and aims to preserve the forest ecosystem of India and the integrity and territory of the forests. It prohibits the felling of forests for any non-forestry use without prior permission of the central government.