Blog Archive - Page 41 of 130 - Accountability Initiative: Responsive Governance

‘People are Apprehensive on Routine Immunisations’

The ‘Inside Districts’ series launched in April was a one-of-its-kind attempt to capture the experiences of district and Block-level officials, panchayat functionaries and frontline workers, on their challenges and best practices. As India enters the fourth phase of a country-wide lockdown, we went back to some interviewees to understand how their situation has changed. Among them is an ASHA worker in Bhopal, Madhya Pradesh (MP).

As per media reports, ASHA workers and other frontline workers are encountering challenges, including violence against them during door-to-door screening. There are over 4,000 urban ASHAs and a little more than 62,500 rural ASHAs in MP.

The interview was originally conducted in Hindi on 12 May 2020, and has been translated.

Q: Has people’s opinion about COVID-19 being a rich person’s disease changed? Are people more cautious than before?

ASHA: Yes. Earlier only the people who came from abroad were infected but now common people who are around us are also getting the infection. The number of people infected has also increased. All of this has led to more awareness among people. People are taking care of cleanliness now; they are also using masks or cloth to cover their face while going out.

Q: Do you now have proper safety equipment for the duties you perform in the village?

ASHA: We have not received anything from the Panchayat or the Ministry of Women and Child Development. We have bought masks and sanitisers on our own because we have to protect ourselves.

Q: Can ration be availed from any shop or the designated shop? What is the government doing for cases that do not have a ration card?

ASHA: People can buy ration only from the designated PDS shops. The people who do not have the ration card have been identified by the Sarpanch and the secretary. They have been given a slip to avail ration.

Q: Are you provided/promised with any extra monetary incentive for your participation in COVID-19 relief work?

ASHA: No, we are not being provided anything extra. What we are doing comes from the sentiment of service.

Q: Have you received any kind of training on COVID-19?

ASHA: No, but we have received information such as COVID-19 symptoms, raising public awareness, through the Auxiliary Nurse Midwife.

Q: Has the routine immunisation of women and children started? If yes, are you facing any challenges?

ASHA: Immunisation has started but there are fewer beneficiaries now. People are scared and apprehensive about it because of the Coronavirus infection. They think that we might use an already used injection on them.

The ASHA is a health activist in the community whose role is to create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation of existing health services. The ASHA works as part of the National Health Mission (NHM) under the Ministry of Health and Family Welfare. The ASHA’s role involves counselling, taking people for referrals, mobilising the community for various health initiatives, and liaising with various officers at the village-level to improve health and nutrition services. The ASHA has to work closely with the Auxiliary Nurse Midwife (ANM) in the health department and the Anganwadi Worker (AWW) – key frontline functionaries for the Ministry of Women and Child Development.

Whither, Local Governments, in the Pandemic?

I had written a few weeks back that the lockdowns ordered in the wake of the COVID-19 pandemic had been instrumental in stalling, if not reversing the trend towards re-centralisation of powers and functions by the State and the Union Governments. A webinar organised by the Gulati institute of Finance and Taxation, Thiruvananthapuram, on 16 and 17 May on the role of Local Governments during the crisis, reinforced that impression. From across the country, with the exception of some States, the experience seemed to be that local governments had been energised by the crisis, and had taken on frontline duties such as ensuring that lockdown instructions were followed strictly, that the poor and migrant labour were fed, that essential supply chains were kept alive and that nobody was left out.

However, as State officials and NGO representatives spoke about local governments, I thought to myself whether the roles assumed by the local governments were actually empowering them or elevating them to more obedient slaves. The first thing I noticed is that, barring some exceptions with Kerala usually being amongst them, the actual local governments are pardanasheen – others speak for them rather than they themselves. Kerala was the outstanding exception; on the second day of the Webinar, the leaders of 14 Municipalities and Panchayats at different levels spoke of the efforts of their elected bodies and administrations to tackle the crisis. While the curative care system led the efforts of rapidly identifying cases and treating patients, it was clear that equally important actions such as contact tracing and quarantining could not have been achieved without the active participation and initiative of the local governments. The local governments led from the front on awareness creation on hand sanitisation, maintaining of physical distancing and usage of masks.

With respect to all the downstream side effects of a lockdown, namely, the economic suspended animation, the loss of livelihoods all around and particularly of the poor and migrant labour, the disruption of normal daily activity, the risks of hunger, the travails of the old, the ones taking medication and the boredom of the young, the local governments were at the forefront of the battle. Panchayats resorted to several innovations to overcome these problems, including the running of community kitchens, painstakingly tracking every vulnerable individual and dealing with their problems not merely through software, but through the warmth of a humane approach.

I also wondered how such cooperative action could be rapidly ensured, in the absence of a fiscal system that puts sufficient funds in the hands of the local governments, in State after State. It is there that I encountered the phenomenon that my friend and mentor, Shri S.M. Vijayanand, the former Rural Development Secretary of the Union Government and former Chief Secretary of Kerala, calls, ‘soft devolution’. Vijayanand terms this as a situation where even when functional assignments and fiscal transfers fall short of the conventional ideal requirements to empower local governments, they still manage to wrest the advantage and serve the people, thus earning their appreciation and trust. I began to see how Panchayats were able to raise public funds and also weave in their own revenues, to organise community kitchens, care for the vulnerable, and even online art and music competitions to keep children happy and occupied.

While all these developments are worthy of note and appreciation, I sense a danger in ‘soft devolution’ and its appreciation beyond a point. ‘Soft devolution’ tends to let off the hook higher level governments who have been remiss thus far in giving funds to local governments.

Actions such as contact tracing and quarantining could not have been achieved without the active participation and initiative of the local governments.

A classic case of such injustice – and injustice I shall term it, for the lack of a more expressive word – is the role that local governments are expected to play in disaster management. Odisha is a state that is not as much appreciated as it ought to be, for the way it has handled the COVID-19 crisis, through its Panchayats. I was intrigued to hear that the government had even endowed the Panchayats with magisterial powers that are usually confined to the revenue administration, to enforce some of the more coercive aspects of the lockdown. Odisha is also a state that has had an impeccable track record in managing major disasters such as super-cyclones, with minimal human casualties, which is something that could never have been achieved without the active participation of local governments. However, all of this is achieved through ‘soft devolution’. Odisha stands with other states in the low extent of fiscal devolution to the Panchayats.

The common refrain heard from most States was that while Panchayats were at the frontline of handling disasters, they were not endowed with funds from the disaster management pool, to the extents of their requirements. Such funds remained confined to State authorities, even as the Panchayats pulled out all stops to provide succor to the people, often relying on local voluntarism, and local contributions in cash and kind.

This is injustice. This, in spite of the track record of States such as Kerala and Odisha in tackling the COVID-19 crisis, is still not efficient enough. And therefore, success achieved or inadvertently realised through ‘soft devolution’, cannot be an excuse to postpone ‘hard devolution’.

Also Read: Inside Districts

Inside Districts: Experience of a Doctor Working in a Coronavirus Ward

The interview was originally conducted in Hindi on 13 May 2020, and has been translated.

Q: How often do you receive PPE Kits? What does it comprise?

Doctor: The supply of PPE kits is adequate now; we receive it twice in a shift. The kit comprises mask, gloves, shoe cover, head cover, face shield, gown and goggles.

Q: How long are your duty hours in the Coronavirus ward? Are you still being tested regularly?

Doctor: My duty is for 8 hours. Yes, we are tested regularly, after isolation of 7 days. The rotation of doctors is after 7 days in the Coronavirus ward.

Q: Have you been trained on how to handle COVID-19 patients?

Doctor: A training or workshop has not been organised as such, but instructions are being shared through circulars. Doctors discuss aspects such as how to wear PPE, handling positive patients, and medicines etc, based on these.

Q: What is the support you need to do your job better?

Doctor: The quality of PPE kits was not great earlier- the gown was double layered and would cause discomfort and sweating. However, for the last 10-11 days, the quality has improved. We are receiving single-layered gowns now, which are comfortable.

Q: How has your work changed during the lockdown period? Is your primary focus still on COVID-19 or are you back to routine work?

Doctor: Easing of restrictions has not affected our duty in any way. When we are assigned to the Coronavirus ward, the focus is always the Coronavirus patients.

Apart from emergency and trauma centres, everything else is closed in the hospital and that is causing a lot of trouble to the patients of other diseases. A decision needs to be taken regarding this and the facilities for other patients need to be reopened at the earliest.

COVID-19 Response: Why Repackaged Health Spending Promises Offer Nothing New

Breaking the silence on specific measures to increase health expenditure and infrastructure on 17th May, Finance Minister Nirmala Sitharaman made health one of the key focus areas for the fifth and last tranche of the stimulus package under the Atmanirbhar Bharat (Self-Reliant India) Yojana. Stating the need to ramp up public expenditure on health by focussing on strengthening investments at the last mile – particularly districts – the package included an allocation of ₹8,100 crore for increasing social infrastructure including Health and Wellness Centres (HWCs), at least partly through viability gap funding [1]. This announcement follows the previous announcements of ₹15,000 crore of which a portion is to be used for providing health insurance cover to essential Front Line Workers (FLWs); procuring essential items and kits, and establishing testing labs. Further, ₹4,113 crore has been distributed to states for healthcare, and the rest is to be used over the next one to four years. (See Table 1 for more details).

Yet, a closer look at the measures suggests that most had already been announced by the Government previously and thus do not offer anything new or radical, despite an ongoing public health emergency. Let’s look at some of these one by one.

Increasing Health and Wellness Centres

A focus on primary care through Health and Wellness Centres (HWCs) has been a key priority of the government under the Ayushman Bharat scheme. Between FY 2018-19 and FY 2019-20, allocations increased 33 per cent from ₹1,200 crore in 2018-19 to ₹1,600 crore in 2019-20 Revised Estimates. Another ₹1,600 crore was allocated for this fiscal year. With over 40,000 HWCs completed till March 2020 and another 30,000 planned for this year, we are well on our way to meeting the target of building 1.5 lakh HWCs by 2022. But the larger question of how these HWCs will be able to respond to the pandemic remains unanswered. Currently, in the absence of an accessible HWC, most rural Indians rely on either private facilities or a network of primary health facilities including Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs). Data available in the latest Rural Health Statistics 2019 however reports that only 3% SCs, 8% PHCs and 22% CHCs function as per Indian Public Health Standard norms and in fact, the proportions have been falling yearly.

Building Hospitals in Aspirational Districts

The second key announcement of building infectious diseases hospitals in aspirational districts, also follows the one made in the Union Budget speech in February which called for increasing the hospital network in aspirational districts which didn’t have PMJAY empanelled hospitals. This was to be done in Public-Private Partnership (PPP) via viability gap funding, similar to the announcement made this time. The introduction of an additional 5% health cess on custom duty for medical equipment was to be used to support this vital health infrastructure. The main change thus is the additional gross budgetary support that will be needed, given that taxes on essential devices for COVID-19 treatment have now been removed. A lack of transparency on the details of the viability gap funding and of PM-CARES, however, means that the exact quantum coming from the Union government versus private players remains unclear.

Strengthening of laboratory network

The third announcement – which appears to be more directly linked to the pandemic – was the call to increase laboratories. As on 25 May 2020, a total of 612 labs comprising a network of 430 government and 182 private laboratories are conducting various COVID-19 diagnostics. The influx of workers returning home from cities, is going to require additional laboratories (and fast) not just in urban areas, but also in rural areas. While the announcement takes a step in recognising this need, here too, a look at the operation guidelines of HWCs suggests that these were already part of the plan. More importantly, difficulties in operationalisation has meant that as of September 2019, the number of diagnostics that could be conducted at HWCs converted from existing PHCs ranged from as low as 7 in Bihar to 63 in Manipur. Add to this the sheer absence of lab technicians across many PHCs (more than half the required posts are vacant), it is unclear how the government will be able to tackle existing operationalisation concerns amidst the need to expand capacity fast, including with an additional specialisation for COVID-19 testing.

Training Medical and Paramedical Workers and Others

Then there were the other announcements, from ensuring training to medical and paramedical workers, to the National Digital Blueprint for digitising patient records, and increasing health insurance cover to frontline functionaries. With the exception of the added health insurance, the first two were again already part of the Government’s original plan. The Budget speech in fact had stated the need to match skill sets with employers standards, given the “huge demand for teachers, nurses, paramedical staff and care-givers abroad”. It had thus proposed that “special bridge courses be designed by the Ministries of Health, Skill Development together with professional bodies to bring in equivalence.” Data on the number of frontline workers trained recently is not publicly available but interviews conducted by us with various functionaries have reported receiving relatively little training with respect to their new COVID-19 specific task requirements, including things like uploading data for active cases, amongst others. Similarly, the draft National Digital Blueprint was first announced by the National Health Policy and placed in the public domain in April 2019. The fact that most of these are repackaged erstwhile announcements is clear given that for most of these measures, associated fiscal costs have not been specified.

A closer look at the measures suggests that most had already been announced by the Government previously and thus do not offer anything new or radical, despite an ongoing public health emergency.

Increasing Public Health Expenditures

Last of course was the slightly vague announcement of increasing public health expenditure. Given the low levels of spending in the past – last year only 1.6% of India’s GDP was spent on health by the Centre and States combined – the importance of increasing public health expenditure goes without saying. Yet despite the National Health Policy calling for an increase to 2.5% of GDP, responses by both Union and State governments have been less than adequate. The Union government’s investments in healthcare have remained low – with budget allocations for the Ministry of Health and Family Welfare increasing only 4% in 2020-21 Budget Estimates (BEs) compared to the Revised Estimates (REs) from last year. Moreover, as per a report on state finances by the Accountability Initiative at the Centre for Policy Research, the percentage of health expenditure among 17 states has remained well below 2% and has, in fact, declined this year for some states. The bulk of this expenditure has been on paying salaries. Capital expenditure (used for building health facilities) has been a meagre 10-15%.

There is no question that there is an urgent need to ensure adequate finances not just for dealing with the immediate pandemic but other pressing health concerns as well. Every day, 1,000 people in India die due to Tuberculosis alone, another 1,935 children under 5 die due to malnutrition. While details of the PM-CAREs fund aren’t publicly available, media reports indicate that only ₹2,100 crore has been dedicated to health so far through the ₹ 9,677.9 crore ($1.27 billion) fund for ‘Made-in-India’ ventilators (₹2,000 crore) and vaccine development (₹100 crore). At this critical juncture, with the number of COVID-19 cases nearing 1.5 lakh (as on 26 May 2020) healthcare must be prioritised and financed through this massive corpus of funds.

For the Union government, this also means ensuring adequate funds reach States in a timely manner and supporting states in developing disaggregated data systems for reviewing health outputs and outcomes. The members of the government and bureaucracy have their work cut out for themselves, in trying to balance the needs of the pandemic whilst maintaining existing healthcare needs. Moving forward, let’s hope there is more creative thinking on how to manage something unprecedented in India: massively increasing healthcare spending.

[1] Grant to support projects that are economically justified but not financially viable, typically used to support public-private partnerships.

To cite this blog, we suggest the following: Kapur, A. and Shukla, R. (2020) COVID-19 Response: Why Repackaged Health Spending Promises Offer Nothing New. Accountability Initiative, Centre for Policy Research. Available at: http://accountabilityindia.in/blog/covid-19-response-why-repackaged-health-spending-promises-offer-nothing-new/.

As people arrive from outside the state, the focus is on preventing COVID-19’s spread: Medical Officer in HP

The interview was originally conducted in Hindi on 12 May 2020, and has been translated.

Q: Have you received any kind of training to handle COVID-19 associated tasks?

BMO: We get the necessary instructions through audio or video conferencing. Block officers are required to take necessary steps in the following three phases:-

Preventive: We need to ensure that social distancing is maintained.
Promotive: We need to encourage people to wear masks and gloves.
Curative: We need to ensure that the infected are treated in the hospital.

There was one COVID-19 positive person in March, and now we have identified four people who have arrived from another state, who are likely to be infected. We are awaiting their reports.

Q: What steps are you taking to prevent community transmission?

BMO: A month ago, we organised an Active Case Finding (ACF) awareness campaign, in which ASHAs, Auxiliary Nurse Midwives and other health workers went door-to-door to create awareness about the virus. These days ASHA workers are going in the community and asking people to take necessary precautions. Apart from this, the Panchayati Raj and all other field workers are also involved on awareness activities.

Q: What were the challenges during the ACF?

BMO: It was challenging to screen people because families were hiding information about people who had arrived from outside.

We were hesitant to send the team on the field because of the lack of availability of masks and gloves. Some families also started misbehaving with the ASHA workers, which was really disappointing.

Q: Have you observed shortages?

BMO: Currently, we have enough availability of masks, gloves and sanitisers, and we have given these to our field staff as well. We faced a shortage in the month of April during the ACF campaign.

Q: How has your worked changed due to the pandemic?

BMO: While earlier there were 400-500 Outpatient Department queries per day this has dropped to 100-150 during the lockdown. This could be because people do not have access to public transport. Now, the focus is on preventing COVID-19 particularly because people are arriving from outside the state.

Download and share illustration: The Forest Voyage

Financing Nutrition in India: Considering the Cost Implications

The nutrition financing community in India is engaged in efforts to strengthen actions for adequate financing for nutrition. On 28 April 2020, a group of 29 participants gathered at a virtual event to discuss the latest findings of a study on how much it would have cost India to finance a set of direct nutrition interventions (DNIs) in 2019 at full scale. The event titled “Financing Nutrition in India: Cost Implications of the Nutrition Policy Landscape” was co-hosted by the International Food Policy Research Institute (IFPRI) and the Accountability Initiative (AI) at the Centre for Policy Research (CPR).

Why should we conduct costing exercises for nutrition interventions?

Despite some improvements over the last decade, outcomes of malnutrition such as stunting, anaemia, wasting, and low birth weight remain high in India (Menon et al. 2017). To address malnutrition and associated risks, the Indian government has brought together a range of nutrition efforts under the umbrella National Nutrition Mission, POSHAN Abhiyaan. The nutrition interventions included in the overarching POSHAN Abhiyaan framework include those implemented by the Ministry of Women and Child Development (MWCD) and several interventions implemented by the Ministry of Health and Family Welfare (MoHFW). Yet, coverage of these interventions is variable across states (IFPRI Data Notes), and the exclusion of some of the poorest and most marginalised groups remains a cause for concern (Chakrabarti et al. 2019).

An important step towards ensuring adequate coverage and quality of interventions is budgeting appropriately across all levels. To this end, costing is a crucial exercise that can help policymakers estimate future funding needs and allocate resources effectively. Furthermore, costing exercises help determine gaps in allocations. Unfortunately, to date, there is limited research estimating the cost of scaling up access to nutrition interventions. Part of the problem is due to India’s planning and budgeting systems which do not always allow for local-state-wise disaggregated unit costs. Moreover, costs of delivering key interventions vary across states due to differing state capacities, geography and terrain, and supply constraints. Reliable estimates of required coverage are also limited.

In the virtual convening on 28 April, participants discussed the key findings of the new costing study conducted by AI, CPR researchers Avani Kapur, Manan Thakkar and Ritwik Shukla. Additionally, participating organisations shared their ongoing research related to nutrition financing to develop a consensus on gaps in knowledge and key questions that could feed into a collaborative research agenda.

What will it cost?

Presenting the key results from the study, Ritwik Shukla said, “The overall objective of our study was to estimate the potential costs to deliver a set of DNIs at scale (i.e. 100 per cent coverage) at the union and state levels, and across departments and ministries, in 2019.”

Building on the methodology used by Menon et al. (2016), the research found that India should have invested a minimum of ₹38,571 crore in 2019 to fully finance these 15 DNIs, at scale. This exercise excluded costs for 3-6 year old children. The highest costs were for food supplements (₹20,796 crore), followed by maternity benefits (₹9,260 crore), and health interventions (₹6,123 crore), such as the provision of insecticide treated bed nets, immunisation, and the treatment of malnourished children at nutrition rehabilitation centres. Counselling (₹1,373 crore) and the provision of micronutrient and deworming interventions (₹1,019 crore) costed the least.

Costs were also presented by population groups, states, and ministries. The analysis suggested that the highest costs were for children aged 6-36 months, driven primarily by food supplement costs. Among states, costs were highest for the most populous states, such as Uttar Pradesh, Bihar, and Maharashtra.

A comparison of required costs for delivering DNIs at scale with the actual allocations in 2019, suggested that the required budgets remained lower than the actual budgeted amount. In 2019-20, assuming that states contributed their share of funds (50 percent of the total allocations) for supplementary nutrition under ICDS, the total allocation stood at ₹17,654 crore. This was lower than the costs estimated, even excluding the ₹ 20,136 crores for 3-6-year olds, by over ₹2,000 crore.

The presentation concluded with some of the methodological challenges in estimating costs particularly for interventions such as counselling. It thus concluded that it is essential for the nutrition community in India to examine the available results on costing for nutrition interventions, and to help expand its scope by contributing to obtaining better unit cost data, improving the methodology, and making the study results useful for the policy-makers.

Identifying knowledge gaps and developing a collaborative research agenda

Following the presentation, Purnima Menon from IFPRI led a discussion on concurrent research by various participating organisations. Giving an overview of some of the big questions for nutrition financing, Saachi Bhalla from the Bill and Melinda Gates Foundation (BMGF) highlighted the importance of mapping research on public financing and looking specifically at issues of costing, fund requirements, resource availability, and utilisation and efficiency from a return-on-investment perspective.

Vani Sethi from UNICEF shared her experience of working on financing for Anemia Mukt Bharat (AMB). They tracked AMB budgets for 14 states, and looked at allocations and bottlenecks to allocative efficiency. “Through our work on AMB, while we directly supported policy-makers, we also feel it is important to build the capacity of organisations supporting planning exercises at state and district levels through training,” she informed.

Applauding the systems lens approach in the way data on AMB budgets had been used, Alok Ranjan from BMGF said that enabling the system to learn to make corrections is crucial for state planners. He encouraged researchers to collectively work towards initiating such feedback loops across components.

The research found that India should have invested a minimum of ₹38,571 crore in 2019 to fully finance these 15 DNIs, at scale.

Information on ongoing research and engagement with nutrition financing at the state and district levels were shared by Happy Pant from the Centre for Budget and Governance Accountability (CBGA) and Saumya Srivastava from IPE Global.

There was consensus around the fact that researchers need to make their work on nutrition financing available and useful for the government in ways that it can contribute to the development of Annual Programme Implementation Plan. Purnima Menon noted that understanding processes related to nutrition financing is just as important as analysing cost estimates and gaps.

The way forward

Reflecting on the discussions, Avani Kapur from AI, CPR acknowledged the need for documenting studies by various organisations on nutrition financing. The participants agreed to collate information on their financing studies, organize similar sharing and learning events and present their findings to policymakers in a pragmatic way.

Moving forward, a policy note on costing will soon be published online by AI and IFPRI, and discussions around nutrition financing will continue. Lastly, in the context of the current COVID-19 pandemic and economic crisis, it is critical that the fiscal space for nutrition, with active attention to equity, is not lost. This is something that the nutrition financing community will continue to work towards.

Please find here the presentation that was shared during the virtual event.

This blog was jointly developed by Accountability Initiative and POSHAN teams and is cross-posted on both the websites.

पॉलिसी बज़्ज़: करोनावायरस आधारित पांचवा संस्करण

विभिन्न कल्याणकारी योजनाओं में क्या घटित हो रहा है, इसको लेकर आपको हर 15 दिन के अंदर यह पॉलिसी बज़्ज़ अपडेट करता है | वर्तमान प्रकाशन भारत में करोनावायरस महामारी पर आधारित है – सरकार द्वारा करोनावायरस के प्रभावों को बढ़ने से रोकने के लिए विभिन्न क़दमों को उठाया जा रहा है |

नीतियों से सबंधित खबरें

देश में लाकडाउन 31 मई 2020 तक बढ़ा दिया गया है |
वित्तमंत्री निर्मला सीतारमण ने 20 लाख करोड़ रूपये के आत्मनिर्भर भारत अभियान आर्थिक पैकेज की घोषणा की है | पैकेज को अच्छे से समझने के लिए हमारा नवीनतम वर्किंग पेपर पढ़िए, जो कि राज्य वित्त के बारे में है |
केन्द्रीय मंत्री नितिन गडकरी ने घोषणा की है कि सरकार एग्रो एम.एस.एम.ई. नीति पर कार्य कर रही है, जो कि ग्रामीण क्षेत्र,आदिवासी क्षेत्र, कृषि और वन क्षेत्र के स्थानीय कच्चे माल का उपयोग कर वस्तुओं का निर्माण करने पर केंद्रित है |
प्रधानमंत्री नागरिक सहायता और आपातकालीन राहत फंड(पी.एम. केयर)के अंतर्गत तय किया गया है कि 3,100करोड़ रूपये महामारी संकट से निपटने के लिए आवंटित किये जायेंगे | लगभग 2,000 करोड़ रूपये वेंटीलेटर खरीदारी पर खर्च किये जायेंगे, 1,000 करोड़ रूपये प्रवासी मजदूर की देखभाल के लिए और 100 करोड़ रूपये वैक्सीन निर्माण के लिए खर्च किये जायेंगे |
उत्तर प्रदेश राज्य मंत्रिमंडल ने 38 श्रम कानूनों में से 35 को तीन साल के लिए निलंबित करने का फैसला लिया है | इसकी मंजूरी के लिए अध्यादेश केंद्र सरकार को भेजा जाएगा | मध्यप्रदेश ने भी अपने श्रम कानूनों में बदलाव किया है |
झारखंड सरकार ने ग्रामीण अर्थव्यवस्था में नौकरियों को जोड़ने के लिए तीन गहन श्रम कार्यक्रमों की घोषणा की है । इन तीन योजनाओं को महात्मा गांधी राष्ट्रीय ग्रामीण रोजगार गारंटी योजना (MGNREGS) के साथ संचालित करने के लिए तैयार किया गया है |

स्वास्थ्य

स्वास्थ्य मंत्रालय ने कोविड देखभाल सुविधा में भर्ती हल्के/बहुत हल्के/पूर्व-लक्षण मामलों के लिए एक संशोधित डिस्चार्ज नीति जारी की है | इन रोगियों को लक्षण शुरू होने के 10 दिनों के बाद और 3 दिनों तक बुखार नहीं होने पर छुट्टी दी जा सकती है। डिस्चार्ज करने से पहले परीक्षण की आवश्यकता नहीं होगी । इससे कोविड-19 परीक्षण किटों की आवश्यकता में कटौती की उम्मीद की जा सकती है
ICMR एक समुदाय आधारित सर्वेक्षण करने जा रहा है, जिससे भारतीय जनसंख्या में SARS-CoV-2 संक्रमण की व्यापकता का अनुमान लगाया जायेगा|यह सर्वेक्षण रैंडम रूप से चयनित 21 राज्यों के 69 जिलों में आयोजित किया जाएगा |
12 मई को जारी की गई ग्लोबल न्यूट्रिशन रिपोर्ट (जीएनआर) 2020 में कहा गया है कि भारत उन 88 देशों में शामिल है, जिनके 2025 तक वैश्विक पोषण लक्ष्य पूर्ण ना कर पाने की संभावना है |
भारत के रजिस्ट्रार जनरल द्वारा जारी आंकड़ों के अनुसार, 2018 में राष्ट्रीय जन्म दर 20 थी, मृत्यु और शिशु मृत्यु दर (आईएमआर) क्रमशः 6.2 और 32 थी। भारत का IMR जो कि 2017 में 33 प्रति 1,000 जीवित शिशु जन्म दर था, वही 2018 में 32 है, जिसका अर्थ है कि सुधार काफी कम हुआ है | देश में मध्य प्रदेश का शिशु मृत्यु दर सबसे खराब है जबकि नागालैंड का सबसे अच्छा |

अन्य

विश्व बैंक ने भारत में रहने वाले प्रवासियों और शहरी गरीबों के लिए 1 बिलियन अमरीकी डॉलर के पैकेज की मंजूरी दी है | पिछले महीने स्वास्थ्य के लिए 1 बिलियन अमरीकी डालर का पैकेज स्वीकृत किया गया था |
यू.एस. सेंटर फॉर डिजीज कंट्रोल एंड प्रिवेंशन (सीडीसी) ने कोविड-19 से निपटने के लिए भारत सरकार की सहायता हेतु 3.6 मिलियन अमरीकी डालर की घोषणा की है |
मध्य प्रदेश राज्य ने ‘एफ.आई.आर.आपके द्वार’ पहल की शरुआत की है, इस पहल के अंतर्गत पुलिस अधिकारी घरों में जाकर प्रथम सूचना रिपोर्ट (एफआईआर) दर्ज करेंगे |
भारत ने ‘मिशन सागर’ अभियान का आरम्भ किया है,जिसका मुख्य लक्ष्य खाद्य सामग्री और कोविड से सबंधित दवाइयों जैसे HCQ टैबलेट्स और विशेष आयुर्वेदिक दवाइयों को इन पाँच द्वीप देशों – मालदीव, मॉरीशस, सेशेल्स, मेडागास्कर और कोमोरोस – में उपलब्ध करवाना है |
एशियाई इन्फ्रास्ट्रक्चर इन्वेस्टमेंट बैंक (AIIB) ने कोविड-19 के लिए भारत के प्रयासों का समर्थन करते हुए 500 मिलियन अमरीकी डालर के ऋण को मंजूरी दी है |
इंटरनेट एंड मोबाइल एसोसिएशन ऑफ इंडिया (IAMAI) की ‘डिजिटल इंडिया’ रिपोर्ट के अनुसार ग्रामीण क्षेत्रों ने इंटरनेट का उपयोग करने में पहली बार शहरी क्षेत्रों के लोगों को पीछे छोड़ दिया है | हालांकि, इंटरनेट पर बिताया जाने वाला समय ग्रामीण क्षेत्रों की तुलना में शहरी क्षेत्रों में अधिक है |

Carrying Out Both COVID-19 and Pre-Pandemic Tasks: ASHA in Himachal Pradesh

There are 7,787 registered rural ASHAs in the state. Hamlets or villages are far from each other and from main towns, requiring travel. As per a recent interview by Chief Minister Jai Ram Thakur, teams involving 16,000 frontline staff (including ASHAs, Anganwadi workers and paramedics) were part of the state’s Active Case Finding campaign held in the first week of April to detect the spread of COVID-19.

The interview was originally conducted in Hindi on 16 May 2020, and has been translated.

Q: Have you got masks, sanitisers and gloves?

ASHA worker: We are making use of the ones we received previously. No, fresh ones have not been issued.

Q: Have you been provided training on COVID-19?

ASHA worker: Yes, we were called for a one-day training on symptoms and prevention, among other things.

Q: Are you able to do any of your routine work that was not related to Coronavirus these days (considering cases in Himachal aren’t too many)?

ASHA worker: Yes, along with the COVID-19 work we are also performing our regular tasks like vaccination or consultation for pregnant and lactating women (over phone now). The problem arises when people who are coming from outside start hiding their information, and it becomes difficult to track them because this is a huge area. When we fail to track these people and we get their information after a few days, we get scolded by the Department.

Q: Are people getting the promised ration? Are they satisfied with the services provided by the government?

ASHA worker: Yes. The PDS shopkeeper is going to the village and distributing ration. People are satisfied because they don’t have to go to the shop anymore to collect ration.

Q: What is the government doing for cases that do not have a ration card?

ASHA worker: I have not seen provisions for people, that is those who do not have ration cards. Communities are contributing ration for these people.

Also Read: Perspective of an ANM in Maharashtra

Download and share illustration: The Forest Voyage

पॉलिसी बझः कोरोना व्हायरस-फोकस पाचवी आवृत्ती

कल्याणकारी धोरणात जे घडत आहे त्या प्रत्येक पंधरवड्यात प्रकाशित झालेल्या बातम्यांच्या निवडीसह अद्ययावत रहा. सध्याची आवृत्ती भारतातील कोरोनाव्हायरस (साथीचा रोग) सर्व देशभर (किंवा खंडभर) असलेला यावर लक्ष केंद्रित करते आणि सरकार वाढ थांबविण्यासाठी करत असलेले प्रयत्न.

धोरण बातमी

देशव्यापी लॉकडाउन 31 मे 2020 पर्यंत वाढविण्यात आले असून लवकरच मार्गदर्शक तत्त्वे अपेक्षित आहेत.
अर्थमंत्री निर्मला सीतारमण यांनी 20 लाख कोटींच्या आत्मनिभार भारत अभियान आर्थिक पॅकेजचा तपशील जाहीर केला आहे. ते येथे आढळू शकतात. पॅकेज अधिक चांगल्या प्रकारे समजण्यासाठी आमच्या नव्याने जाहीर केलेल्या वर्किंग पेपरमध्ये राज्य वित्तपुरवठा स्थितीवर प्रवेश करा.
केंद्रीय मंत्री नितीन गडकरी यांनी जाहीर केले की, सरकार ग्रामीण कृषी (एम.एस.एम.ई) धोरणावर काम करत असून ग्रामीण, आदिवासी, कृषी व वनक्षेत्रात उद्योजकतेच्या विकासावर स्थानिक कच्च्या मालाचा वापर करून उत्पादनांच्या उत्पादनावर लक्ष केंद्रित केले जाईल.
पंतप्रधानांचे नागरिक सहाय्य आणि आपत्कालीन परिस्थितीत मदत (PM-CARES) फंड ट्रस्टने साथीच्या प्रतिसादासाठी 3,100 कोटी रुपये देण्याचे ठरविले आहे. अंदाजे व्हेंटिलेटर खरेदीसाठी 2,000 कोटी रुपयांचा उपयोग केला जाईल. स्थलांतरित मजुरांच्या देखभालीसाठी 1,000 कोटी आणि लस विकासास मदत करण्यासाठी 100 कोटी.
उत्तर प्रदेश मंत्रिमंडळाने राज्यातील 38 कामगार कायद्यांपैकी 35 कामगार कायद्यां मधे तीन वर्षांसाठी स्थगित करण्याचा निर्णय घेतला आहे. हा अध्यादेश त्याच्या मंजुरीसाठी केंद्र सरकारकडे पाठविला जाईल. मध्य प्रदेशनेही आपल्या कामगार कायद्यात बदल केले आहेत.
झारखंड सरकारने ग्रामीण अर्थव्यवस्थेत रोजगार जोडण्यासाठी तीन कामगार-केंद्रित कार्यक्रमांची घोषणा केलीआहे. महात्मा गांधी राष्ट्रीय ग्रामीण रोजगार हमी योजनेत (MGNREGS) एकत्र येण्यासाठी या तीन योजना आखल्या गेल्या आहेत.

स्वास्थ्य

आरोग्य मंत्रालयाने कोविड केअर सुविधेमध्ये दाखल केलेल्या सौम्य / अत्यंत सौम्य / पूर्व-लक्षणेच्या प्रकरणांसाठी सुधारित लक्षण धोरण जारी केले आहे. लक्षण सुरू झाल्यानंतर 10 दिवसानंतर आणि 3 दिवस ताप न आल्यास या रूग्णांना सोडण्यात येते. लक्षण होण्यापूर्वी चाचणी घेण्याची गरज भासणार नाही. यामुळे कोविड -19 चाचणी किट्सची गरज कमी होईल.
भारतीय लोकसंख्येमध्ये SARS-CoV-2 संसर्गाच्या प्रसाराचा अंदाज घेण्यासाठी ICMR समुदाय आधारित सर्वेक्षण करणार आहे. हे सर्वेक्षण 21 राज्यांमधील यादृच्छिकपणे निवडलेल्या 69 जिल्ह्यांमध्ये केले जाईल.
12 मे रोजी जाहीर करण्यात आलेल्या ग्लोबल न्यूट्रिशन रिपोर्ट (जी.एन.आर) 2020 मध्ये म्हटले आहे की 2025 पर्यंत जागतिक स्तरावरील पोषण लक्ष्य गमावण्याची शक्यता असलेल्या 88 देशांमध्ये भारत आहे.
भारताच्या रजिस्ट्रार जनरलने जाहीर केलेल्या आकडेवारीनुसार, 2018 मध्ये राष्ट्रीय जन्म दर 20 होता, मृत्यू आणि बालमृत्यू (आय.एम.आर) अनुक्रमे 2.6 आणि 32 होते. भारताचा IMR, जो 2017 मध्ये 1000 जीवंत जन्मांपैकी 33 होता आणि 2018 मध्ये तो 32 होता, जो सुधार म्हणून पाहिले जाऊ शकतो. देशात मध्य प्रदेशामधे सर्वात ज्यास्त बालमृत्यू दर खराब आहे तर नागालँडमध्ये सर्वोत्कृष्ट आहे.

इतर

जागतिक बँकेने भारतात स्थलांतरित आणि शहरी गरीबांसाठी 1 अब्ज डॉलर्सच्या पॅकेजला मान्यता दिली आहे. गेल्या महिन्यात आरोग्यासाठी 1 अब्ज डॉलर्सचे आणखी एक पॅकेज मंजूर झाले होते.
यू.एस सेंटर फॉर डिसीज कंट्रोल अँड प्रिव्हेंशन (सी.डी.सी) ने कोविड -19 विरूद्ध भारत सरकारच्या प्रतिसादासाठी मदत करण्यासाठी 3.6 दशलक्ष डॉलर्सची घोषणा केली आहे.
मध्य प्रदेशातर्फे “एफ.आय.आर आपल्या दारी” हा उपक्रम सुरू करण्यात आला आहे, ज्यामधे पोलिस अधिकारी घरी जाऊन प्रथम माहिती अहवाल (एफ.आय.आर) नोंदवतील.
देशातील साथीच्या आजाराच्या पार्श्वभूमीवर सरकारने; ही योजना सुरू केली आहे ज्या मधे खाद्यपदार्थ, कोरोनाशी संबंधित औषधे, HCQ टॅब्लेट्स आणि विशेष आयुर्वेदिक औषधे या पाच बेटांच्या देशांना – मालदीव, मॉरिशस, सेशल्स, मेडागास्कर आणि कोमोरोस या देशांमध्ये (साथीच्या रोगांच्या दरम्यान) पुरविणे आहे.
एशियन इन्फ्रास्ट्रक्चर इन्व्हेस्टमेंट बँक (AIIB) ने कोविड- 19 प्रतिसादावरील भारताच्या प्रयत्नांना पाठिंबा देण्यासाठी 500 दशलक्ष डॉलर्सचे कर्ज मंजूर केले आहे.
इंटरनेट अँड मोबाईल असोसिएशन ऑफ इंडियाने (IAMAI) ‘डिजिटल इंडिया’ च्या अहवालानुसार ग्रामीण भागातील इंटरनेट वापरकर्त्यांनी शहरी भागातील लोकांना प्रथमच मागे टाकला आहे. तथापि, ग्रामीण भागापेक्षा इंटरनेटवर घालवलेला वेळ शहरी भागात जास्त आहे.

Work Remains Unchanged but the Risk has Increased: Auxiliary Nurse Midwife in Maharashtra

Over 33,000 people have been confirmed COVID-19 positive in the state till 18 May 2020, among the highest rates in states. There are only 18,871 registered ANMs in Maharashtra.

The interview was originally conducted in Hindi on 12 May 2020, and has been translated.

Q: What are your tasks now?

ANM: The work has not changed much, but now the risk has increased. People are still coming from outside and we are collecting their information and giving it to the authorities; the number of people we are monitoring has increased. We are home quarantining these people and monitoring them closely along with the ASHA workers.

Apart from this, we are also performing tasks we were performing before the crisis hit like – vaccination, Antenatal Care visits, record-keeping, maintaining the stock of medicine, informing and serving the beneficiaries.

Q: You mentioned the challenge of too few workers for the area that has to be covered. Has this been raised to your seniors? What have they said?

ANM: My area is bigger and is also connected to the city and hence there is a shortage of workers. Generally, there is one ANM for a population of 5,000-10,000 people; however, in my area, there are only two ANMs for 29,000 people, including me. Everyone is aware of this situation, including the Medical Officer, Taluk (Block) Health Officer and District Health Officer, but no one takes any action. When we talk to them about this, they say that they will look at it later because there are not enough workers right now. They motivate us to do our jobs well and the conversation ends there.

Q: Is there anything that you want to share which has helped the team in its work or anything you are proud of?

ANM: All the field workers are doing their jobs very diligently despite increased work hours due to a huge population. ASHA workers are working even on Sundays and holidays, and I am proud of them!

ANMs are village-level female health workers in village Health Sub-centres, and are the first contact person between the community and health services. ANMs are expected to be multi-purpose health workers playing a critical role in maternal and child health including immunisations, family planning services, and treatment of minor injuries and first aid in emergencies and disasters. As per the Rural Health Statistics 2019, there are a total of 2,34,220 ANMs across Sub-centres and Public Health Centres in the country.