पॉलिसी बज़्ज़

विभिन्न कल्याणकारी योजनाओं में क्या घटित हो रहा है, यह पॉलिसी बज़्ज़ आपको हर 15 दिन के अंदर ख़ास ख़बरों के साथ अपडेट करता है |

नीतियों से जुडी खबरें

  • मनरेगा और केरल की राज्य शहरी रोजगार गारंटी योजना के पंजीकृत श्रमिकों को पेंशन प्रदान करने के लिए केरल सरकार द्वारा कल्याण निधि बोर्ड शुरू किया गया।
  • पूर्वोत्तर क्षेत्र विकास मंत्रालय (डी.ओ.एन.ई.आर) के तहत योजनाओं को 15वें वित्त आयोग (2022-23 से 2025-26) की शेष अवधि के लिए 12,882 करोड़ रुपये के परिव्यय के साथ केंद्र द्वारा जारी रखने की मंजूरी दी गई।
  • केंद्र ने विभिन्न विकास मापदंडों में पिछड़ रहे प्रखंडों के प्रदर्शन में सुधार करने के उद्देश्य से आकांक्षी ब्लॉक कार्यक्रम शुरू किया।
  • उत्तराखंड सरकार ने सरकारी नौकरियों मे महिलाओं के लिए 30 प्रतिशत आरक्षण अनुमोदित किया।
  • केंद्र द्वारा बहु-राज्य सहकारी समिति (एम.एस.सी.एस) अधिनियम, 2002 के तहत राष्ट्रीय स्तर की बहु-राज्य सहकारी निर्यात समिति की स्थापना को मंजूरी दी गई।
  • राष्ट्रीय बाल अधिकार संरक्षण आयोग (एन.सी.पी.सी.आर) ने प्रारंभिक मूल्यांकन पर एक मसौदा दिशानिर्देश जारी किया है कि क्या कुछ मामलों में, किशोर न्याय (बच्चों की देखभाल और संरक्षण) अधिनियम के तहत, कानून के अनुसार कुछ नाबालिगों पर वयस्कों की तरह मुकदमा चलाया जा सकता है।
  • देश की जनगणना, जो 2021 में होने वाली थी, को 2024-25 तक विलंबित कर दिया गया।

स्वास्थ्य और पोषण

  • नई एकीकृत खाद्य सुरक्षा योजना का नाम प्रधानमंत्री गरीब कल्याण अन्न योजना (पी.एम.जी.के.ए.वाई) रखा गया था।
  • राष्ट्रीय स्वास्थ्य प्राधिकरण द्वारा आयुष्मान भारत योजना के तहत सूचीबद्ध अस्पतालों के प्रदर्शन को मापने के लिए एक नई प्रणाली शुरू की गई थी।

शिक्षा

  • विश्वविद्यालय अनुदान आयोग (भारत में विदेशी उच्च शिक्षण संस्थानों के परिसरों की स्थापना और संचालन) विनियम, 2023 का मसौदा जारी किया गया।
  • पारदर्शिता की दिशा में कदम बढ़ाते हुए राष्ट्रीय मूल्यांकन और प्रत्यायन परिषद द्वारा विश्वविद्यालयों और स्वायत्त कॉलेजों के लिए निर्धारित बेंचमार्क जारी किए।

स्वच्छता

  • “जल दृष्टि @ 2047” पर पहला अखिल भारतीय वार्षिक राज्य मंत्री सम्मेलन भोपाल, मध्य प्रदेश में आयोजित किया गया।

अन्य खबरें

  • ‘वैश्विक जोखिम रिपोर्ट 2023’ विश्व आर्थिक मंच द्वारा जारी की गई। रिपोर्ट के अनुसार, भारत के लिए पहचाने गए शीर्ष पांच जोखिमों में डिजिटल असमानता, संसाधनों के लिए भू-राजनीतिक प्रतिस्पर्धा, जीवन यापन की लागत, ऋण संकट, और प्राकृतिक आपदाएं और चरम मौसम की घटनाएं शामिल हैं।

यह लेख पॉलिसी बज़्ज़ के अंग्रेजी संस्करण पर आधारित है जो 16 जनवरी 2023 को प्रकाशित हुआ था।

In a Glance: Winter Session 2022

The Winter Session 2022 of Parliament commenced on 9 December 2022 and was scheduled to conclude on 29 December 2022. The session, however, adjourned sine die six days prior on 23 December 2022. Below are curated highlights from the Question Hour and Zero Hour during the second week of the session (between 19 December 2022 to 23 December 2022), and a brief summary of reports related to welfare schemes.

Highlights from Question Hour and Zero Hour

Health

  • According to a Lok Sabha answer, the Ministry of Health and Family Welfare stated that the doctor-population ratio in India stands at 1: 834. This was calculated based on the information provided by the National Medical Commission (NMC).

As of June 2022, there were 13,08,009 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) across the country. Additionally, there were 5.65 lakh AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) doctors in the country. The doctor-population ratio has been calculated by assuming 80% availability of registered allopathic doctors and AYUSH doctors.

Similarly, the Ministry of Health and Family Welfare stated that the nurse-population ratio in India stands at 2.06 nurses per 1,000 population. This was calculated based on the information provided by Indian Nursing Council (INC). As on 31 December 2021, there were about 35.14 lakh nursing personnel registered across the country.


  • Under the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), as on 4 December 2022, a total of 20.96 crore beneficiaries have been provided with Ayushman cards. Under the scheme, over 4.18 crore hospital admissions worth ₹48,954.33 crore have been authorised through a network of 26,267 empanelled healthcare providers, including 11,700 private hospitals across the country. State-wise data show that Uttar Pradesh and Bihar account for the highest number of eligible families under the AB-PMJAY at 1.17 crore and 1.08 crore families respectively.

  • On the 4th anniversary of Ayushman Bharat Health and Wellness Centres (AB-HWCs), Block Health Melas were organised all across the country between 18-22 April 2022. A total of 4,849 Block Level Health Melas were organised with cumulative footfall of over 47.3 lakh eligible citisens across the country. (Learn more about the Block Health Melas here.)

Women and Child Development

  • Under Poshan 2.0, along with  local foods and fresh produce, fortified rice and the incorporation of millets at least once a week in meals, has been mandated to tackle anaemia and promote health. During FY 2021-22, a total of 7.34 lakh metric tons of fortified rice (fortified with Iron, Vitamin B-12 and Folic Acid) was allocated to states.

For FY 2022-23, a total of 9.32 metric tons of fortified rice has been allocated to states. A Centrally Sponsored Pilot Scheme has been launched to provide fortified rice to eligible citizens of PM POSHAN, Anganwadi services, and Public Distribution System (PDS) by 2024 in a phased manner. (Download our 2022 briefs on PM POSHAN, and Saksham Anganwadi and POSHAN 2.0 to know the status and progress of the schemes.)


  • The National Commission for Protection of Child Rights (NCPCR) has launched a portal called ‘GHAR’ – Go Home and Re-Unite for digitally coordinating the repatriation of children under various child protection and welfare schemes.


Table 1. Unutilised Funds under BBBP scheme (in ₹ crore)

The high percentage of unutilised funds under the BBBP scheme has been attributed to a lack of qualitative initiatives at the level of state and district administration.


Panchayati Raj

  • Under the Digital India programme, the Ministry of Panchayati Raj (MoPR) is implementing the e-Panchayat Mission Mode Project (MMP). The objective of the mission is to transform the functioning of PRIs (Panchayati Raj Institutions) with ePanchayat initiatives like eGramSwaraj, AuditOnline, and others. Launched in 2020, the eGramSwaraj encompasses all aspects of Panchayat functioning such as budgeting, asset management, monitoring, accounting, etc., on a single digital platform including online payments. In 2022-23, about 2.53 lakh Gram Panchayats (GPs) have prepared and uploaded their Gram Panchayat Development Plans (GPDPs) on eGramSwaraj.

Rural Development

  • Under the Pradhan Mantri Awaas Yojana- Gramin (PMAY-G), as on 15 December 2022, a total of 2.50 crore houses (84.75%) have been sanctioned and construction of 2.11 crore houses (71.5%) have been completed, against the target of 2.95 crore houses by 31st March 2024. (Download our 2022 brief on PMAY-G to know the status and progress of the scheme.)

  • On 26 August 2021, the eShram portal was launched by the Ministry of Labour & Employment with the objective of creating a national database of unorganised workers in the country. Initially, the eShram portal was designed with a daily registration capacity of 10-15 lakh per day. However, given the unprecedented response, the daily registration capacity of the portal was enhanced to support 80 lakh registrations per day. Additionally, the Ministry has also onboarded more than 4 lakh Common Service Centres (CSCs) to boost registration on the portal.

  • As on 1 December 2022, under the Pradhan Mantri Gram Sadak Yojana (PMGSY), a total road length of 7,98,739 km has been sanctioned and 7,21,362 km (i.e. 90.3%) has been completed.

  • While the Pradhan Mantri Gram Sadak Yojana (PMGSY) was launched in 2000, new components like PMGSY-I, II, III and Road Connectivity Project for Left Wing Extremism Affected Areas (RCPLWEA) were added subsequently.

The PMGSY-III was launched in 2019 with the aim of consolidating 1,25,000 kms through major rural links by connecting habitations, higher secondary schools, hospitals and Gramin Agricultural Markets (GrAMs). As on 8 December 2022, against the total target, 91,371 km of road length has been sanctioned and 45,946 km has been completed. The implementation period  of PMGSY-III is till March 2025.


  • The Start-up Village Entrepreneurship Programme (SVEP) aims to support rural entrepreneurs in the non-farm sector. It was launched in 2016 as a sub-scheme under the Deendayal Antyodaya Yojana – National Rural Livelihoods Mission (DAY-NRLM). As part of the SVEP,  a total of 2,21,072 enterprises have been provided support for business development and seed capital through a dedicated Community Enterprise Fund (CEF).

Other

  • The One Nation, One Ration Card (ONORC) scheme enables nation-wide portability of benefits under the National Food Security Act (NFSA), 2013. Under the scheme, NFSA beneficiaries can lift foodgrains from any Fair Price Shop (FPS) across the country by using their ration card along with biometric authentication. As on 30 November 2022, a total of 93.31 crore portability transactions have been recorded under the scheme. Out of these, 92.7 crore (99.4%) transactions were intra-state and the remaining 59.64 lakh (0.64%) transactions were inter-state.

  • Under the PM Street Vendor’s AtmaNirbhar Nidhi (PM SVANidhi), the Ministry of Housing and Urban Affairs provides affordable loans to street vendors in three phases: 1st loan of ₹10,000, 2nd loan of ₹20,000, and a 3rd loan of ₹30,000. The implementation of the PM SVANidhi scheme has been extended beyond March 2022 to December 2024.

The scheme aims to provide collateral-free special micro-credit to 42 lakh street vendors by December 2024.  As on 30 November 2022, a total of 31.73 lakh street vendors availed the benefit of 1st loan under the scheme. Out of these, 5.81 lakh have availed the benefit of 2nd loan, and 6,926 street vendors have also availed the benefit of 3rd loan.


Highlights from Reports tabled in the Parliament

  • The Standing Committee on Labour, Textiles, and Skill Development presented its 36th report titled ‘Implementation of Pradhan Mantri Kaushal Vikas Yojna (PMKVY)’. Launched in 2015, the scheme promotes skill development by providing a variety of industry-relevant skill training courses at the PMKVY Training Centres (TCs) across the country. After successful completion of course mandated assessment and certification, candidates are also provided placement assistance by Training Partners (TPs).

The Committee highlighted the following major trends:

  • Under-utilisation of funds under the PMKVY 3.0. In 2021-22, only 72% funds have been utilised under the scheme.

Table 2. Financial Progress of PMKVY 2.0 & PMKVY 3.0 (in crore)

  • Out of total enrolment, placement figures for PMKVY 2.0 were low  at 23% and PMKVY 3.0 at 8% (up till December 2022 ).

To read the curated highlights of the Budget session 2022 click here, and the Monsoon session 2022 here.


Also Read: It is Time to Emphasise on Community Participation and Empower Panchayats: Interview with IAS Aditya Ranjan

पॉलिसी बझ

हे पॉलिसी बझ तुम्हाला विविध कल्याणकारी योजनांमध्ये काय चालले आहे याविषयी दर 15 दिवसांनी विशेष बातम्या अपडेट करते.

धोरण बातम्या 

  • MGNREGS आणि राज्याच्या शहरी रोजगार हमी योजनेसाठी नोंदणीकृत कामगारांना पेन्शन देण्यासाठी कल्याण निधी मंडळ केरळ सरकारने सुरू केलेआहे.
  • 12,882 कोटी रुपयांच्या खर्चासह 15 व्या वित्त आयोगाच्या (2022-23 ते 2025-26) उर्वरित कालावधीसाठी केंद्राने पूर्वोत्तर क्षेत्र विकास मंत्रालयाच्या (DoNER) अंतर्गत योजना सुरू ठेवण्यास मान्यता दिली आहे. 
  • विविध विकास पॅरामीटर्समध्ये मागे असलेल्या ब्लॉक्सची कामगिरी सुधारण्याच्या उद्देशाने एस्पिरेशनल ब्लॉक प्रोग्राम (ABP) केंद्राने सुरू केला आहे. 
  • राज्य सरकारच्या नोकऱ्यांमध्ये उत्तराखंडमधील महिलांसाठी 30 टक्के क्षैतिज आरक्षणाला राज्य सरकारने मान्यता दिली आहे.
  • राष्ट्रीय स्तरावरील बहु-राज्य सहकारी निर्यात सोसायटीच्या स्थापनेला केंद्राने मल्टी स्टेट कोऑपरेटिव्ह सोसायटीज (MSCS) कायदा, 2002 अंतर्गत मान्यता दिली आहे.
  • राष्ट्रीय बाल हक्क संरक्षण आयोग (NCPCR) द्वारे बाल न्याय (मुलांची काळजी आणि संरक्षण) कायद्यांतर्गत, विशिष्ट प्रकरणांमध्ये, विशिष्ट अल्पवयीन मुलांवर कायद्यानुसार प्रौढ म्हणून खटला चालवला जाऊ शकतो की नाही या प्राथमिक मूल्यांकनावरील मार्गदर्शक तत्त्वांचा मसुदा जारी केला आहे.
  • 2021 मध्ये होणारी देशाची जनगणना 2024-25 पर्यंत ढकलण्यात आली आहे.

आरोग्य आणि पोषण

  • नवीन एकात्मिक अन्न सुरक्षा योजनेला प्रधानमंत्री गरीब कल्याण अन्न योजना (PMGKAY) असे नाव देण्यात आले आहे.
  • आयुष्मान भारत PM-JAY योजनेंतर्गत पॅनेलमध्ये समाविष्ट असलेल्या रुग्णालयांच्या कामगिरीचे मोजमाप आणि दर्जा देण्यासाठी एक नवीन प्रणाली राष्ट्रीय आरोग्य प्राधिकरणाने (NHA) सुरू केली आहे.

शिक्षण 

    • विद्यापीठ अनुदान आयोग (भारतातील परदेशी उच्च शैक्षणिक संस्थांच्या कॅम्पसची स्थापना आणि संचालन) विनियम, 2023 मसुदा प्रसिद्ध करण्यात आला. मसुदा नियम येथे प्रवेश करा.
    • पारदर्शकतेच्या दिशेने एक पाऊल म्हणून नॅशनल असेसमेंट अँड अॅक्रेडिटेशन कौन्सिल (NAAC) द्वारे विद्यापीठे आणि स्वायत्त महाविद्यालयांसाठी सेट बेंचमार्क जारी केले गेले आहे

स्वच्छता

  • “जल दृष्टी @ 2047” वर पहिली अखिल भारतीय वार्षिक राज्य मंत्र्यांची परिषद भोपाळ, मध्य प्रदेश येथे आयोजित करण्यात आली होती.

इतर बातम्या

  • वर्ल्ड इकॉनॉमिक फोरम द्वारे ग्लोबल रिस्क रिपोर्ट 2023 प्रसिद्ध करण्यात आला. अहवालानुसार, भारतासाठी कार्यकारी मत सर्वेक्षणाद्वारे ओळखल्या गेलेल्या शीर्ष पाच जोखमींमध्ये डिजिटल असमानता, संसाधनांसाठी भू-राजकीय स्पर्धा, राहणीमानाचा खर्च, क्रेडिट क्रंच आणि नैसर्गिक आपत्ती आणि अत्यंत हवामानाच्या घटना होत्या.

हा लेख पॉलिसी बझच्या इंग्रजी आवृत्तीवर आधारित आहे जो 16 जानेवारी 2023 रोजी प्रकाशित झाला.

Policy Buzz

Keep up-to-date with all that is happening in welfare policy with this curated selection of news – Policy Buzz – published every fortnight.

Policy News

  • A welfare fund board to provide pension to workers registered for MGNREGS and the state’s urban job guarantee scheme was launched by the Kerala government. 
  • Schemes under the Ministry of Development of North Eastern Region (DoNER) were approved for continuation by the Centre with an outlay of Rs 12,882 crore for the balance period of the 15th FC (2022-23 to 2025-26). 
  • The Aspirational Block Programme (ABP), aimed at improving performance of blocks lagging on various development parameters, was launched by the Centre.
  • A 30 per cent horizontal reservation to women of Uttarakhand for state government jobs was approved by the state government. 
  • Setting up of a national level Multi-state cooperative export society was approved by the Centre under the Multi State Cooperative Societies (MSCS) Act, 2002.
  • Draft guidelines on the preliminary assessment of whether certain minors can be tried as adults under law in particular cases, under the Juvenile Justice (Care and Protection of Children) Act was released by National Commission for Protection of Child Rights (NCPCR).
  • The Census of the country, scheduled to take place in 202, has been pushed to 2024-25.

Health and Nutrition 

  • The new integrated food security scheme was named Pradhan Mantri Garib Kalyan Ann Yojana (PMGKAY).
  • A new system to measure and grade performance of hospitals empaneled under Ayushman Bharat PM-JAY scheme was introduced by the National Health Authority (NHA).

Education

Sanitation

  • The first All India Annual States’ Ministers Conference on “Water Vision@2047” was held in Bhopal, Madhya Pradesh.

Other News

  • The Global Risks Report 2023 was released by the World Economic Forum. According to the report, the top five risks identified by the Executive Opinion Survey for India were digital inequality, geopolitical contestation of resources, cost-of-living crisis, debt crises, and natural disasters and extreme weather events.

Also Read: Immunisation and Child Nutrition Outcomes, Is India’s Performance Stagnating?

पॉलिसी बज़्ज़

विभिन्न कल्याणकारी योजनाओं में क्या घटित हो रहा है, यह पॉलिसी बज़्ज़ आपको हर 15 दिन के अंदर ख़ास ख़बरों के साथ अपडेट करता है |

नीतियों से जुडी खबरें

  1. संसद को शीतकालीन सत्र की सारणी से छह दिन पहले 23 दिसंबर, 2022 को स्थगित कर दिया गया।
  2. आवास और शहरी मंत्रालय द्वारा शहरी स्थानीय निकाय के प्रमुख वित्तीय मापदंडों की मज़बूती को पहचानने, मूल्यांकन करने और पुरस्कृत करने के लिए “सिटी फिनान्स रैंकिंग” की शुरुआत की गई
  3. केंद्र द्वारा राष्ट्रीय मोबाइल निगरानी प्रणाली ऐप के माध्यम से मनरेगा उपस्थिति को डिजिटल रूप से कैप्चर करना सार्वभौमिक बना दिया गया।
  4. राष्ट्रीय महिला आयोग ने सभी राज्यों और केंद्र शासित प्रदेशों के मुख्य सचिवों को शैक्षणिक संस्थानों में महिलाओं की सुरक्षा सुनिश्चित करने के लिए परामर्श जारी किया।
  5. छठे कॉमन रिव्यू मिशन ने मनरेगा को लागू करने में राज्यों को अधिक स्वतंत्रता प्रदान करने और पीएमएवाई योजना के तहत घरों के लिए समय पर भुगतान करने की सिफारिश की।

स्वास्थ्य और पोषण

  1. केंद्र ने एकीकृत खाद्य सुरक्षा योजना शुरू की। नई एकीकृत योजना में खाद्य और सार्वजनिक वितरण विभाग की पिछली दो खाद्य सब्सिडी योजनाएं शामिल हैं। केंद्र एन.एफ.एस.ए के तहत 81 करोड़ पात्र नागरिकों को मुफ्त खाद्यान्न प्रदान करेगा।
  2. प्रधानमंत्री गरीब कल्याण अन्न योजना (PMJKAY) को केंद्र द्वारा बंद कर दिया गया था।
  3. एबीडीएम-अनुरूप अस्पताल प्रबंधन सूचना प्रणाली (एच.एम.आई.एस) का बीटा संस्करण राष्ट्रीय स्वास्थ्य प्राधिकरण द्वारा जारी किया गया था।

स्वच्छता

  1. आवास और शहरी मामलों के मंत्रालय द्वारा अमृत 2.0 के तहत पेय जल सर्वेक्षण का जमीनी सर्वेक्षण शुरू किया गया था।

अन्य खबरें

  1. ग्रामीण अर्थव्यवस्था को बदलने के लिए विचारों और समाधानों को आमंत्रित करने के लिए ग्रामीण विकास मंत्रालय द्वारा प्रज्वला चैलेंज शुरू किया गया।
  2. भारतीय रिजर्व बैंक द्वारा 2021-22 में भारत में बैंकिंग की प्रवृत्ति और प्रगति पर रिपोर्ट जारी की गई थी।
  3. मरम्मत का अधिकार पोर्टल खाद्य और उपभोक्ता मामलों के मंत्री द्वारा लॉन्च किया गया था।
  4. भारत का चुनाव आयोग (ECI) घरेलू प्रवासियों के लिए रिमोट वोटिंग का पायलट करने के लिए तैयार है।
  5. प्रतिस्पर्धात्मकता और सामाजिक प्रगति अनिवार्यता संस्थान द्वारा विकसित सामाजिक प्रगति सूचकांक, आर्थिक सलाहकार परिषद-प्रधान मंत्री द्वारा जारी किया गया।

यह लेख पॉलिसी बज़्ज़ के अंग्रेजी संस्करण पर आधारित है जो 4 जनवरी 2023 को प्रकाशित हुआ था।

Immunisation and Child Nutrition Outcomes, Is India’s Performance Stagnating?

In the Global Hunger Index (GHI) released in October 2022, India’s ranking fell by six places, to 107 out of 121 countries, compared to 2021. Immunisation and better nutrition are key to curbing child malnutrition, but what does the recent data on coverage reveal?


India’s GHI Performance


The GHI computes a score based on four parameters: overall undernourishment, child wasting, child stunting, and child mortality. While the Government of India (GoI) has dismissed the report, calling it a “one-dimensional view” and questioning the integrity of its methodology, the fact remains that India’s once stellar performance in the domain of health and nutrition has now stagnated.

According to GHI 2022, India’s performance in two of the indicators has worsened since 2014;  an increase in the proportion of undernourished people and children showing symptoms of wasting. Child wasting refers to a child who is too thin for their height, and this is the result of recent rapid weight loss or the failure to gain weight. It is often the result of poor nutritional practices, infections, poverty, and lack of access to safe, potable water. Growing evidence indicates that wasting occurs early in life and disproportionally affects children under 2 years of age. 


Relation between Immunisation and Malnutrition


Among several other factors, children with incomplete vaccination coverage are more likely to have poor nutritional outcomes, including being wasted or stunted. This is because infectious diseases can hamper the body’s ability to absorb nutrients and cause undernutrition. Similarly,  malnutrition can impact the effectiveness of immunisations, with malnourished children having weaker immune systems and a higher likelihood of disease compared to well-nourished children. Thus, both immunisation and nutrition are important drivers of a child’s healthy development.  

In India, to be considered fully vaccinated, an infant must be vaccinated against viruses such as the Rotavirus, which causes diarrhoea which is a major cause of malnourishment in low-income countries. 


India’s Immunisation Coverage


While India has been one of South Asia’s top performers in the last two decades in advancing immunisation coverage, COVID-19 has threatened to undo the impressive gains made.  During the Financial Year (FY) 2020-21, when multiple lockdowns were enforced nationally due to the pandemic, access to healthcare facilities was limited. Despite multiple catch-up sessions under Intensified Mission Indradhanush,  GoI’s flagship immunisation campaign aimed at increasing full immunisation coverage among children, there were 10 lakh fewer fully-immunised children (9-11 months), compared to FY 2019-20

A look at regular immunisations is revealing. Although 96% of planned immunisation sessions were held in FY 2020-21,  similar to the 98% seen in FY 2019-20, in actual terms,  approximately 9.4 lakh fewer sessions were held in 2020-21 compared to the previous year. Similarly, the number of Anganwadi centres and Urban Primary Health Care centres that reported conducting Village Health and Nutrition Day (VHNDs), Urban Health and Nutrition Day (UHNDs) or Outreach programmes in FY 2020-21 was almost 11 lakh fewer than in FY 2019-20.  VHNDs, which serve as a platform for providing preventative services (including immunisations), particularly for marginalised groups in rural areas, play a crucial role in fostering community-led impact and implementation. 


Immunisation and Institutional Births


In addition, the first chance an infant has at immunisation is at a hospital. Institutional births are associated with better immunisation rates among children, as well as lower maternal mortality rates. However, given the restriction on movement and access to healthcare facilities during the lockdown periods, the number of institutional deliveries decreased in FY 2020-21 by approximately 8 lakh. This figure is validated by RTI data on Janani Suraksha Yojana (JSY), a conditional cash transfer scheme with the objective of promoting institutional delivery among poor pregnant women, which saw 7 lakh and 10 lakh fewer institutional births in FY 2020-21 and FY 2021-22 respectively, compared to the non-COVID FY 2019-20. This detriment can be observed specifically for vaccines that are to be administered at birth, which saw a substantial decrease in FY 2020-21 such as for BCG (13 lakh lower), OPV (11 lakh lower), and Hepatitis-B (7 lakh lower) compared to FY 2019-20, signalling more home deliveries or births without proper medical assistance. 

While the Ministry of Family and Health Welfare (MoFHW) has not yet published the number of estimated births in FY 2020-21, given that India’s Total Fertility Rate is 2.18, one can clearly expect a greater number of live births in FY 2020-21, than in FY 2019-20. This implies that the increase in the number of unvaccinated infants will be much higher in percentage terms as well. Analysis for FY 2021-22 and 2022-23 could not be conducted due to the unavailability of recent data. 

Immunisation and improved nutrition have been critical in curbing child malnutrition and ameliorating children’s health globally, and in India over the last 30 years.  For real, resilient and inclusive growth, India needs to categorically ensure that immunisation outcomes of the past are maintained.


Jenny Susan John is a Research Associate at Accountability Initiative.

Also Read: Big Questions India Needs to Focus on About Implementing a Right to Health


Glossary

  1. Child Mortality: The probability of a child dying between birth and exactly 5 years of age. (Source)
  2. Child Stunting: The share of children under age five who have low height for their age. (Source)
  3. Child Wasting: The share of children under age five who have low weight for their height. (Source)
  4. Global Hunger Index: The Global Hunger Index is an annual report, jointly published by Concern Worldwide and Welthungerhilfe, designed to measure and track hunger at the global, regional, and country levels. (Source)
  5. Immunisation: A process by which a person becomes protected against a disease through administration of a vaccine. (Source)
  6. Institutional Birth: This refers to a child birth which has taken place in a medical institution, like hospital.
  7. Malnutrition: Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. (Source)
  8. Mission Indradhanush: The Government of India’s immunisation campaign which was launched in 2014 with the objective of achieving full immunisation coverage for at least 90 per cent Indian children by 2020.

पॉलिसी बझ

हे पॉलिसी बझ तुम्हाला विविध कल्याणकारी योजनांमध्ये काय चालले आहे याविषयी दर 15 दिवसांनी विशेष बातम्या अपडेट करते.

धोरण बातम्या 

  1. हिवाळी अधिवेशनाच्या वेळापत्रकाच्या सहा दिवस अगोदर 23 डिसेंबर 2022 रोजी संसदेचे कामकाज तहकूब करण्यात आले. संसदेच्‍या राउंड-अपसह अधिवेशनातील प्रमुख ठळक मुद्दे वाचा.
  2. ‘सिटी फायनान्स रँकिंग’ हा उपक्रम गृहनिर्माण आणि शहरी व्यवहार मंत्रालयाने ULB चे मूल्यमापन करण्यासाठी, ओळखण्यासाठी आणि त्यांच्या प्रमुख आर्थिक पॅरामीटर्सच्या सामर्थ्यावर आधारित पुरस्कार देण्यासाठी सुरू केले होते.
  3. केंद्राने नॅशनल मोबाईल मॉनिटरिंग सिस्टीम अॅपद्वारे मनरेगा उपस्थितीचे डिजिटली कॅप्चरिंग सार्वत्रिक केले आहे.
  4. शैक्षणिक संस्थांमध्ये महिलांची सुरक्षा सुनिश्चित करण्यासाठी राष्ट्रीय महिला आयोगाने सर्व राज्ये आणि केंद्रशासित प्रदेशांच्या मुख्य सचिवांना एक सल्लागार जारी केला आहे.
  5. सहाव्या कॉमन रिव्ह्यू मिशनने MGNREGS लागू करण्यात राज्यांना अधिक स्वातंत्र्य देने आणि PMAY योजनेअंतर्गत घरांसाठी वेळेवर पैसे देण्याची शिफारस केली आहे.

आरोग्य आणि पोषण

  1. केंद्राने एकात्मिक अन्न सुरक्षा योजना सुरू केलीआहे. नवीन एकात्मिक योजना अन्न आणि सार्वजनिक वितरण विभागाच्या दोन पूर्वीच्या अन्न अनुदान योजनांचा समावेश आहे. केंद्र NFSA अंतर्गत 81 कोटी पात्र नागरिकांना मोफत अन्नधान्य पुरवेल.
  2. प्रधानमंत्री गरीब कल्याण अन्न योजना (PMGKAY) केंद्राने बंद केली आहे
  3. ABDM-अनुरूप हॉस्पिटल मॅनेजमेंट इन्फॉर्मेशन सिस्टीम (HMIS) ची बीटा आवृत्ती राष्ट्रीय आरोग्य प्राधिकरणाने जारी केली आहे.

स्वच्छता

  1. AMRUT 2.0 अंतर्गत गृहनिर्माण आणि शहरी व्यवहार मंत्रालयाने पेय जल सर्वेक्षणाचे ग्राउंड सर्वेक्षण सुरू केले आहे.

इतर बातम्या

  1. ग्रामीण अर्थव्यवस्थेचा कायापालट करण्यासाठी कल्पना, उपाय आणि कृती आमंत्रित करण्यासाठी ग्रामीण विकास मंत्रालयाने प्रज्ज्वला चॅलेंज सुरू केले आहे.
  2. भारतीय रिझर्व्ह बँकेने 2021-22 चा बँकिंगचा ट्रेंड आणि प्रगतीचा अहवाल प्रसिद्ध केला आहे.
  3. दुरुस्तीचा अधिकार हे पोर्टल अन्न आणि ग्राहक व्यवहार मंत्री यांच्या हस्ते सुरू करण्यात आले आहे.
  4. भारतीय निवडणूक आयोग (ECI) घरगुती स्थलांतरितांसाठी पायलट दूरस्थ मतदानासाठी तयार आहे.
  5. इन्स्टिट्यूट फॉर कॉम्पिटिटिव्हनेस अँड सोशल प्रोग्रेस इम्पेरेटिव्हने विकसित केलेला सामाजिक प्रगती निर्देशांक, आर्थिक सल्लागार परिषद- पंतप्रधान यांनी जारी केला.

हा लेख पॉलिसी बझच्या इंग्रजी आवृत्तीवर आधारित आहे जो 4 जानेवारी 2023 रोजी प्रकाशित झाला.

Policy Buzz

Keep up-to-date with all that is happening in welfare policy with this curated selection of news – Policy Buzz – published every fortnight.

Policy News

  1. The Parliament was adjourned sine-die on 23rd December 2022, six days ahead of their schedule of the Winter Session. Read key highlights from the session with our Parliament round-up here.                                              
  2. ‘City Finance Rankings’ initiative was launched by the Ministry of Housing and Urban Affairs (MoHUA) to evaluate, recognize and reward ULBs on the basis of their strength across key financial parameters.
  3. Digitally capturing of MGNREGA attendance was made universal through the National Mobile Monitoring System App (NMMS) by the Centre.
  4. An advisory was issued to the Chief Secretaries of all states and Union Territories by the National Commission for Women (NCW) to ensure the safety of women in educational institutions.
  5. The sixth Common Review Mission recommended providing more freedom to states in implementing the MGNREGS and timely payment for houses under the PMAY scheme.

Health and Nutrition 

  1. Integrated food security scheme rolled out by the Centre. The new integrated scheme subsumes the two former food subsidy schemes of the Department of Food and Public Distribution. Under the scheme, the Centre will provide foodgrain at no cost to 81 crore eligible citizens under NFSA. 
  2. Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) was discontinued by the Centre.
  3. Beta version of an ABDM-compliant Hospital Management Information System (HMIS) was released by the National Health Authority (NHA).

Sanitation

  1. Ground survey of Pey Jal Survekshan was started by MoHUA under AMRUT 2.0.

Other News

  1. The Prajjwala Challenge was launched by the Ministry of Rural Development to invite ideas, solutions and actions to transform the rural economy.
  2. Report on Trend and Progress of Banking in India 2021-22 was released by the Reserve Bank of India. 
  3. The Right to Repair portal was launched by the Minister of Food and Consumer Affairs.
  4. The Election Commission of India (ECI) is ready to pilot remote voting for domestic migrants.
  5. The Social Progress Index, developed by the Institute for Competitiveness and Social Progress Imperative, was released by the Economic Advisory Council- Prime Minister.

Also Read: Why Think Tanks Are Critical to Indian Policymaking?

Mental Health and the Question of Public Provision

India and the world have committed to Universal Health Coverage (UHC) as part of achieving the Sustainable Development Goals by 2030. UHC is realised when all people have access to the health services they need, when and where they need them, without financial hardship. This includes services linked with mental health and well-being, which is an often overlooked public health concern in India. 

In 2019, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, asserted: “Mental health must be an integral part of Universal Health Coverage (UHC). Nobody should be denied access to mental health care because she or he is poor or lives in a remote place.” Such declarations, especially from influential figures and organisations are important since mental health is often invisible, is perceived as weakness, and is therefore neglected. Globally, people who suffer from mental health issues often face discrimination, stigma, and human rights violations. India is no exception.

Therefore, the question that we should ask is: What does mental health mean, what is its impact as a public health concern, and does this impact necessitate government intervention?


What is mental health?


Mental health is a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community. Mental health includes our emotional, psychological, and social well-being. Our mental health strongly affects our own lives, and the ways in which we shape the world around us. Mental health, therefore, has intrinsic and instrumental value, helping us to connect, function, cope, and thrive.

So then, what characterises mental illnesses? Three terms are crucial here. 

‣ First, mental disorders, which are characterised by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour. These include anxiety disorders, depression, bipolar disorder, Post-Traumatic Stress Disorder, Schizophrenia, disruptive behaviour, dissocial disorders, and neurodevelopmental disorders.

Second, psychosocial disability that arises when someone with a long-term mental impairment interacts with various barriers that may hinder their full and effective participation in society on an equal basis with others. Examples of such barriers are discrimination, stigma, and exclusion. 

Third, the broad term mental health condition covers mental disorders and psychosocial disabilities. It also covers other mental states associated with significant distress, impairment in functioning, or risk of self-harm.

Therefore, mental health is more than simply the absence of mental disorders. It should be understood as a varied and comprehensive part of life, and is experienced differently by each person.


What causes mental health conditions?


There are four broad sets of factors that contribute to mental health conditions.

First are individual psychological and biological factors. Psychological factors relate to individuals’ intrinsic and learned abilities and habits for dealing with emotions and engaging in relationships, activities, and responsibilities. These include severe psychological trauma suffered as a child, such as emotional, physical, or sexual abuse; critical early loss, such as the loss of a parent; and neglect. Biological factors include genetics, but also, for example, high potency cannabis use, substance use by the mother, and oxygen deprivation at birth, among others.

Second, a person’s mental health is strongly shaped by their family and community. Parenting is extremely influential. Harsh and authoritarian parenting, neglect, emotional abuse, and corporal punishment significantly contribute to mental health issues. Bullying is a leading risk factor as well. Community level factors include neighbourhood trust and safety, community-based participation, and violence or crime. Furthermore, in India, vulnerable communities and groups including marginalised caste and religious groups and LGBTQIA+ individuals are also at higher risk.

Third, structural factors affect mental wellness. These factors exist outside of individuals and families, and operate at a social level. This includes access to basic services such as access to quality education, health services, sanitation, housing, and social support, food insecurity, unemployment and uncertainty in employment determine the opportunities available to people and their capabilities. This subsequently affects their ability to shape their lives, which is linked to mental wellness. One way in which this was sharply brought to the fore was the COVID-19 pandemic, and related job loss and financial hardship, future especially due to lockdowns. The pandemic caused stress, anxiety, or depression due to social isolation, and uncertainty about the future. Additionally, social stability is critical. Wars, conflict, terrorism, and displacement cause significant mental stress.

Lastly, prevailing beliefs, norms, and values are also crucial. Placing the responsibility of mental health on individuals rather than structural issues causing them and broader notions of productivity culture also adds to mental health conditions. 

These factors often overlap and interact with each other in complex and dynamic ways. For instance, a child may face neglect at home due to parents working long hours to support the family, which in turn could be due to precarity in employment, which again may be due to broader public policy.


Given this complexity, should the government intervene?


In India, mental disorders are among the leading causes of non-fatal disease burden. One in seven Indians were affected by mental disorders of varying severity in 2017. And worryingly, the proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. As per the WHO, the estimated economic loss due to mental health between 2012 and 2030 amounts to a staggering ₹85.25 lakh crore. Furthermore, mental healthcare is often unaffordable.

One argument for the government to intervene is to provide support to those who need it. Governments, especially in countries like India aim to protect vulnerable groups and provide social services. Since the determinants of mental health are diverse and varied and merit a response across many sectors, the government is best placed to form policy and programmes to intervene. 

Additionally, reshaping the determinants of mental health often requires action beyond the health sector and so promotion and prevention programme involve the education, labour, justice, transport, environment, housing, and welfare sectors. The government can facilitate multisectoral collaboration and coordination, enabling a broad-based response.

However, government intervention would be a costly endeavour. As per one study, implementing the Mental Healthcare Act (2017), would cost more than ₹90,000 crore, or more than the entire allocation for the Ministry of Health and Family Welfare in Financial Year 2022-23. This is a major stumbling block to government intervention, especially in a resource constrained environment like India. 


This blog is part of a series on mental health as a public health matter and public policy in India. The next blog in this series will explore the Government of India’s response.


Ritwik Shukla is a Senior Research Associate at Accountability Initiative.

Also Read: Big Questions India Needs to Focus on About Implementing a Right to Health

2022 in Review: Untying the Knots

As India emerged from the long shadow cast by the pandemic, one thing was reconfirmed for us — knowledge and accurate information are key to finding solutions to the country’s persistent development challenges. In the year 2022, we chose to unknot some tough policy questions and cross-pollinate knowledge about them to catalyse Responsive Governance or a public system that is responsive to citizen needs. Below is a sample of our efforts.

 

How is India’s welfare system faring given current fund flows?


Crores of rupees are being allocated to welfare programmes. Like every year since 2008, we published our flagship Budget Briefs series to unpack this. The 14th volume contained the trends in allocations, release, expenditure and implementation for 9 major Centrally Sponsored Schemes (CSSs). They spanned health, nutrition, education, rural livelihoods, housing, the availability of water, and food security. The volume is available here

Sharad Pandey, Avani Kapur, and Tanya Rana wrote a Working Paper on State Finances in FY 2022-23. This paper attempted to break down the dynamics between the Union and state governments, and focused on Grants-in-Aid from the Union government. By looking at state budgets over a period of five years from FY 2017-18 to FY 2022-23, the soon-to-be published paper looks at the trends in dependence of states on Union transfers, with a focus on CSSs.

Government’s ability to raise, allocate, and use public funds effectively forms the cornerstone of its ability to provide public goods and undertake service delivery. Encouraging conversation on public finance management has been our longstanding focus. As part of this year’s CPR Dialogues, we hosted a panel featuring leaders in the public finance management space on The Welfare State in the Digital Age: Planning for Stronger Public Fund Flows. We hosted another panel discussion on what can constitute an agile Public Finance Management System (PFMS) and evidence-based next steps with MSC (MicroSave Consulting) earlier this year. Key takeaways can be found here.

 

What are the emerging priorities in health?


For over 14 years, the Accountability Initiative has developed a deep understanding of health budgets, which we have regularly shared with the public. Taking another step in this direction, we collaborated with the World Bank to produce a primer entitled ‘Understanding India’s Health Budgets’. The primer’s main objective is to offer the reader a way to simply understand and accurately interpret India’s Union and state health budgets. It includes guidance on existing processes, involved actors, types of budget documents, and terminologies to keep in mind. The primer will be available in the public domain in early 2023.

Ritwik Shukla and Avani Kapur co-authored a paper on ‘Methods and Lessons from Costing a Large mHealth Intervention at Scale in India’. Among its objectives was to present a detailed protocol for determining the costs of a large national mHealth job aid and behaviour change communication tool known as the Integrated Child Development Services – Common Application Software (ICDS-CAS). The paper presents lessons for policymakers on how to ensure financial planning for scaling mHealth interventions. The study uses the Activity Based Costing—Ingredients (ABC-I) method, which brings clarity to costs for each input and activity, across levels and geographies.

 

What are the learnings on government nutrition interventions?


Researchers at the Accountability Initiative collaborated with researchers at the International Food Policy Research Institute to write a policy note on Financing for Nutrition in India. This note examined costs to fully finance a set of core Direct Nutrition Interventions (DNIs) at scale in FY 2022-23. This exercise is crucial to enable better planning, budgeting, and decision-making to ensure maximum possible coverage of nutrition for children, pregnant and lactating women, and adolescent girls in India.

Avani Kapur and Ritwik Shukla co-authored a paper with researchers from the Institute of Economic Growth  entitled Improving nutrition budgeting in health sector plans: Evidence from India’s anaemia control strategy. Following the four phases of the budget cycle — planning, allocations, disbursements and expenditure — this paper presented a new method to track nutrition budgets within health sector plans. Using the example of the Anemia Mukt Bharat (AMB), it reported preliminary findings on the application of the first two phases of the method, that is, to track and act for improved planning and allocations, for 12 states. 

A new interactive learning tool called Mapping Governance was launched to provide practitioners with a comprehensive, macro-level understanding of government structures responsible for delivering nutrition related public services in Bihar, Madhya Pradesh, and Rajasthan. Similarly, maps linked to education were also created. Both thematic streams are available here

 

How is India’s welfare architecture operating post-pandemic?


In September 2022, a new Memorandum of Understanding (MoU) was signed between the Accountability Initiative and the Government of Meghalaya to understand the on-ground  status of the Sustainable Development Goals (SDGs) in the state. The project involves interviews with key stakeholders across various indicators, discussions with government departments, and  household-level field surveys across the 11 districts of Meghalaya. In addition, we assisted the departments of Finance and Planning in developing Meghalaya’s first Gender and Youth Budgets as part of a previous MoU.

We are also  supporting the Government of Andhra Pradesh to undertake an evaluation of some of its welfare programmes. 

We partnered with the Chief Minister of Rajasthan’s Economic Transformation Advisory Council (CMRETAC) to understand data use for better policy formulation. This project includes mapping data generation, use, and processes across education, health and family welfare, and rural development departments. The study will focus on identifying limitations, duplication, and redundancies. It will recommend  methods to manage data flows and use it for effective decision-making, while considering global and domestic best practices. 

Tribal Sub Plan (TSP) funds are difficult to track once they leave the Government of India’s coffers. Researchers at the Accountability Initiative are tracking overall spending of the TSP component and  attempting to estimate tribal health spending across five districts spanning three states in order to understand the emerging patterns in health financing in tribal areas. The analysis will be informed through qualitative interviews with key stakeholders both within and outside government. This study has received the support of Piramal Swasthya. 

Sidharth Santhosh, Ritwik Shukla, and Avani Kapur prepared an issue brief detailing how convergence is understood by the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS). The study looks at various government documents, including guidelines, letters, and circulars.

Kiran Bhatty, Mridusmita Bordoloi, Avani Kapur, Mohammad Hamza and Anupriya Singh wrote a background paper entitled the ‘Regulation of Non-State Actors in School Education in India’. Commissioned by the UNESCO Global Education Monitoring (GEM) Report, the paper serves as background research for the development of the GEM 2022 Regional Report on non-state actors in education in South Asia. 

The PULSE (Platform to Understand, Learn, Share and Exchange) for Development was launched in 2020, immediately after the COVID-19 pandemic began in India, in order to bring together development practitioners who were working to mitigate the pandemic’s adverse impacts. In 2022, a conscious decision was made to connect practitioners also on longstanding development challenges confronted by India and the attainment of the SDGs. The revamped community of practice that reflects this change will come into action from the first month of 2023.  

To mark the 75th year of India’s independence, an exclusive interview series called State Speak was launched. The interviews have captured the experience of  IAS officers posted in India’s districts and other public officials who have a vantage point on how the country is being governed, related challenges, and best practices. The collection of interviews is available here, and provide valuable insights into decision-making associated with local communities.  

We have been supporting the Ministry of Rural Development on two national-level surveys (Ease of Living and Mission Antodaya) through data checks, validation, and analysis of previously completed surveys. Furthermore, suggestions were provided for improving the surveys and data quality.

 

What are the lived experiences of frontline officials, and citizens?


Launched in 2020, almost-immediately after the onset of the COVID-19 pandemic in India, Inside Districts has been our flagship interview series that documents the experiences of frontline workers, government officials, and eligible citizens of government schemes. Over 150 interviews from Bihar, Himachal Pradesh, Madhya Pradesh, Maharashtra, and Rajasthan have been published in the past two years. In 2022, the focus of the series was expanded to cover longer term development challenges of the country, with rich information emerging on labour rights and the migration of informal workers for livelihoods, among other aspects. Know about their perspectives, in their own voice at this link.  

Avani Kapur and Sidharth Santhosh co-authored a paper that characterises the challenges that street-level bureaucrats are facing in five Indian states amidst digital transitions in the provisioning of social welfare schemes. The authors presented their initial findings at the Indian Institute of Management Ahmedabad’s IPPN Annual Conference in December 2022. The paper is due to be published.

Tanya Rana and Ritwik Shukla conducted a Needs Analysis for Women’s Safety Schemes, which examined the costs and needs for providing key women’s safety schemes – One Stop Centre (OSC) and Shakti Sadan (SS) – of the Ministry of Women and Child Development (MWCD). The findings suggest that there are significant gaps in the number of victims of Violence Against Women (VAW) receiving assistance to those who may need it. This, correspondingly, leads to under-estimating the number of shelter facilities to VAW victims in India in FY 2021-22. The brief will be available in the public domain in early 2023. 

 

How can citizen participation in governance be augmented?


For close to half a decade, our flagship learning programme –  ‘Hum Aur Humaari Sarkaar’ – has sparked deliberation on the government system among grassroots development leaders. Two offline courses were conducted in Madhya Pradesh and Bihar, training 70 grassroot development professionals. In addition, keeping with demand, two additional modules on Social Protection and E-governance were added to the course. Also, course alumni and practitioners at-large continued to access the Hum Aur Humaari Sarkaar website. The website’s three most popular sections are – ‘Prashasan ke sitaare‘ (Star performers from the public administration), ‘Seekhne ke saadhan’ (Learning resources), and ‘Saathiyon ke vichaar’ (Alumni speak).

Sidharth Santhosh, Rajika Seth, Avani Kapur and Neeha Susan Jacob conducted a study that unpacks how social accountability mechanisms are institutionalised. The study proposes a novel framework to understand the process of institutionalisation by looking at dimensions such as incentives and institutional design. The team members studied the design and implementation of the Meghalaya Community Participation and Public Services Social Audit Act of 2017 to test the framework. A  research paper and a policy note will be released in early 2023. 

Project ‘Samanvay’, in collaboration with Piramal Foundation, is aimed at the capacity building of Panchayati Raj Institution members from the tribal district of Barwani (Pati Block), Madhya Pradesh. Among the objectives is to enable them to learn and reflect on the complexities of the administrative and financial structures that they operate within, as well as engineer solutions at their level.   

In-person sessions of another flagship learning programme – ‘Understanding State Capabilities’ – was conducted for students from the FLAME University and the Indian School of Development Management. A workshop was also conducted with staff of Mantra4Change on ‘Understanding the Bureaucracy’.