Topic 1 : Have India’s health centres really ‘collapsed’
Introduction
There is a well-documented infamy around public health centres. As sometimes there are no doctors, no diagnostics, no drugs. There are no buildings either sometimes, and people walk for miles to get substandard treatment. These centres, as reflections of the vast network of public healthcare, stoke the fear that India’s health system has either collapsed or is disintegrating rapidly.
Importance of Health centres
- Health centres are the lowest rung of India’s public health system, charged with offering accessible and affordable primary care.
- Almost two lakh in number, they are conceptualised as a three-tier system: sub-centres (later renamed as health and wellness centres), public health centres (PHCs) and community health centres (CHCs).
- 94% of these centres are located in rural areas, but reports show that less than 20% of them function effectively, pushing disadvantaged communities to rely on expensive, exploitative private health care.
- Last year’s Economic Survey showed that in the absence of proper insurance and affordable services, almost half of all health spending in India is still paid by patients themselves, pushing many households into poverty.
- Localised healthcare “is a much better way of dealing with most health problems than to let patients loose on larger public hospitals or the private sector”.
Changes between 2002 and 2022
- The share of health expenditure in the Union Budget increased drastically, coupled with the introduction of the National Rural Health Mission.
- India’s flagship Ayushmann Bharat programme, launched with the vision of achieving universal health coverage, in 2018 introduced a health insurance component (PMJAY) and a public provision component through health and wellness centres (HWCs).
- COVID-19 contributed to a sustained increase in patient utilisation, with people placing greater trust in public health facilities.
Issues
- Progress is rarely ever linear or logical.
- The study contextualises these signs of life as “modest improvements” only.
- The centres are still “grossly underutilised”: there is high staff absenteeism, the number of patients per day is low, services are limited and quite likely, of poor quality.
- Some sub-centres are still trapped in the old pattern where Auxiliary Nurse Midwife (ANMs) focus mainly on family planning targets and ‘motivating’ people—mainly women—for sterilisation.
- The health workers interviewed listed challenges that remain neglected: lack of staff ; irregular flow of funds; lack of toilet facilities; no transport or residential facilities; no drugs or functional testing equipment; and the growing burden of both online and on-field work.
- The study also documented social discrimination in health centres: some upper-caste doctors had disparaging attitudes towards marginalised communities and upper-caste families routinely disrespected Dalit ANMs.
- The study found female nurses and staff members ran district hospitals and did “the bulk of the effort”, while men in senior positions tended “to take advantage of their seniority”.
- ANMs and ASHAs worked in grim environments with centres lacking running water and toilets.
The pursuit of development
- Investment in healthcare increased, but the improvements are patchy and allocations prioritise material development in tertiary healthcare.
- Take the composition of the healthcare budget: the allocation in 2022–23 (1.9%) was almost the same as a decade ago in 2013–14 (1.7%).
- The National Health Mission share shrank from 69% to 44%.
- In comparison, the government spent 10 times as much money on PMJAY and new regional AIIMS hospitals than on public welfare arms like the HWCs.
- The researchers poked holes in the claim that lakhs of HCWs created were minor upgrade of existing centres.
Way forward
- The study sketches India’s health centres as sites of hope, debunking cynicism surrounding its failures and dissects claims of progress.
- These struggles cannot be regarded as successful, but nor is it hopeless because hope lies in the experiences of States that have shown how decent standards of healthcare can be achieved in the public sector.
- Beyond the current tokenism of Ayushmann Bharat, major support from the centre would make it much easier for the poorer states to emulate these initiatives.
Topic 2 : Green jobs and the problem of gender disparity
Context
Increasing women’s representation in green jobs will lead to benefits such as boosting a low-carbon and environmentally sustainable economy.
Green jobs
- The transition to low-carbon development has the potential to add about 35 million green jobs in India by 2047.
- The International Labour Organization defines green jobs as ‘’decent jobs that contribute to preservation or restoration of the environment”.
Gender disparity
- Many of these green jobs span across sectors, such as manufacturing, construction, renewable energy, energy efficiency and automobiles, which traditionally saw a lower representation of women.
- Globally, men are likely to transition to green jobs faster than women.
- Even as India increased its renewable energy capacity by 250% between 2015 to 2021, women comprised merely 11% of workers in the solar rooftop sector.
- The Annual Survey of Industries 2019-20 shows that women workers are mostly concentrated in industries such as apparel, textile, leather, food, and tobacco.
- In contrast, a Confederation of Indian Industry (CII) 2019 report shows that men comprise 85% of the work force in sectors such as infrastructure, transport, construction, and manufacturing.
- A study in 2023 by the Skill Council for Green Jobs indicated that 85% of the training for green skills was imparted to men while over 90% of women believed that social norms limited their participation in training for green jobs.
- These restrictive social norms include factors such as the belief that women are unsuitable for certain technical roles, safety concerns, lower representation in science, technology, engineering, and mathematics (STEM) subjects, and familial constraints.
Addressing the gap
- As India embraces a green transition, empowering women and advancing gender equity in climate actions will be one of the keys to unlock the co-benefits of a low-carbon and environmentally sustainable economy.
- Increasing women’s representation in green jobs has several benefits.
- In the short run, it can address the gender biases in the Indian labour market and improve women’s labour force participation rates.
- In the long run, this can contribute to improving women’s agency and their empowerment by creating economic, technical, and social opportunities.
- Mapping emerging areas for green growth and collecting sex-disaggregated data on green jobs could be the starting point to improve women’s participation.
- There is need to build evidence on the present and future impact of low-carbon transitions on women workers and entrepreneurs while considering the hidden and invisible roles played by women across different sectors and geographies.
- This could be done by conducting gender analysis, collecting gender statistics on green jobs through periodic labour force surveys and mobilising additional resources to emphasise and encourage women’s role in the green transition.
Women’s stance
- Globally, women are being left behind in the worldwide race to achieve climate targets and sustainability goals.
- This is particularly evident in the transition to a low-carbon economy, where new opportunities are created alongside job displacement and transformation.
- COP 28’s high-level dialogue launched ‘Gender-Responsive Just Transitions and Climate Action Partnership’ with a focus on improved data, targeted finance, and skill development.
- Given the unequal landscape of women’s work and participation in green jobs, we need to ensure that women can access emerging opportunities from low-carbon transitions.
Conclusion
- In India, despite 42.7% of the total number of STEM graduates being women, they represent only 30.8% in engineering, manufacturing and construction programmes which are the key sectors for green transition. To bridge this gap early hands-on learning, mentorship, scholarships, financial assistance, and awareness generation are crucial to empower women in green jobs-related fields.