Topic 1 : Viksit Bharat, litmus test
Introduction: As the country is moving towards Amrit Kaal, the country will also see the beginnings of Ram Rajya in the true sense, where communal harmony and safety of all people, especially women, is secured, and poverty is abolished.
The poverty estimates in India: latest trends
- The NITI Aayog has recently come up with a report estimating that 248.2 million Indians have been lifted out of poverty in the nine years of the Modi government.
- This is based on the National Multidimensional Poverty Index (NMPI).
- While UNDP’s methodology of MPI has 10 indicators under three dimensions – health (nutrition and child mortality), education (years of schooling and school attendance) and standard of living (cooking fuel, sanitation, drinking water, housing, electricity and assets), NMPI adds maternal health and bank accounts to this list making it 12 indicators.
- NITI Aayog argues that NMPI is a better measure to estimate poverty than the traditional estimates based on income/consumption.
- It has been driven largely by government investments.
The household income shows the sustainability of poverty alleviation
- The household incomes are also important.
- What is the point of enrolment in schools if the quality of education remains poor, as pointed out in Pratham’s ASER report.
- The education system may create “educated unemployable youth”.
- Similarly, what is the point in having accounts if the poor have low incomes and hardly any savings.
- This raises questions about the sustainability of a development model that provides better access to public utilities (education, health, and even gas) but does not work towards improving its quality or income levels.
Need to track the income level with the NMPI
- There is an equal need to track income poverty, real wages, and unemployment in the country to make sure that the development pathway to 2047 helps people improve their incomes significantly.
- India still has the largest number (160 million) of people under extreme poverty in the world as per the World Bank’s estimate based on $2.15/capita/day income (at 2017 purchasing power poverty).
- True Ram Rajya will be established only when these poor people come out of income poverty and are also not poor as defined by NMPI.
Changes in real wages under UPA and NDA rules
- The majority of them are in rural areas, working both in agriculture as well as in the non-farm sector as labourers.
- So, it is important to see what is happening to employment in agriculture and the real wage rates in rural areas over the last two government regimes.
- Research shows that during UPA-1 (2004-05 to 2008-09), real agricultural wages for men (deflated by CPI-AL) grew at a meagre 0.2 per cent per annum, while real rural non-agricultural wages (deflated by CPI-RL) declined at -0.9 per cent per annum.
- But it is observed that a spectacular growth during UPA-2 (2009-10 to 2013-14) with real agriculture and non-agriculture rural wages growing at 8.6 per cent and 6.9 per cent per annum respectively.
- In contrast, during the NDA-1 period (2014-15 to 2018-19), growth of real farm and non-farm wages in rural areas decelerated to 3.3 per cent and 3 per cent per annum respectively.
- However, most concerning has been the situation in the last five years of NDA-2 (2019-20 to 2023-24), when the annual growth rate of real rural wages has become negative for both agriculture (-0.6 per cent) and non-agricultural (-1.4 per cent).
- It may be the impact of Covid-19 and its aftermath, giving credence to the K-shaped recovery.
The change in the workforce engaged in the farm sector
- The share of the workforce engaged in agriculture had seen a secular decline — from 69.7 per cent in 1951 to 54.6 per cent in 2011 (Census), then to 42.5 per cent in 2018-19 (PLFS).
- But in 2019-20, it reversed to 45.6 per cent and then increased to 46.5 per cent in 2020-21 (reverse migration due to Covid), before falling to 45.5 per cent in 2021-22.
- This may be one reason why growth in farm and non-farm rural real wages has become negative during Modi-2 period.
The change in the unemployment rate
- As far as the unemployment rate is concerned, the ILO data suggests that it averaged around 8.4 per cent during 10 years of the UPA government (2004-05 to 2013-14) and roughly 7.9 per cent during the 10 years of the Modi government.
- So, the growth model under both governments has not seen a significant reduction in unemployment.
- During the UPA government, the BJP was at the forefront saying that it was “jobless growth”, and the same criticism is being flung at it by the Congress and other opposition parties.
- Interestingly, government data from the PLFS, which started collecting information on unemployment from 2017-18, shows a much lower level and a clear declining trend.
- It has come down from 6 per cent in 2017-18 to 4.1 per cent in 2021-22.
- The difference between ILO estimates and PLFS estimates, says Santosh Mehrotra, Economic Adviser in the erstwhile Planning Commission and a prolific writer on this topic, is due to difference in the definition.
- PLFS tends to include some work as employment even when it is not paid for.
- That makes PLFS estimates non-comparable with other countries, which follow ILO criteria.
- Mehrotra further argues that CMIE estimates are on the lines of ILO, and it shows much higher levels of unemployment compared to PLFS.
Conclusion: The litmus test of employment hinges on real wage rates, and it has been seen from the government data itself that in rural areas, real wages have had negative growth in the last five years of the Modi-2 period. This needs urgent attention and further research to create more employment-intensive growth processes.
Topic 2 : The right treatment
Introduction: The Union Health Ministry has asked physicians to write down the exact reasons for advising patients to use these medicines. It has also asked pharmacists to not dispense antimicrobials without a prescription.
Reason for government’s control on antimicrobial use
- The country has had a policy to prevent the overuse of antibiotics for close to a decade.
- However, the use of such medicines is still not monitored by the government.
- A Lancet study in 2022 noted that “India consumes a large volume of broad-spectrum antibiotics that should ideally be used sparingly”.
- Antibiotic overuse is the primary reason for bugs developing resistance to these medicines.
- That is why patients with severe diseases like tuberculosis are increasingly not responding to the first line of treatment.
What is Antimicrobial Resistance (AMR)?
- Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.
What are Broad-spectrum antibiotics?
- Broad-spectrum antibiotics target a wide variety of bacteria and are antidotes to serious infections.
- However, anecdotal evidence shows that doctors tend to err on the side of caution and prescribe these medicines without diagnosing whether an infection is viral or bacterial.
- They also advise antibiotics to prevent secondary infections even when the threat of such a malady is remote.
Who is responsible for the rise in antimicrobial resistance in India?
- Individual doctors, though, are only one part of the problem.
- Medical protocols require hospitals to have a policy for rational use of antibiotics — this is important because studies show that these healthcare facilities are major breeding grounds for antimicrobial resistance.
- But only a few big hospitals follow this mandate.
- A recent study by the National Centre for Disease Control revealed that three out of four patients who went to a tertiary care centre were prescribed an antibiotic, often to prevent an infection rather than to cure it.
- The study conducted between November 2021 and April 2022 under the National Programme of Antimicrobial Containment found only a 10-percentage point difference in antibiotic use between intensive care units that have the sickest patients and the other wards.
What are the Steps taken by the Government to address AMR?
- National Action Plan (NAP) for AMR: In April 2017, India's NAP for AMR was released by the Union Ministry of Health and Family Welfare. The objectives of the NAP include increasing awareness, strengthening surveillance, promoting research, and improving infection prevention and control.
- Signing the Delhi Declaration on AMR: The Delhi Declaration on Antimicrobial Resistance (AMR) is an inter-ministerial consensus that was signed by the ministers of the concerned ministries in India.
- The declaration aims to address AMR in a mission mode by involving research institutes, civil society, industry, small- and medium-sized enterprises, and encouraging public-private partnerships.
- Antibiotic Stewardship Program (AMSP): The Indian Council of Medical Research (ICMR) has initiated the AMSP on a pilot project basis in 20 tertiary care hospitals across India. The program aims to control the misuse and overuse of antibiotics in hospital wards and ICUs.
- Ban on inappropriate fixed dose combinations (FDCs): On the recommendations of the ICMR, the Drug Controller General of India (DCGI) has banned 40 FDCs that were found to be inappropriate.
- Ban on the use of Colistin as a growth promoter in animal feed: The ICMR, in collaboration with the Indian Council of Agriculture Research, Department of Animal Husbandry, Dairy and Fisheries, and the DCGI, has banned the use of Colistin as a growth promoter in animal feed in poultry.
- One Health approach: The government is working on a One Health approach by encouraging interdisciplinary collaboration at the human-animal-environmental interface. The key priority areas include zoonotic diseases, food safety, and antibiotic resistance.
- Integrated One Health Surveillance Network for AMR: The ICMR has undertaken a project on an "Integrated One Health Surveillance Network for Antimicrobial Resistance" in collaboration with the Indian Council of Agriculture Research to assess the preparedness of Indian Veterinary laboratories to participate in an integrated AMR surveillance network.
The way forward
- Given the heterogeneity of the country’s healthcare settings, a one-size-fits-all approach might not be apt to regulate antibiotic use.
- In 2013, the Chennai Declaration by a group of concerned doctors suggested strict control of the use of such medicines in areas with relatively well-provisioned medical facilities and a more liberal system based on the strict monitoring of select oral antimicrobials in other areas.
- Another school of experts believes that medical experts must create more awareness within their community.
- Some others advocate that healthcare centres must have more microbiologists to guide doctors.
Conclusion: The government’s nudge to doctors should spur such conversations. The medical community must now step in to tackle the problem in all its dimensions.