Note: Please note that some inputs have been given by our team in order to make the topic more relevant to UPSC.

Prelims Focus  Soliga: It is a hunter-gatherer tribe living in the forests of South Karnataka. The tribe sustains itself by collecting Non-timber forest produce (NTFP). It has been in the news because they make handicraft items and furniture from lantana (lantana camara). It is an invasive shrub, which is native to South America, but has invaded almost 40% of the Western Ghats.

1. Institutional Oversight

Topics covered from the syllabus: GS-2: Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections. GS-2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Context: Indian government has been promoting institutional delivery with an intention to improve maternal and child health. Despite a manifest increase in such deliveries, the results have been mixed and challenges in public health remain to be addressed.

Government Schemes to promote Institutional Delivery

• Janani Suraksha Yojana (JSY): It was launched in the year 2005. The scheme incentivizes institutional deliveries by providing an incentive of Rs 1,300-2,000 in rural areas and Rs 1000-1400 in urban areas for every institutional delivery. The institutions under the scheme are Sub-Centres, Public Health Centre, Community Health Centres, District Hospitals, Medical Colleges and also Private Hospitals.

• Regions targeted: The scheme targets nine laggard states in the matters of maternal and child health viz. Bihar, UP, MP, Rajasthan, Uttarakhand, Odisha, Jharkhand, Chhattisgarh and Assam.

• Janani Shishu Suraksha Karyakram: It was launched in 2011 by Ministry of Health and Family Welfare (MoHFW). The scheme provides free of cost health facilities to pregnant women including transport to hospitals, drugs, diet, diagnostic services, blood transfusion services and any other ante-natal and post-natal complications for infants up to 1 year of age.
• PM Surakshit Matritva Abhiyan: It was launched in 2016 to provide free, universal ante-natal care to pregnant women on the 9^th of every month. The Scheme includes identification of high risk pregnancies so that special focus can be maintained on such pregnancies and safe delivery can be ensured by planning for complications.

• Outreach Programme: The scheme also envisages an outreach programme for the women who are unable to enroll for the scheme (Miss-outs) as well as the women, who have enrolled but are not able to attend the checkups (Drop-outs).

• LaQshya Programme (Labour Room Quality Improvement Initiative): It is an initiative to improve the quality of institutional care by providing better care in labor rooms and maternity operation theatres in public facilities. The scheme provides for national and state certification for the facilities which have achieved the required standards.
• State-specific Schemes: States have also launched specific schemes focusing on improving the quality of service delivery in the area of child birth. Such schemes include Shramik Seva Prasuti Sahayata Yojana (MP), Janani Suvidha Yojana (Haryana), Ayushmati Scheme (West Bengal), Chiranjeevi Yojana (Assam) and Mamta Friendly Hospital Scheme (Delhi).

 

• Aspirational District Programme: It is a programme of NITI Aayog for the development of 117 most backward districts in the country. The districts have been chosen on the basis of socio-economic backwardness. It is considered that they are low-hanging fruits which can see faster improvement if sustained efforts are undertaken to develop them.

Impact of the Schemes

• Improvement in Institutional Deliveries: The concerted governmental effort to promote institutional deliveries has resulted in an increase of such deliveries from just 40.8% in 2005-06 to 88.6% in 2019-21, as per National Family Health Survey-5 (NFHS-5).
• Maternal and Child Mortality: Despite many states doing better on the metric of institutional delivery, the Maternal Mortality Rate (MMR) has not decreased as per expectations. This has led Ministry of Health and Family Welfare (MoHFW) to conclude that increased institutional deliveries do not necessarily lead to better MMR outcomes.

• Child mortality: Indicators like Neonatal Mortality Rate (NMR) and Infant Mortality Rate (IMR) have shown better outcomes than MMR as an impact of government efforts.

Challenges

• Lack of Awareness: Poor lack access to critical information regarding precautions and best practices during pregnancy and childbirth. For e.g., World Health Organization (WHO) mandates at least 4 Ante-natal checkups during pregnancy for diagnosing any issues to the health of mother and child. However, in India, checkups are only done if any complication has already risen.
• Lack of Infrastructure: Experts point out that the government efforts are not supplemented by on-field infrastructure. For instance, due to the efforts of government, institutional delivery has reached 88.6% of total deliveries. Similarly, guidelines mandate at least 48-72 hrs. postnatal care. However, the government medical institutions like PHC, CHC, District Hospitals etc. lack such large number of beds to support the pregnant mothers and infants for a long duration.
• Resource Crunch: Media reports have pointed out that public health centres and community health centres are not working at their full strength due to unavailability of staff. Most hospitals do not have the required strength of ward boys and nurses. Even the availability of doctors is affected by irregularity and lack of punctuality.
• Regional Imbalance: As stated earlier, most states of the Central and North India are backward states in terms of healthcare. For e.g., the nine states, viz. UP, MP, Bihar, Rajasthan, Uttarakhand, Chhattisgarh, Jharkhand, Odisha and Assam, account for 60% of the maternal deaths and 70% of the infant death in India, as per a study by researchers in Sweden, despite these states hosting just half of the Indian population.

• Performance of the Schemes: The problem with these states is that they are unable to translate the financial outlay to justifiable outcomes in the healthcare sector. For e.g., despite being focus states in Janani Suraksha Yojana, the states are unable to overcome the national average of 103 maternal deaths per lakh live births.

• Capacity Building: Despite doing extremely well on the metric of institutional delivery, the country has not seen a proportionate improvement in maternal mortality. Experts have opined that this is because of the lack of training accorded to nurses and Auxiliary Nurse Midwives (ANMs). In most institutions, they are the ones entrusted with deliveries, but they do not have the requisite training to handle complications in childbirth.
• Eligibility Criteria: The schemes also have inherent challenges due to the associated formalities. For e.g., many schemes are applicable to women over 19 years of age, which leads to many of the younger pregnant women, not being covered under the scheme. Similarly, providing a proof of poverty is also difficult to produce for most of the beneficiaries.
• Financial dependency: Experts have pointed out that the cash transfers in lieu of institutional delivery is an issue for the women as they do not have regularly maintained bank accounts. On the other hand, they find it suitable if they are provided direct benefits as under JSSK.
• Lack of Nutrition: Studies have pointed out that women in India get married at a younger age. At the same time, they have more than two children, which is difficult to bear for their bodies. This has led to a prevalence of anaemia and hypertension in the pregnant and lactating mothers. As per the National Health Portal, post-partum haemorrhage is the cause of death for 35% of all deaths in India.

• Malnourished children: Further, the lack of nutrition also affects the child’s health, thus, decreasing the body’s immunity. This is the chief cause of infant mortality.

Conclusion

• The government has done well to improve the rate of institutional delivery. As is clear from the data, many of the schemes have worked well in achieving their stated objectives. However, there is a need to translate these efforts to actual results in the mortality rates of mothers as well as infants. Also, the critical input gaps in the implementation of the schemes need to be plugged for advancing socio-economic development in the country.

Practice Question

• Assess the government steps in the direction of improvement of maternal and infant healthcare. Also, discuss the challenges associated with improving the rate of maternal and infant mortality in the country.

UPSC PYQs

• Performance of welfare schemes that are implemented for vulnerable sections is not so effective due to absence of their awareness and active involvement at all stages of policy process – Discuss. (GS2 - 2019)
• Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? (GS2 - 2015)

2. A New Energy Disorder

Topics covered from the syllabus: GS-2: Effect of policies and politics of developed and developing countries on India’s interests, Indian diaspora. GS-3: Infrastructure: Energy, Ports, Roads, Airports, Railways etc. GS-3: Conservation, environmental pollution and degradation, environmental impact assessment.

 

Prelims Focus Organization of the Petroleum Exporting Countries (OPEC): It is an inter-governmental cartel of oil-exporting nations, which holds sway over the decisions relating to oil trade in the world. It is headquartered in Vienna, though Austria is not a member of OPEC. It was founded in 1960 in Baghdad. Currently, OPEC has 13 members, having 81% of world’s proven oil reserves and controlling 44% of global oil production. India is not a member of OPEC.

Context: Russia-Ukraine war has led to changes in global supply of crude and natural gas, after US sanctions on Russian exports. The changed scenario has the potential to disrupt the world’s march towards clean energy and the pathway to ‘Net Zero’ by 2050.

Impact of Russia-Ukraine war on Energy Security

• US Sanctions: Russian attack on Ukraine has led to coordinated sanctions by the Western countries including US, UK and Japan on the Russian exports. US administration is also making concerted efforts to coerce nations into decreasing their trade with Russia and to not find ways to bypass sanctions. In fact, six of top 19 shipping companies, which control 60% of the global capacity have suspended Russian bookings, in compliance with the sanctions.

• Threats to third parties: In fact, in a recent visit of US’s Deputy NSA to India, India was warned of ‘long term and significant consequences’ if it bypassed the US sanctions on Russia. Though, it was later clarified that this was not a ‘threat’ to India. India and Russia are planning to increase Rupee-Rouble trade as a way of continuing Russian defence and energy imports.

• Uncertainty in Fuel Prices and Supply: Russia is the third largest crude oil producer (after US and Saudi Arabia) as well as the second largest producer of natural gas after US. Therefore, sanctions on Russia have led to volatility in the prices of energy products. For e.g., Brent Crude has crossed $100 per barrel for the first time since 2014 and reached a maximum of $127.98 leading to increase in inflation in many countries including India.
• Energy Poverty: It refers to lack of assured and reliable electricity supply for fulfilling the basic needs of standard of life. The term is used mostly in the context of poor African and South Asian countries. However, US sanction has led to the term being used in European countries as they expect volatility in supply and inflation in energy prices in the coming years.
• Dilemma for EU: European Union has been one of the largest importers of Russian natural gas and crude oil. In fact, it imports 40% of its natural gas, 27% of its crude oil and 47% of its solid fuel (mostly coal) from Russia. Therefore, tapering off its imports from Russia will come at the cost of energy security for EU countries.
• Other factors: Strong economic recovery after COVID as well as huge demand from China and India had already raised the price of crude oil in the global market. Also, COVID times had led to a shortfall in production, while lack of investment in the oil supply infrastructure.
• Fall-back to Coal plants: To tide over the temporary mismatch in demand-supply, many countries in the world are planning or have already switched to the fossil fuel sources like coal-based thermal power plants. For e.g., Germany Energy Network Agency has asked the country’s coal plants to remain on standby if needed, despite its commitment to phase out coal by 2030.

Other Effects of Russia-Ukraine war

• Slowdown in Growth: Inflation in Energy prices due to the war has the potential to stem the economic recovery happening in the world. WTO has already lowered the forecast for growth rate of the global merchandise trade from earlier 4.7% to 3%.
• Food Security: Russia and Ukraine account for 30% of global wheat exports, 18% of corn exports and 70% of sunflower oil exports in the world. Therefore, supply restrictions from these countries will impact the global availability of agricultural products. Food and Agriculture Organization (FAO) releases a Food Price Index, which has seen a jump from 98 points in 2020 to 140 points in Feb 2022, signaling heating up of the prices of food products in the global market.

• Ukraine’s Ban: In anticipation of future shortages, Ukraine has banned the exports of wheat, millets, meat and other such products. This is expected to cause a shortage in the importing countries. A similar ban by Russia would see food shortages and inflation in West African and North African countries.
• Other Factors: As we have already seen, war has led to increase in oil prices across the world. This could affect agricultural prices by increasing the transportation and harvesting costs. Similarly, a rise in the prices of natural gas has the potential to increase the prices of fertilizers, thereby, increasing the prices of agricultural products.

• Climate Security: A shortage of agricultural products can indirectly affect global efforts to combat climate change by increasing deforestation and razing of grasslands to increase the global agricultural area.
• Shift from Climate Change to Energy Security: Similarly, unavailability of cheap Russian gas and crude oil has led to a shift of European nations from committing to arresting climate change, to looking for cheap energy sources. Another worrying trend is the reclassification of natural gas and nuclear energy as clean fuels, despite protests by the environmental organizations against doing so.
• Russian Loss is American Gain: Russia exports almost 3 million barrels of oil and oil products a day into the global market. It earns $350 million per day from oil and $200 million per day from gas. Therefore, a ban or tapering off of its exports may lead to economic crisis in Russia.

• American Exports: At the same time, shale gas revolution in US has brought it to the top spot in global crude oil (20% of global production) as well as natural gas production (24% of global natural gas production). Therefore, any void in supply being created by the sanctions on Russia will lead to a windfall for the US.
• Cost of Production: Till now, investments in Shale gas extraction in the US were not growing enough due to direct competition from Russia. US shale gas exports had to be compressed and supplied via tankers specially designed for the purpose. Therefore, they were unable to compete with Russian gas exports, which could be supplied cheaply through overland or under-the-sea pipelines. However, sanctions have changed the scenario with American shale gas seeing a renewed interest.

 

Way Forward

• Investments in Renewable Energy: Experts are keeping their fingers crossed that due to global energy shock, countries would increase their funding in the renewable energy sector. This will be a step in the positive direction as it would help the world hasten its march in the direction of arresting global temperature rise within permissible limits.
• Investment in Storage Infrastructure: In the short term, it is critical to ensure adequate energy reserves as insurance against the global supply shocks. This is true for countries like India and EU countries, which are import-dependent for their energy requirements. For e.g., European Commission plans to fill its underground storage to 90% before October each year.
• Diversifying the Sources: There is a need to work out deals with OPEC nations (see inset), to ensure the country’s energy security. At the same time, investments in renewable energy, as well as production of Hydrogen from cleaner sources, is the need of the hour. This would ensure sustenance of domestic economy in the face of supply shocks or western sanctions.
• Taking Advantage of the Opportunity: Despite US threats against the move, India has continued with its oil and natural gas imports from Russia. India has rightly shown that, in international relations, there are no permanent friends or enemies, but only permanent national interests, which are supreme. This is important considering India’s hunger for oil and an opportunity to fill in its oil reserves with discounted Russian oil.

Conclusion

• Russia-Ukraine war has raised geo-political tensions beyond the countries involved in the war, along with fears of interruption and volatility in fuel, grain and other supplies. It is important to create alternate sources for ensuring energy security of the country to tide over such mismatches in demand and supply of essential goods and services.

Practice Question

• Do you think the impact of Russia-Ukraine war has been felt all over the globe? Discuss, while highlighting its impact on energy security and climate change.

UPSC PYQs

• Access to affordable, reliable, sustainable and modern energy is the sine qua non to achieve Sustainable Development Goals (SDGs). Comment on the progress made in India in this regard. (GS3 - 2018)
• The question of India’s Energy Security constitutes the most important part of India’s economic progress. Analyze India’s energy policy cooperation with West Asian Countries. (GS2 - 2017)