Rashtriya Bal Swaasthya Karyakram A New Preventive Health Care Initiative

The newly launched Rashtriya Bal Swaasthya Karyakram of the Ministry of Health & Family Welfare assures a package of health services for children up to 18 years of age. The initiative, which is part of the National Rural Health Mission, was launched on February 6, in Palghar, a tribal dominated block of Thane district in Maharashtra, by UPA Chairperson Sonia Gandhi, in the presence of Union Health & Family Welfare Minister Ghulam Nabi Azad and Maharashtra Chief Minister Prithviraj Chavan. The programme will be extended to cover all districts of the country in a phased manner.

Early Detection; Early Intervention

Rashtriya Bal Swaasthya Karyakram, also known as Child Health Screening and Early Intervention Services aims at early detection and management of ‘4Ds’ prevalent in children. These are Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including Disabilities. The health screening of children is a known intervention under School Health Programme. It is now being expanded to cover all children from birth to 18 years of age. The services aim to cover all children of 0-6 years of age group in rural areas and urban slums, in addition to children enrolled in classes 1^st to 12^th in Government and Government aided schools.  A set of 30 common ailments / health conditions have been identified for screening and early intervention.

Defects at Birth

Globally, about 7.9 million children are born annually with a serious birth defect of genetic or partially genetic origin which account for 6 percent of the total births. In India about 1.7 million babies are born with birth defects annually.  For those who do not receive specific and timely intervention and yet survive, these disorders can cause irreversible life-long mental, physical, auditory or visual disability.

Deficiencies

Anaemia prevalence has been reported as high as 70% amongst under-five children largely due to iron deficiency. The situation has remained virtually unchanged over the past decade. Almost half of children under age five years (48 %) are chronically malnourished. During pre-school years, children continue to suffer from adverse effects of anaemia, malnutrition and developmental disabilities, which ultimately also impact their performance in school.

Diseases

The prevalence of dental caries varies between 50-60 percent among Indian school children as reported in different surveys. Rheumatic heart disease is reported at 1.5 per thousand among school children in the age group of 5-9 years. The median prevalence of reactive air way disease including asthma among children is reported to be 4.75 percent.

Developmental Delays

Globally, 200 million children do not reach their developmental potential in the first five years because of poverty, poor health, nutrition and lack of early stimulation. The prevalence of early childhood stunting and the number of people living in absolute poverty could be used as proxy indicators of poor development in under five children. Both of these indicators are closely associated with poor cognitive and educational performance in children and failure to reach optimum developmental potential.

Defects at Birth

·         Neural tube defect

·         Down’s Syndrome

·         Cleft Lip & Palate / Cleft palate alone#

·         Talipes (club foot)

·         Developmental dysplasia of the hip

·         Congenital cataract

·         Congenital deafness

·         Congenital heart diseases

·         Retinopathy of Prematurity

Deficiencies

·         Anaemia especially Severe anaemia

·         Vitamin A deficiency (Bitot spot)

·         Vitamin D Deficiency, (Rickets)

·         Severe Acute Malnutrition

·         Goitre

Child hood Diseases

·         Skin conditions (Scabies, fungal infection and Eczema)

·         Otitis Media

·         Rheumatic heart disease

·         Reactive airway disease

·         Dental caries

·         Convulsive disorders

Developmental delays and Disabilities

· Vision Impairment

· Hearing Impairment

· Neuro-motor Impairment

· Motor delay

· Cognitive delay

· Language delay

· Behaviour disorder (Autism)

· Learning disorder

· Attention deficit hyperactivity disorder

· Congenital Hypothyroidism, Sickle cell anaemia, Beta thalassemia (Optional)

Implementation mechanism

Facility Based Newborn Screening

This includes screening of birth defects in institutional deliveries at public health facilities, especially at the designated delivery points by nurses, medical officers/ gynaecologists.

Community Based Newborn Screening

Accredited Social Health Activists (ASHAs) during home visits for newborn care will use the opportunity to screen the babies born at home and the institutions till6 weeks of age. ASHAs will be trained with simple tools for detecting gross birth defects. For performing this task, ASHA would be provided with a tool kit consisting of a pictorial reference book with self-explanatory pictures for identification of birth defects.

Screening at Anganwadi Centres and Schools

The children in the age groups 6weeks to 6 years of age will be examined in the Anganwadi centres by the dedicated mobile health teams. The children in the age groups 6 to 18 years will be screened in Government and Government aided schools.  The screening of children in the anganwadi centres would be conducted at least twice a year and at least once a year for school children to begin with.

Block to be the Hub of Activity

The Block will be the hub of activity for the programme. At least three dedicated mobile health teams in each Block will be engaged to conduct screening of children. Villages within the jurisdiction of the Block would be distributed amongst the 3 teams. The number of teams may vary depending on the number of anganwadi centres, schools, difficult to reach areas and enrolments of children in the schools.  The mobile health team will consist of four members - two Doctors (AYUSH) one male and one female, one nurse and one pharmacist.  The Block Programme Manager will chalk out a detailed screening plan for all the three teams in consultation with schools, anganwadi centres and CHC Medical Officer. A tour diary will be maintained by block health teams.

Early Intervention Centre at District Level

An Early Intervention Centre will be established at the District Hospital. The purpose of Early Intervention Centre is to provide referral support to children detected with health conditions during health screening. A team consisting of paediatrician, medical officer, staff nurses, paramedics will be engaged to provide services. This centre would have the basic facilities to conduct tests for hearing, vision, neurological tests and behavioural assessment.

Training and Management

Training of the personnel involved in Child Health Screening and Early Intervention Services would be through a cascading training approach. Standardized training modules are to be developed in partnership with technical support agencies and collaborative centres.  KEM Hospital, Mumbai and Pune and Ali Yavar Jung National Institute for Hearing Handicapped, have been identified as public sector collaborative centres in Maharashtra for imparting training.

Ministry of Health & Family Welfare has drawn up ‘Operational Guidelines’ for effective planning and systematic implementation of the programme. These guidelines explain the process of identification and management of select conditions of huge public health significance in India.

Impact of the Programme

By providing early intervention service, the new initiative is expected to bring economic benefits in the long run by directly reducing expenditure in terms of providing critical health care. “Extending preventive and promotive health care would impact the National Human Capital, reduce disease burden and also public health expenditure.” says Union Minister for Health & Family Welfare Ghulam Nabi Azad.

When fully implemented, the Rashtriya Bal Swasthya Karyakram is expected to benefit approximately 270 million (27 crore) children across the country.

Direct Benefits Transfer: Timely and Quick Transfer to Beneficiaries

The Direct Benefits Transfer (DBT) scheme first found mention in the 2011-12 Union Budget speech, by the then Finance Minister, Pranab Mukherjee who had stated that the government plans to move towards direct transfer of cash subsidy for kerosene, Liquefied Petroleum Gas (LPG), and fertilizers.  A task force headed by Nandan Nilekani was set up to work out the modalities of operationalising Direct Cash Transfer for these items.  Later this task force submitted its report in February 2012.

The Government launched Direct Cash Transfer scheme on 1 January 2013 to transfer cash into bank accounts of beneficiaries across 20 districts in the country. The scheme has now been rechristened as Direct Benefits Transfer (DBT) and curtailed beneficiary districts to 20. It covers 7 welfare schemes instead of 20.  At least two lakh beneficiaries are expected to benefit from DBT scheme immediately. Food, fertilisers, and fuel have been kept out of its purview for the present.

The National Food Security Bill, 2011, pending in Parliament, includes cash transfer and food coupons as possible alternative mechanisms to the Public Distribution System.

But it should be borne in mind that DBT is just been launched. There would be several lessons on the way as scheme expands and progress and is implemented in the entire country before 2014.

How does the Scheme Work?

The money is directly transferred into bank accounts of beneficiaries having Aadhar cards. The Aadhaar number is a unique identification number that every resident of India (regardless of citizenship) is entitled to get after he/she furnishes demographic and biometric information. 

LPG and kerosene subsidies, pension payments, scholarships and employment guarantee scheme payments as well as benefits under other government welfare programmes will be made directly to beneficiaries. The money can then be used to buy services from the market.

Already on a pilot basis Electronic Benefit Transfer has begun in Andhra Pradesh, Chhattisgarh, Punjab, Rajasthan, Tamil Nadu, West Bengal, Karnataka, Puducherry and Sikkim. The Government claims the results are encouraging.

Under the DBT each and every beneficiary has to establish his identity and eligibility many times by producing multiple documents for verification.  The verification of such documents is done by multiple authorities. Interestingly an Aadhaar enabled bank account can be used by the beneficiary to receive multiple welfare payments as opposed to the one scheme, one bank approach, followed by a number of state governments.

A Game Changer

Government believes that the Direct Cash Transfer or Direct Benefits Transfer is likely to be a game-changer in more than one way.

The Centre releases as much as Rs 2, 00,000 crore as subsidies under various schemes for the targeted sections across the country. Therefore it is within its right to devise methods to reach beneficiaries the way it wants.

Firstly, the Direct Benefits Transfer (DBT) scheme is aimed at cutting the bloated subsidy bill of Rs.1, 64,000 crore. India’s budget deficit was 5.8 per cent of gross domestic product in the financial year ending 2012 March.

Secondly, unlike other welfare scheme launched so far by the Centre, DBT helps in timely and quick transfer to intended beneficiaries.

Thirdly, the transfer of direct cash into account of targeted beneficiary is a winning proposition for  the recipients as it aims to eliminate middlemen in various government sponsored welfare schemes and subsidized food, fuel and fertiliser schemes. Take for instance, it's estimated that public coffers can be richer by several crore yearly just by switching to cash handouts for LPG and kerosene, a proposed move that would also curb diversion of subsidised cylinders for commercial use and diesel adulteration with inexpensive kerosene. Bringing all subsidies under DBT's ambit can be the major fiscal game-changer the economy needs very much.

Fourthly, the Direct Benefits Transfer scheme is likely to be simple and error free. On the basis of Aadhar cards money is deposited in beneficiaries’ accounts.

Fifthly indirect transfers are more prone to leakages than direct cash transfers. So, that is why the Central Government has put in a mechanism of direct cash transfer. According to Planning Commission the Public Distribution System has become so inefficient that 58 per cent of the subsidized grains do not reach targeted beneficiaries while one-third of it siphoned from the system.

Sixthly, the Aadhar based DBT helps eliminate duplicate cards and cards for non-existent persons or ghost beneficiaries often found in schemes such as the PDS and MNREGS.  

Seventhly, with the actual transfer of cash taking place with the help of micro automated teller machines (ATMs) it would infuse financial inclusion on a greater scale in rural India. Quoting a World Bank Study the Reserve Bank of India last year in its annual report has said, in India only 35 per cent have formal accounts versus an average of 41 per cent in developing economies. With the implementation of DBT, it could fuel financial inclusion.

Eighthly, aided by Aadhar technology Direct Benefits Transfer will not be a mere welfare scheme but also the world's largest experiment in administrative reform. It will revolutionise the delivery of welfare measures in world’s populous democracy.

DBT: Not a Magic Wand

Can Direct Benefits Transfer Scheme act like magic wand? Probably it cannot solve all the problems by India’s poor and improve country human resources index.

It will have problems with banks, post offices and online connectivity. These have to be resolved. But there is no point in throwing the baby with bath water attitude and abandon DBT altogether.

DBT in ultimate analysis aims at poverty elimination, inclusive growth and delivering better welfare measures. No doubt rampant corruption, inefficiencies and leakages have made many welfare schemes dysfunctional. Direct Benefits Transfer to the poor aims to mitigate these many malaises.

Considering these benefits, India would be in right direction to implement cash transfer though there would be many lessons to be learnt and hurdles to cross.

Wildlife Conservation- A Pressing Need

Of late, there is good news. Tiger population in India has increased for the first time in a decade, thanks to better conservation efforts. It has been put at 1706, which is 295 more than it was in 2008. The figure then stood at 1411.

But that is only a small consolation. The bigger picture is that there has been a persistent decline in tiger population over the years, which is a cause for concern.

The story is no different in the case of another big cat species- The leopard. In the first nine months of 2012 India lost 252 leopards which according to the figures available with the Wildlife Protection Society of India was the highest since 1994. In 2011, the figure was 187. During the decade before, it averaged about 200 a year.

            Even as we write this, India has lost at least 3 more tigers in January so far. We lost 923 tigers from 1994 to 2010. The country which had a tiger population of about 40, 000 about a hundred years ago is now left with a handful of them. The story of depletion in tiger population is in fact similar the world over. The global tiger population today is estimated at just 3500 to 4000. Half of these are in India.

More than half of the killings take place for poaching. Despite leopards being covered under the Wildlife Protection Act, there is no respite in targeting them. The body parts, particularly skin, are then traded internationally through illegal channels. The same is true about tigers. It is left with just 10 % of the habitat it used to have earlier, touching a bottom of 7.5 million Acres. Besides the habitat, tiger has been losing its prey species as well. This has brought it in conflict with humans leading to further attacks on it. Though the government banned hunting of tiger in 1972 with the passing of the Wildlife Conservation Act, the problem is still there. The other important factor is the large scale destruction of natural habitat due to developmental works like road networks and hydel projects in hilly and forest areas. Rapidly growing human population living close to forest areas is no less a factor responsible for this story.

But there is still hope to reverse this trend, if only some basic issues are taken care of. They are - strict vigil on poaching, creating awareness among the people that protection of tiger is in the interest of humanity itself since its presence is important for the balance in ecosystem and taking care of the day to day requirements of the people living near forest areas. Enhancing NGO participation in this field by identifying the dedicated ones and extending them all support will also benefit.

            Despite some disappointments, the project tiger has achieved good results. The project was started in 1973 when the tiger population touched an all time low in the seventies. It raised the figure from 1200 in the seventies to 3500 in the nineties though there have been repeat setbacks later.

Recently, the Supreme Court asked the state governments and the Union Territories to frame   Tiger Conservation Plans. It gave them 6 months to do it. The plans have to be sent to the National Tiger Conservation Authority, NTCA, for its approval before these are implemented. In July last year, the Apex Court imposed an interim ban on tourism in National Parks and Wildlife Sanctuaries. The sanctuaries are designated as core and critical tiger habitats and therefore need to be given special attention.  The Court later lifted the interim ban on tourism in these areas. But all the stake holders have been asked to take appropriate action in this regard.

            To give a thrust to conservation of endangered animals, in principal approval has been given for setting up five more wildlife parks in the country. There is also a proposal to have 6 more Tiger Reserves which will take the strength of such reserves from the current 41 to 52. The number of National parks and Wildlife Sanctuaries has also been progressively increasing.

            The planning Commission too has made a generous allocation for tiger conservation in the 12th plan. The tiger gets the lions share, so to say.  The Commission has earmarked Rs.5889 crore for tiger conservation in the plan against just 651 crore in the 11th Plan. That marks a nine- fold increase. The funds allotted for all other endangered species are Rs.3600 crore. They include elephants, lions, deer, rhinos and leopards whose number runs into over 45,000. It is argued that by taking care of tiger, some other animals like deer and rhinos would automatically benefit. This may be true to an extent but perhaps more needs to be done in respect of other animals.

            For over a thousand years, tigers have been hunted as a status symbol and used as souvenirs. Its parts have been used in traditional Asian medicines. This led to a fall in tiger population until 1930’s. Out of the 9 tiger species 3 have already become extinct. There is therefore a great need to take more effective steps to check the falling population of tigers in particular and other wildlife species in general. It is in our own interest and any lapse on this account can prove costly. The challenge is huge but it has to be met.

North Korea threatens US over rockets launches

North Korea is threatening to retaliate for what it calls U.S. double-standards over recent rocket launches by Pyongyang and U.S. ally Seoul.

A North Korean Foreign Ministry spokesman did not elaborate on what that might entail in his comments today to the official Korean Central News Agency. But Pyongyang has recently threatened to conduct its third nuclear test in response to what it calls U.S. hostility.

Washington says Seoul’s rocket launch  had no military intent while Pyongyang’s in December was a test of banned ballistic missile technology.

The U.N. Security Council has imposed new sanctions on Pyongyang for its launch. Pyongyang says it should be allowed to launch satellites for peaceful purposes.

Both Koreas say their satellites are working properly. U.S. experts say Pyongyang’s satellite is apparently malfunctioning.

Rohinton Nariman resigns as solicitor-general

Eighteen months after his appointment as Solicitor-General of India, senior advocate Rohinton Nariman has resigned from the post amid speculation that the decision came over his differences with the Law Ministry.

Mr. Nariman was appointed as the Solicitor-General (SG) on July 23, 2011.

There has been speculation Mr. Nariman was unhappy over certain directions of Law Minister Ashwani Kumar and the ministry.

He was appointed after the then SG Gopal Subramaniam had resigned on July 14, 2011.

Mr. Subramaniam had resigned as SG in the wake of Mr. Nariman being appointed as special counsel to represent government in a 2G scam-related case in the Supreme Court, apparently without his knowledge.

Mr. Nariman is the son of eminent jurist Fali S Nariman.

President of India Pranab Mukherjee Gave Assent to the Criminal Law (Amendment) Ordinance, 2013

The President of India, Pranab Mukherjee on 3 January 2013 agreed to the Criminal Law (Amendment) Ordinance, 2013 for sharpening the laws against sexual assault. The President mandated harsher punishment such as death penalty for the offenders in such cases where the victim either dies or lands into the vegetative state. The amended law would come into force almost immediately. 

What does the ordinance include?

The Criminal Law (Amendment) Ordinance, 2013 which is agreed to by the President introduced stalking, voyeurism, acid attacks as well as disrobing of women. These crimes were given the status of specific offences under the Indian Penal Code. The ordinance was approved by Union Cabinet of India on 1 February 2013. 

The Criminal Law (Amendment) Ordinance, 2013 comprises of various recommendations from the JS Verma committee as well.
 
The ordinance is an impact of the Delhi gangrape which took place on 16 December 2012 in a moving bus. The ordinance brought changes to the clauses of already-existing criminal law by making amendments in Code of Criminal Procedure (CrPC), Indian Penal Code (IPC) and the Evidence Act.

How will the Criminal Law (Amendment) Ordinance, 2013 be converted into law?

Even though the nod of the President brought these changed provisions of law in force, but now the Government will also have to get it passed in the Parliament within six months, i.e., by August 2013. The government of India decided to discuss or modify, if required, this ordinance during the upcoming budget session which will begin from 21 February 2013 as well. 
 
The new provisions will be presented in the Parliament as official amendments to the Criminal Law (Amendment) Bill, 2012 that was introduced in December 2012. This is a pending legislation which at present is being examined by the parliamentary standing committee that will meet on 4 February 2013.
 
Impact of the President’s assent

The main opposition party BJP welcomed this move. However, the women's rights activists were unhappy over these provisions because of refusal of the Government to include marital rape under the definition of an offence and also for not holding the command officers accountable for such offences like rapes. 

Going beyond the JS Verma committee

The Criminal Law (Amendment) Ordinance, 2013 goes beyond the recommendations of Justice Verma committee to prescribe capital punishment for those rape cases where victim’s death is involved or under a situation where the victim is pushed to coma. The ordinance considers such cases as rarest-of-rare and so awards capital punishment for it. 

Also, the ordinance for such cases prescribed a minimum sentence of 20 years, extendable up to life imprisonment until natural life of a convict.

100th Indian Science Conference: ISCA Awardees 2012-13

Name of Award	Name of Awardees
Asutosh Mookerjee Memorial Award	Dr Venkataraman Ramakrishnan, NL
C. V. Raman Birth Centenary Award	Prof. S. Rajarajan, Chennai
Srinivasa Ramanujan Birth Centenary Award	No Award
S. N. Bose Birth Centenary Award	No Award
S. K. Mitra Birth Centenary Award	No Award
Birbal Sahani Birth Centenary Award	Dr Ashok K Singvi, Ahmedabad
S. S. Bhatnagar Memorial Award	No Award
M. K. Singal Memorial Award	Prof. S. G. Dani, Mumbai
Vikram Sarabhai Memorial Award	No Award
D. S. Kothari Memorial Award	No Award
Jawaharlal Nehru Prize	No Award
Excellence in Science and Technology Award	No Award
R. C. Mehrotra Memorial Life Time Achievement Award	No Award
G. P. Chatterjee Memorial Award	Prof Amalendu Bandopadhyay, Kolkata
Professor Hira Lal Chakravarty Award	Dr. Sudesh Kumar Yadav, Palampur
Pran Vohra Award	Dr. Gyan prakash Mishra, Ladakh
Professor Umakant Sinha Memorial Award	Dr. Durai Sundar, New Delhi
Dr. B. C. Deb Memorial Award for Soil/Physical Chemistry	Dr Alok K Sinha, New Delhi
Dr. B. C. Deb Memorial Award for Popularisation of Science	Dr. Debasis Mandal, Dehradun
Professor R. C. Mehrotra Commemoration Lecture	Prof. Sandip Verma, New Delhi
Prof.(Mrs.) Anima Sen Memorial Lecture	Prof. G. P.Thakur, New Delhi
Dr.(Mrs.) Gouri Ganguly Memorial Award	Dr. Rajnish Kumar Chaturvedi, Lucknow
Prof. G. K. Manna Memorial Award	No Award
Prof. Sushil Kumar Mukherjee Commemoration Lecture	No Award
Prof. S. S. Katiyar Endowment Lecture	Prof. J. P. Khurana, New Delhi
Prof. R. C. Shah Memorial Lecture	Dr. J Mathiyarasu, Tamilnadu
Prof. Archana Sharma Memorial Award	Prof. A. K.Kaul
Dr. V. Puri Memorial Award	Dr. Raghavendra Rao, Bangalore