Crore

Abstract: The total expenditure on central schemes for the poor and on the major subsidies exceeds the states’ share of central taxes. These schemes are chronic bad performers due to a culture of immunity in public administration and weakened local governments. Arguing that the poor should be trusted to use these resources better than the state, a radical redirection with substantial direct transfers to individuals and complementary decentralisation to local governments is proposed. The benefits, risks and associated reinforcement of institutions and accountability are outlined. There are few countries where the state and the policy and intellectual community have been as committed to poverty eradication as India – both in terms of rhetoric and through a range of subsidies and an array of targeted poverty reduction programmes. In 2006-07, there were at least 151 central sector (including centrally-sponsored) schemes – hereafter collectivley referred to as CSS – entailing annual expenditures of about Rs 72,000 crore. Of this, about Rs 64,000 crore, i e, almost 90 per cent, were allocated to 30 schemes.1 In the 2008-09 budget, these 30 schemes (now reduced to 27 due to consolidation) have been allocated nearly Rs 79,000 crore, i e, an increase of 23 per cent over two years. This is even without including other CSS that masquerade as additional central plan assistance, such as the Jawaharlal Nehru National Urban Renewal Mission (JNNURM) and the Backward Region Grant Fund (BGRF).2 A similar amount is budgeted for food, fertiliser and fuel subsidies. An amount of Rs 32,666 crore has been allocated to the Food Corporation of India (FCI) for procuring and distributing foodgrains through the public distribution system (PDS), and Rs 30,986 crore for fertiliser subsidies (not including any fertiliser bonds that will have to be issued).3 If we add to this the budgeted PDS expenditure on kerosene and LPG of Rs 2,700 crore and Rs 21,554 crore of oil bonds that were issued until December 2007, the total amount of these subsidies is nearly Rs 88,000 crore. Once one adds the remaining CSS and the oil bonds for the last quarter of 2007-08, total expenditures on CSS and subsidies will comfortably exceed the Rs 1,78,765 crore that is the states’ share of central tax revenue. Is this enormous expenditure through centralised mechanisms the best way of improving the welfare of India’s poor and achieving India’s development objectives? For instance if these budgetary trends continue, these expenditures will soon be sufficient to transfer Rs 1 crore annually to each panchayat – more than an order of magnitude of what they receive today. Might that be a better way to achieve these goals?

Abstract: Byline: E. Mohandas Introduction " We are responsible for what we are, and whatever we wish ourselves to be, we have the power to make ourselves. If what we are now has been the result of our own past actions, it certainly follows that whatever we wish to be in future can be produced by our present actions; so we have to know how to act ." - Swami Vivekananda With all its alluring contrasts and remarkable features, India has a grand heritage of 34,000 years. Down the traditional lane, it has evolved into a pluralistic, multilingual, and multiethnic society. It is quite striking that while India is the second-most populous country, it has the largest democracy in the world. The second fastest growing economy and the third largest military force are also her golden quills. Seventy-four per cent of the 1.14 billion population of India live in rural areas. India has 28 states, seven union territories, 612 districts, and 6, 38,365 villages. The fact that there are 22 official languages in a single country is ample evidence for the heterogeneous nature of the society it represents. Having a literacy rate of about 64.8%, India has 80 million internet users. With all this, I do not mean to say that India is not without its lacunae. Even while India is the world's twelfth largest economy, we cannot close our eyes to the grim truth that 22% of the population exists below the poverty line.[sup] [1],[2],[3] With regard to the academic scene, India is proud to have 289 institutions providing undergraduate medical training (196 MCI recognized, 77 MCI permitted, and 16 in the "danger zone"). The postgraduate training in psychiatry includes Doctor of Medicine (MD) (83 centers, 159 seats), Diploma in Psychological Medicine (DPM) (46 centers, 107 seats), and Diplomate of National Board (22 centers, 36 seats). Strikingly, 25% of the medical colleges in India do not have a Psychiatry Department.[sup] [4],[5],[6] Apparently, there are only around 4000 psychiatrists in India to serve the five crore mentally ill population currently. Mental Health Scenario in India Obviously, in a vast country like India, the threat posed by the psychiatric and behavioral disorders is just inexplicable. A meta-analysis of 13 epidemiological studies consisting of 33,572 persons reported a total morbidity of 58.2 per 1000. Another meta-analysis of 15 epidemiological studies reported a total morbidity of 73 per 1000.The saddest aspect is that the bulk of the affected falls in the 15 to 45 year age group. The existing facilities in the country fall short of the required norms, which makes the situation still worse. The number of psychiatric beds in the country is only about 0.2 per 1, 00,000 population and there are only two psychiatrists per 10 lakh population. The major share of psychiatric facilities lies with the government sector (especially mental hospitals), which is centered on certain areas of particular states. The psychiatric services have not yet been integrated into the primary health care system and this leaves large populations in dire need of such facilities, with no hope of effective treatment. Therefore, they seek help from the private sector and there are no clear policies regarding treatment of the mentally ill in the private sector. A significant population in India cannot afford private hospital care and the insurance system in the country is in its infancy. The rehabilitation of psychiatric patients is also given little importance in the existing mental health framework. The integration of psychiatric services to primary care needs a public-private partnership to enable comprehensive mental health care.[sup] [7],[8],[9],[10] Indian Psychiatric Society Evolution Our society sprouted from the Indian Association for mental hygiene founded in 1929 by Berkeley Hill. In 1935, the Indian division of the Royal Medico-Psychological Association (RM-PA) was formed, due to the efforts of Dr. …

Abstract: For negating the impact of early adversities on the development and ensuring a healthy, dynamic future for all children, Ministry of Health and Family Welfare in 2013 launched a programme for child health screening and early intervention services as Rashtriya Bal Swasthya Karyakram (RBSK) which aims to improve the quality of life with special focus on improving cognition and survival outcomes for “at risk” children. It has a systemic approach of prevention, early identification and management of 30 health conditions distributed under 4Ds: Defects at birth, Diseases, Deficiencies and Developmental delays including Disabilities spread over birth to 18 y of age in a holistic manner. There is a dedicated 4 member Mobile Health team for community screening and a dedicated 14 member team at District Early Intervention Center (DEIC) for comprehensive management. Existing health infrastructure and personnel are also integrated and utilized in this endeavor. Defects at birth are screened at Delivery points, home visits by accredited social health activist (ASHA), Anganwadi centers and at schools. Developmental delays are evaluated at DEIC through a multidisciplinary team with interdisciplinary approach. Five thousand four hundred eighteen dedicated Mobile Health teams have screened a total of 12.19 crore children till Dec.14. From April to Dec. 2014, 4.20 crore children were screened, of which birth to 6-y-old children were 2.13 crore while 2.07 crore were from 6 to 18 y. 17.7 lakh children were referred to tertiary centers and 6.2 lakh availed tertiary care. 50.7 lakhs were found positive for 4Ds; 1.35 lakhs were birth defects. RBSK is a step towards universal health care for free assured services.

Abstract: Background & objectives: India's Universal Immunization Programme (UIP) is one of the largest programmes in the world in terms of quantities of vaccines administered, number of beneficiaries, number of immunization sessions, and geographical extent and diversity of areas covered. Strategic planning for the Programme requires credible information on the cost of achieving the objectives and the financial resources needed at national, State, and district levels. We present here expenditures on immunization services in India in 2012 (baseline) and projected costs for five years (2013-2017). Methods: Data were collected from the Immunization Division of the Ministry of Health and Family Welfare, Government of India, and immunization partners, such as the World Health Organization and UNICEF. The cost components were immunization personnel, vaccines and injection supplies, transportation, trainings, social mobilization, advocacy and communication activities, disease surveillance, Programme management, maintenance of cold chain and other equipment, and capital costs. Results: Total baseline expenditure was ₹ 3,446 crore [1 crore = 10 million] (US$718 million), including shared personnel costs. In 2012, the government paid for 90 per cent of the Programme. Total resource requirements for 2013-2017 are ₹ 34,336 crore (US$ 5, 282 million). Allocations for vaccines increase from ₹ 511 crore in 2013 to ₹ 3,587 crore in 2017 as new vaccines are assumed to be introduced in the Programme. Interpretation & conclusions: The projections show that the government immunization budget will be double in 2017 as compared to 2013. It will increase from ₹ 4,570 crore in 2013 to ₹ 9,451 crore in 2017.