India's Pillars of Well-being

Objective:

To provide Comprehensive Primary Health Care (CPHC) closer to the homes of people. Aims to transform existing Sub-Centres and Primary Health Centres into HWCs.

Target:

Establishment of 1.5 lakh HWCs by December 2022 (target achieved and exceeded).

Services Offered (Expanded range):

• Care for maternal and child health services and communicable diseases.
• Screening, prevention, control and management of non-communicable diseases (NCDs) like hypertension, diabetes, oral, breast, and cervical cancer.
• Basic oral health care.
• Care for common ophthalmic and ENT problems.
• Elderly and palliative health care services.
• Emergency medical services, including free essential drugs and diagnostic services.
• Wellness activities like Yoga.

Significance:

Shifts focus from selective to comprehensive primary care, emphasizes promotive and preventive health. Forms the foundation of India’s healthcare system.

Objective:

To provide health insurance coverage to poor and vulnerable families for secondary and tertiary care hospitalization. Aims to protect them from catastrophic health expenditure.

Launch Year: September 2018.

Type: Centrally Sponsored Scheme (funding shared between Centre and States, typically 60:40 for most states, 90:10 for NE/Himalayan states).

Features:

• World's largest government-funded health insurance scheme.
• Provides health coverage of ₹5 lakh per family per year for secondary and tertiary hospitalization.
• Beneficiary Identification: Based on socio-economic deprivations in rural areas and occupational categories in urban areas as per Socio-Economic Caste Census (SECC) 2011 data. Targets over 12 crore poor and vulnerable families (approx. 55 crore beneficiaries).
• Cashless and Paperless: Services at empanelled public and private hospitals.
• Portability: Beneficiaries can avail treatment in any empanelled hospital across the country.
• Covers pre-hospitalization (3 days) and post-hospitalization (15 days) expenses.
• Includes ~1,949 treatment packages.
• No cap on family size or age of members.

Implementation:

Through State Health Agencies (SHAs) in states, either in insurance mode, trust mode, or mixed mode. National Health Authority (NHA) is the apex body for implementation.

Challenges:

• Fraud and Abuse: False claims, unnecessary procedures by some empanelled hospitals.
• Infrastructure Gaps: Shortage of empanelled hospitals, especially quality private hospitals, in rural and remote areas.
• Human Resources: Shortage of specialist doctors and paramedics.
• Portability: Smooth inter-state portability can be challenging due to varying IT systems and claim processes.
• State Adoption & Integration: Some states have their own similar schemes and integration/co-branding can be complex. (e.g., West Bengal opted out).
• Awareness among beneficiaries about entitlements and procedures.
• Ensuring quality of care in empanelled hospitals.

Recent Developments:

Focus on fraud detection using AI/ML. Efforts to increase empanelment of private hospitals. Linking with Ayushman Bharat Digital Mission.

Objective:

To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner.

Key Building Blocks:

• Ayushman Bharat Health Account (ABHA) / Health ID: A unique 14-digit randomly generated ID for every citizen for authentication and threading of health records.
• Healthcare Professionals Registry (HPR): Repository of all healthcare professionals.
• Health Facility Registry (HFR): Repository of all health facilities.
• ABHA Mobile App: For managing health records.
• Unified Health Interface (UHI): Open network to enable interoperability of digital health services.

Benefits (Potential):

Seamless access to health records, improved diagnosis and treatment, enhanced efficiency of healthcare delivery, better public health surveillance.

Challenges:

• Data Privacy and Security: Protecting sensitive health data is paramount. (Digital Personal Data Protection Act, 2023 provides a framework).
• Digital Literacy and Access: Ensuring inclusivity for those without digital access/skills.
• Interoperability: Ensuring different IT systems can communicate.
• Standardization of health data.
• Consent management for sharing data.

Objective:

To provide for food and nutritional security in human life cycle approach, by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity.

Coverage:

• Up to 75% of the rural population and up to 50% of the urban population for receiving subsidized foodgrains under Targeted Public Distribution System (TPDS). Overall, nearly two-thirds of the population.
• Beneficiaries identified by States/UTs based on criteria evolved by them.

Entitlements:

• Priority Households (PHH): 5 kg of foodgrains per person per month at subsidized prices of ₹3/2/1 per kg for rice/wheat/coarse grains respectively.
• Antyodaya Anna Yojana (AAY) households: Continue to receive 35 kg of foodgrains per household per month at the same subsidized prices.
• Pregnant Women and Lactating Mothers: Entitled to maternity benefit of not less than ₹6,000 (partially met by PMMVY). Also, free meals during pregnancy and six months after child birth through Anganwadi Centres.
• Children (6 months to 14 years): Age-appropriate meals through ICDS and Mid-Day Meal Scheme.

PDS Reforms (under NFSA and otherwise):

• End-to-end Computerization: Digitization of beneficiary data, online allocation of foodgrains, computerization of supply chain management to reduce leakages.
• Aadhaar Seeding: Linking Aadhaar with ration cards for de-duplication and better targeting.
• ePoS (Electronic Point of Sale) devices: At Fair Price Shops (FPS) for biometric authentication of beneficiaries.
• Portability - One Nation One Ration Card (ONORC): Allows beneficiaries, especially migrants, to access their entitled foodgrains from any FPS across the country using their existing ration card with biometric authentication. (Achieved near national rollout).

Challenges:

Inclusion/exclusion errors in beneficiary identification, quality of foodgrains, leakages (though reduced), FPS viability, grievance redressal.

Objective:

To achieve improvement in nutritional status of Children (0-6 years), Adolescent Girls, Pregnant Women and Lactating Mothers in a time bound manner. Aims to reduce malnutrition in the country in a phased manner through a life cycle approach.

Targets (Key ones, to be achieved by 2022, progress ongoing):

• Reduce stunting in children (0-6 years) by 2% per annum (Mission target of 25% by 2022 from NFHS-4 levels).
• Reduce under-nutrition (underweight prevalence) in children (0-6 years) by 2% p.a.
• Reduce anaemia among young Children (6-59 months) by 3% p.a.
• Reduce anaemia among Women and Adolescent Girls (15-49 years) by 3% p.a.
• Reduce Low Birth Weight (LBW) by 2% p.a.

Strategies:

• Convergence: Among various ministries/schemes (WCD, Health, Drinking Water & Sanitation, Rural Dev, etc.).
• Technology Usage (ICT-RTM): Use of ICDS-CAS (Common Application Software) by Anganwadi Workers for real-time monitoring, growth monitoring, service delivery tracking.
• Intensified Health & Nutrition Services: For the first 1000 days (conception to 2 years of age).
• Jan Andolan (People's Movement): Community mobilization and awareness generation.
• Behavior Change Communication (BCC).

Challenges:

Effective convergence on the ground, capacity building of frontline workers, ensuring quality of services, addressing social determinants of malnutrition (sanitation, poverty, women's education).

Recent Developments:

Now subsumed under Saksham Anganwadi and Poshan 2.0 which aims for a holistic approach. Data from NFHS-5 (2019-21) shows mixed progress on nutritional indicators.

Objective:

To enhance enrolment, retention and attendance and simultaneously improving nutritional levels among children studying in Government and Government-aided primary (Classes I-V) and upper primary (Classes VI-VIII) schools, and also pre-primary (Balvatikas).

Entitlement:

Hot cooked meal with specified nutritional content.

Nutritional Impact:

Addresses classroom hunger, improves concentration, provides vital micronutrients.

Challenges:

Quality and hygiene of meals, infrastructure for cooking and storage, pilferage of foodgrains, caste-based discrimination in some areas, timely release of funds.

Recent Developments under PM-POSHAN:

• Extension to students of Balvatikas (pre-primary classes) in government schools.
• Emphasis on Social Audit, School Nutrition Gardens, involvement of FPOs and Women SHGs.
• Focus on Tithi Bhojan (community participation).

Objective:

To provide a defined pension for citizens, mainly targeting the unorganized sector workers, after the age of 60 years.

Eligibility:

Any citizen of India between 18-40 years of age having a savings bank account/post office savings bank account. (From Oct 1, 2022, income tax payers are not eligible to join APY).

Features:

• Guaranteed minimum monthly pension of ₹1,000, ₹2,000, ₹3,000, ₹4,000 or ₹5,000 at the age of 60 years, based on contributions made.
• Contribution amount varies with age of entry and chosen pension amount.
• Central Government co-contributes 50% of the subscriber's contribution or ₹1,000 per annum, whichever is lower, for 5 years for those who joined before March 31, 2016, and are not income tax payers and not covered by any statutory social security scheme. (This co-contribution feature is largely phased out for new subscribers).

Significance:

Addresses old age income security for the vast unorganized sector.

Objective:

To provide social assistance benefits to poor households in the case of old age, death of primary breadwinner and maternity. The scale of assistance is modest but aims to ensure minimum national standards.

Components:

1. Indira Gandhi National Old Age Pension Scheme (IGNOAPS): For BPL persons aged 60 years or above. Pension amount varies (e.g., ₹200 p.m. for 60-79 yrs, ₹500 p.m. for 80+ yrs from Central share; States add their share).
2. Indira Gandhi National Widow Pension Scheme (IGNWPS): For BPL widows aged 40-79 years.
3. Indira Gandhi National Disability Pension Scheme (IGNDPS): For BPL persons aged 18-79 years with severe or multiple disabilities.
4. National Family Benefit Scheme (NFBS): Lump sum assistance of ₹20,000 to a BPL household on the death of the primary breadwinner (aged 18-59 years).
5. Annapurna Scheme: Provides 10 kg of foodgrains per month free of cost to destitute senior citizens not receiving old age pension. (Limited coverage).

Challenges:

Low pension amounts, identification of beneficiaries (BPL lists often outdated), delays in payment.

Objectives:

SBM-U Phase I:

• Achieve 100% Open Defecation Free (ODF) status in all urban areas.
• 100% scientific solid waste management in all statutory towns.
• Generate awareness and bring about behavior change regarding sanitation practices.

SBM-U Phase II (ODF+ and ODF++ and Water+ Focus):

• Sustain ODF outcomes.
• Achieve ODF+ status for all statutory towns (focuses on O&M of community/public toilets and ensuring faecal sludge/septage management).
• Achieve ODF++ status for all statutory towns (focuses on complete faecal sludge and septage management, including treatment and reuse/disposal).
• Achieve Water+ certification for cities (focuses on treatment of wastewater before discharge into water bodies and reuse of treated wastewater).
• Focus on source segregation of solid waste, processing of all municipal solid waste, and remediation of all legacy dumpsites.
• Making all cities ‘Garbage Free’ (Star Rating Protocol for Garbage Free Cities).

Components:

Construction of individual household toilets (IHHL), community/public toilets, solid waste management (SWM) infrastructure, IEC activities. SBM-U 2.0 adds focus on wastewater treatment, faecal sludge management, and remediation of old landfills.

Achievements (Phase I):

Urban India declared ODF. Significant progress in toilet construction and SWM coverage.

Challenges:

• Sustainability of ODF status (behavior change, O&M of toilets).
• Effective solid and liquid waste management (segregation, processing, scientific disposal).
• Managing legacy waste dumpsites.
• Capacity of Urban Local Bodies (ULBs) for implementation and O&M.
• Funding for capital-intensive waste management projects.

Recent Developments:

Swachh Survekshan (annual cleanliness survey) drives competition among cities. Focus on circular economy principles in waste management.

Objective:

AMRUT 1.0:

Ensure that every household has access to a tap with assured supply of water and a sewerage connection; increase amenity value of cities by developing greenery and well-maintained open spaces; and reduce pollution by switching to public transport or constructing facilities for non-motorized transport.

AMRUT 2.0:

• Aims to provide 100% coverage of water supply to all households in around 4,700 statutory towns (universal coverage of water supply).
• Provide 100% coverage of sewerage and septage management in 500 AMRUT cities.
• Rejuvenation of water bodies and creation of green spaces.
• Promote circular economy of water through development of City Water Balance Plan for each city focusing on recycle/reuse of treated sewage, rejuvenation of water bodies and water conservation.
• Promote data-led governance in water sector through ‘Pey Jal Survekshan’.

Funding:

Central assistance to states/UTs for projects. States prepare State Water Action Plans (SWAPs).

Features:

Focus on project implementation by ULBs, capacity building, reform implementation (e.g., energy audit, water audit, urban planning).

Challenges:

• Huge investment required for universal coverage of water and sewerage.
• Ensuring source sustainability for water supply.
• Capacity of ULBs for project planning, execution, and O&M.
• Ensuring quality of water supplied.
• Achieving financial sustainability of water utilities (user charges).

Recent Developments:

Emphasis on technology use (SCADA systems), public-private partnerships. "Pey Jal Survekshan" to foster competition among cities for better water service delivery.