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1. The Second Wave of COVID-19 and Beyond: Rural Healthcare
Context
As the new variant of Covid-19 has begun to spread in India, the challenges with the Economy and Healthcare continue. The article analyses the healthcare challenges of rural areas, especially during the pandemic years.
Background
India was severely hit by the second wave of the COVID-19 pandemic. The new variant of the virus, omicron, is also spreading rapidly in India.
The attention of the government, global community, and mass media is mostly focused on metro cities and urban areas.
But the virus spread has been alarming in the rural areas especially after events such as election campaigns and religious gatherings.
Ground Realities of Rural Areas
Two-thirds of India’s population lives in rural areas which have the highest burden of emerging infectious diseases in the country.
The rural areas have socio-economic and education-related disadvantages which make them more vulnerable to the pandemic.
Many migrant workers have returned to rural villages unemployed as the pandemic and economic slowdown continue for a longer duration.
Other factors like poor diet, reduced food intake, and hesitancy to undergo testing have made the situation worrying.
The long-standing systemic, functional, and health inequities have put rural communities at increased risk of contracting COVID-19 and suffering from the lack of essential healthcare services.
As per a report by the SBI, the share of rural districts in the new caseload increased to 45.5% in April and 48.5% in May 2021 compared to around 37% in March 2021.
Poor digital literacy, limited connectivity, and the scarcity of appropriate devices in rural areas mean that a considerable section of the population will be excluded from the vaccination drive.
Healthcare Disparities in Rural and Urban Areas
In India, health indicators have significant rural-urban disparities and the disparities are in terms of risk factors, life expectancy and also healthcare capacity.
The disease burden analysis of the rural areas shows that disability-adjusted life years (DALY) rates are higher among rural communities, particularly for many infectious diseases.
DALY rates in rural areas are at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin.
59.2% of the health workers are in the urban areas, where 27.8% of the population resides, and 40.8% are in the rural areas, where 72.2% of the population reside.
The ratio of urban density to rural density for doctors is 3.8, for nurses and midwives 4.0.
Bed availability is 11.9 per 10,000 population in urban areas but only 3.2 per 10,000 in rural areas.
Indicators
Rural Areas
Urban Areas
Average life expectancy
66.7 years
72.5 years
Death rate
6.5%
5%
Infant mortality rate
36 per 1,000
23 per 1,000
Total fertility rate
2.5%
1.8%
Underweight children under five years of age
39%
28%
Major Causes for Divide in the Healthcare Results
The unemployment rate in the rural areas has been at the highest levels in the last two decades which has a severe impact on hunger, food security, and income.
India’s healthcare system is predominantly concentrated in urban centres, wherein tertiary-level services, lab test facilities, and other medical support services are located.
The lack of proper information and right healthcare guidance among the rural population has been crucial in the deteriorated healthcare results.
Rural poor are unaware and do not avail the benefits of even various government insurance schemes like the Rashtriya Swasthya Bima Yojana.
The COVID-19 treatment requires tertiary services with intensive care units, availability of tests, and fast oxygen supplies, which is scarcer in the rural areas.
Private sector healthcare facilities account for 40% of all available beds which are largely concentrated in urban areas and bigger cities.
Poor health resource management and less investment in infrastructure resulted in inequality in health indicators and infrastructure.
Strategies to Tackle the Pandemic Effectively in Rural Areas
The rural communities need specific strategies, which are better suited to their health needs and local cultures.
Health communication strategies should be tailored to target rural populations.
The use of traditional and creative modes of communication like songs, street theatre, etc. could effectively disseminate clearer and more appropriate messaging.
The involvement of community leaders, faith-based organisations and other multi-stake holders’ participation can help to better understand the community’s knowledge, needs, barriers, and challenges around COVID-19 prevention.
Temporary lab facilities can be set up in rural areas, exploring mobile testing lab facility options, and forming micro-teams to strengthen the surveillance system and estimate a more accurate number of cases and fatalities.
The government informed the Supreme Court that the rural people can use common service centres to register on the CoWIN platform to counter the digital limitations of rural areas.
The CSCs are maintained by the Ministry of Electronics and Information Technology.
More capacity for walk-in registration and vaccination should be made available in rural areas, such as the Tamil Nadu model of implementing massive vaccination camps.
Capacity-building among health workers and providing them with adequate financial rewards or incentives could boost the morale of healthcare workers in rural areas.
The public distribution system can be very instrumental in order to cover the poorest migrants who have returned to their villages and ensure food security in the rural areas.
The midday meal schemes and supplementary nutrition provided through schools and anganwadi centres need to be restarted at the earliest.
The health expenditures by the government as a percentage of gross domestic product (GDP) must be increased to a proposed 2.5%.
Strengthening the public health surveillance system, generating epidemiological databases, and establishing registries for each of the communicable and non-communicable diseases is important.
Introducing medical social workers (MSW), mid-level care providers and on-the-job training and skill up-gradation for the accredited social health activist (ASHA), and multipurpose health worker (MPW) is important because many healthcare providers in rural areas are unregistered and untrained and do not know what to do in such an emergency.
Conclusions
The pandemic experience is revealing major lessons for both short term and long-term health planning.
The Covid-19 challenges the health infrastructure of the country where a major concern remained around the rural areas.
For better health outcomes, the primary healthcare system needs to be strengthened especially in rural areas followed by more research and stakeholder participation.
Equitable distribution of resources, including public health infrastructure, priority-based budgetary allocations, training frontline health workers, timely availability and accessibility to essential healthcare services will help in bridging the rural-urban disparities.
Owing to the several benefits that forests provide, a comprehensive framework focusing on holistic aspects is necessary for sustainable management and effective utilization.
Details
Forests are major ecosystems in the world covering about 31% of the global terrestrial area.
About 1.6 billion people worldwide are dependent on forest resources and nearly 350 million people depend directly on them for their livelihoods.
Forests also contribute greatly to the GDP of the Nations.
This has resulted in the reduction of forests globally, mainly due to the conversion of forests to other land use and unsustainable economic activities.
Forests in India
India is ranked 10th among the countries with the largest forest area.
India comprises 1.8% of the world’s forests, they constitute 21.67% of the land area.
India has a livestock population of 18% and a human population of 17% globally leading to increased pressure on the existing forests for fodder, fuelwood, and timber.
As a result of rising population, industrialisation, infrastructure development, agricultural conversion, illegal logging, and forest fires are leading to the decline of forests.
Additionally, the forests are impacted by climate change.
Such loss and damage will pose a challenging situation for the country to provide livelihoods to the dependent communities.
Therefore, in a country like India, where more than one-fifth of the geographical area is under forest cover and supports the livelihoods of more than 60% of the population, comprehensive monitoring and reporting of forest health on different social, ecological, and economic indicators assumes significance to promote sustainable management.
Forest Management and Monitoring in India
During the pre-independence era, Forests were mainly supervised for timber production for the railways by the British.
Post-independence, there has been a steady switch in the system of forest supervision from timber production purposes to that of different ecological and social functions.
This called for the formulation of policies concerning the multidimensional assessment of forests in terms of estimation, monitoring, and reporting, which is important for conservation, restoration, and sustainable management.
The Forest Survey of India (FSI) under the Ministry of Environment, Forest and Climate Change, is the nodal agency responsible for the mapping and reporting of the nation’s forest cover and evaluation of forest resources.
The India State of Forest Report (ISFR) is published biennially to assess forests based on the factors like forest cover, forest density, and forest canopy cover.
It surveys the nationwide forest cover based on 1:50,000 scale according to various canopy density classes.
The tree cover is also evaluated.
The recent report also involves biodiversity assessment of plant species, areas prone to forest fires, the cover of wetlands in forests, forest areas on slopes, etc.
The National Forest Inventory (NFI) helps to assess the growing stock of trees, the number of trees, bamboo, carbon stock of forests, invasive species, and several other parameters that signify the vitality of forests.
However, at present, there is no mechanism to evaluate the social and economic indicators of forest health which are important to understand the full potential.
There are steps taken to develop criteria and indicators to assess forests as part of the National Working Plan Code (NWPC) that forms the basis of devising forest working plans.
But this approach needs to be strengthened further at national and local levels to promote sustainable utilization and management of forest resources.
Valuation of India’s Forest Ecosystem Services
India has 27.5 crores, rural people, including 8.9 crore tribal people depending on forest resources for their livelihood.
The contribution of the forestry sector to India’s GDP is around 2%.
The low number is due to the un-accounting of the intangible benefits of forests in economic terms and the under-reporting of tangible resources.
Hence, proper validation of forest resources based on potential indicators is essential to strengthen the GDP and allow the provision of services to the huge dependent population.
The forestry sector lacks consistent data from different sources, and there is inadequate assessment of the socio-economic aspects in the current monitoring model of the FSI report.
There are a few socio-economic criteria and factors included in the NWPC, but the extensive evaluation of the forestry sector based on these is currently lacking.
Forests and Climate Change
Forestry is a cost-effective method to counter climate change.
The forests in India are exposed to the ill effects of climate change due to various anthropogenic activities.
Global mechanisms that attempt to mitigate climate change require developing proper monitoring, reporting, and verification framework of forest resources.
Thus, a comprehensive monitoring framework emphasizing the evaluation of forest ecosystem services is required to reach the goals committed by India under various international conventions.
Way Forward
Due to the high reliance of people on ecosystem services for sustenance, it is suggested that relevant economic and social indicators should be part of the national forest monitoring system.
Participation of people in decision-making and forest management activities is important to uplift social awareness.
The economic and social dimensions in forestry are vital to strengthen the economy of the nation, promote forest-based livelihoods and uplift social well-being.
Effective skills, expertise, technologies, research, and adequate funding support by government bodies are necessary to develop a vigilant forest monitoring framework.
It is significant to devise better management strategies and efficient benefit-sharing mechanisms to achieve climate-smart forestry and fulfil the objectives of the international conventions, of which India is a member.
Conclusion
India is a fast-growing developing nation that has a huge population including the tribal communities, causing stress on the existing forest resources for their subsistence. Therefore, a comprehensive forest monitoring framework based on relevant indicators is required to unlock the full potential of the forestry sector of India from a multidimensional perspective to optimize multiple benefits and augment the overall socio-economic development of the nation.
The minimum wage laws remain in demand around the world, despite heated debate in the developed countries regarding their continuation.
Details
Considering the monopsonistic nature of the labour market, there is a need for rewriting the concerns of unemployment.
Given the distinct nature of minimum wages in low-income countries when compared to high-income ones, minimum wage laws are significant in effectively tackling inequality.
Given the job polarisation because of the technologies replacing labour, minimum wage policy is still relevant in low-income countries.
The minimum wage law
The law is becoming one of the most popular tools to address concerns regarding inequality and poverty.
More than 100 countries have constituted some form of a wage floor, and there is a renewed urge to accept new minimum wage rates or empower the old ones.
From 2010 onwards, countries like Cabo Verde, Germany, Malaysia, Surinam, and Qatar have adopted a minimum wage system.
In 2019, India made a national minimum wage universal, covering workers across all sectors through the Code on Wages, and a national minimum wage floor came into effect in South Africa.
An estimated 19% of all wage earners globally are paid at or below the applicable minimum wages.
There have been several positive impacts of minimum wages on welfare, resulting in increased implementation of minimum wage laws.
A study by the Organization for Economic Co-operation and Development (OECD) stated that “minimum wages can help ensure that work is rewarding for everyone”.
When minimum wages are moderate and well designed, adverse employment effects can be avoided.
It is found that in more concentrated labour markets, minimum wages have a positive employment effect.
The minimum wage laws work to ensure that labourers are not subjected to exploitation.
Studies in the US have found strong proof that minimum wages have led to an increase in incomes at the bottom of the family income distribution.
The existence of a minimum wage law also helps reduce the inequity between two different groups of people.
In the US, the Fair Labor Standards Act, 1966 extended the federal minimum wage coverage to sectors that employed mostly Black workers, like agriculture, restaurants, and nursing homes.
The minimum wages law almost doubled the earnings of Black workers compared to that of White workers.
The act resulted in a 20% reduction in the racial earnings and income gap between 1965 and 1980.
In Poland and Indonesia, the law resulted in a significant reduction in the gender wage gap.
A potent minimum wage law can help secure a basic standard of living and help eradicate social discrimination.
Arguments against Minimum Wages
Critics opine that there is a need to reassess the role of statutory minimum wages as an instrument to achieve redistributive goals and switch to more direct instruments.
In a survey conducted in 1992, of the members of the American Economic Association, 79% of participants suggested minimum wages can lead to unemployment among young and low-skilled workers.
In developed countries, the workers earning minimum wage are mostly teenagers, this would result in low-skilled workers.
Economists argue that in a competitive market any compulsory wage floor above the market wage will result in the reduction of employment.
The firms like restaurants and retail stores may pass on the cost arising because of the minimum wages on to the customers.
For example, in Hungary, it was seen that 75% of the cost of an increase in minimum wages was passed on to the consumers.
The minimum wage laws do not include other benefits, like pension, sick leaves, on-the-job training, or working conditions.
In the present age of globalisation, firms may become uncompetitive after an increase in the minimum wage.
Firms may either exit the market or adopt modern automation technologies to substitute labour.
In the US after an increase in the minimum wages, it was seen that low-wage jobs decreased as they were automated.
Conclusion
The fear of exploitation of low-wage earners is still large as it was when the first minimum wage laws were passed in the early 20th century. If maintained at a sufficiently moderate level and fixed after the consultation of employer federations and labour unions, the minimum wage will ensure that everyone enjoys a decent life in society.
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