Fight against hunger too slow and uneven

The Millennium Development Goal of halving the proportion of chronically undernourished people in developing countries by 2015 is within reach. But progress must accelerate by the end of this year

Almost 800 million people, or one in nine in the world, continue to suffer from hunger. The number of hungry people has declined globally by more than 167 million over the last decade, and by more than 200 million since 1991; 780 million of the chronically hungry are in developing countries, where their share has declined from 23.4 per cent in 1991 to just under 13.0 per cent at the end of 2014.

Thus, according to the latest State of Food Insecurity in the World (SOFI 2015) report, the Millennium Development Goal (MDG) of halving the proportion of chronically undernourished people in developing countries by 2015 is within reach, but only if progress accelerates sufficiently by the end of this year.

Progress too slow

At the 1996 World Food Summit (WFS), heads of government and the international community committed to reducing the number of hungry people in the world by half. Five years later, the MDGs lowered the level of ambition by seeking to halve the proportion of the chronically undernourished.

By the end of 2014, 72 developing countries had reached the MDG Goal 1 target. Of these, 29 have also achieved the more ambitious WFS goal. However, the number of hungry people in the world has only declined by a fifth from the billion estimated for 1991.

…and uneven

Overall progress has been highly uneven. Some countries and regions have seen only slow progress in reducing hunger, while the number of hungry has even increased in several cases.

In sub-Saharan Africa, more than one in four people remains chronically hungry, while Asia, the world’s most populous continent by far, is also home to over half a billion hungry people. Meanwhile, Latin America, the Caribbean, East and Southeast Asia have significantly reduced both the share and the number of undernourished. Most countries have reached the MDG target. West Asia and Central Africa have seen a rise in the share of the hungry compared to 1991, while progress in sub-Saharan Africa, South Asia and Oceania has not been sufficient to meet the MDG hunger target by 2015.

Lessons from experience

While there is no one-size-fits-all solution for how to improve food security, SOFI 2015 identifies several factors that have played a critical role in achieving the hunger target.

Growth needs to be inclusive to reduce poverty and hunger. Access to food has improved rapidly and significantly in countries that have experienced inclusive economic growth, notably in East and South-East Asia. Better performers in Africa met the MDG hunger target while those that made slow progress did not.

Raising the productivity of family farmers can be an effective way out of poverty and hunger by increasing net incomes and in town investments for further improvements. improved agricultural productivity, especially by small holder family farmers and incomes, leads to poverty and hunger reduction.

Economic growth is usually helpful as it can expand the fiscal revenue base, including to finance social transfers and other assistance programmes. In Latin America and South Asia, social protection has made the difference, especially for the rural poor, who comprise 78 per cent of the poor globally.

The expansion of social protection — cash transfers to vulnerable households, food vouchers, health insurance or school meal programmes — correlates strongly with progress in hunger reduction. Besides the direct impact on relieving hunger and poverty, social protection can enable those with fewer assets to boost their incomes, and invest more, thus enhancing their resilience.

SOFI 2015 estimates that some 150 million people worldwide have escaped extreme poverty thanks to social protection. However, more than two-thirds of the world’s poor still do not have access to regular social support. Transfers help households manage risk and mitigate shocks that would otherwise trap them in poverty and hunger.

With the number of undernourished people remaining “unacceptably high”, the need to strengthen the political commitment to eliminate hunger cannot be overemphasised. The pledges of the Community of Latin America and the Caribbean at its 2013 summit and of the 2014 African Union summit to end hunger in their respective continents by 2025 are very encouraging. In 2015, the governments of the world are expected to strengthen financing for development, commit to the post-2015 Sustainable Development Goals and ensure the needed collective action to address global warming. SOFA 2015 is a timely reminder of the enduring legacy of needless hunger and poverty which we must eliminate by 2030.

(Jomo Kwame Sundaram is the Coordinator for Economic and Social Development at the Food and Agriculture Organization and received the 2007 Wassily Leontief Prize for Advancing the Frontiers of Economic Thought.)

Coming south in search of a bride

The strange case of how women from Kerala are wedding men from Haryana in what often turn out to be disastrous marriages.

Some trends seem astonishing at first, but begin to make sense when closely examined. The case of Kerala women marrying Haryanvi men is one such example. Why would women from a State known for its excellent social and human development indicators, particularly its treatment of women, marry men from a State infamous for its skewed sex ratio?

Recent newspaper reports show that in the context of a huge sex ratio imbalance and an imminent shortage of brides, several Haryanvi men are heading to Bihar, West Bengal and Kerala in search of brides. In order to understand the nature of these marriages and the motivations of these women, we visited Kerala recently.

Women incur the costs

In a hegemonic and heteronormative society, not being married carries a huge cost, as desperate Haryanvi men seeking wives know only too well. In our study, we found that several men who may not have been seen as marriageable in the local context have made their way to Kerala with no expectation except that of getting a wife. Typically, the brides came from very poor families with more than one daughter. And when the women are above a certain ‘marriageable’ age, it is considered better for them to be married than remain single. It is these women, priced out of marriage in Kerala, who marry Haryanvi men. As the father of a recent such bride put it, “If the family was well off, the girl would not be married away in Haryana”.

The case of Rani (name changed) points to the troubling aspect of this arrangement: how marriage is regarded as indispensable, and how women, in particular, incur the greater costs in the process. Rani, about 32 years old, has studied up to Class 8. About eight or nine years ago, she married a man from Haryana and now has two children. She was introduced to her husband through a relative (also married in Haryana to a Haryanvi but returned to Kerala to marry a Malayali). But Rani did not see her fiancé or even his photo until the day of the wedding. “He was quite old,” she recalls. Rani’s wedding was not registered in the temple or in the Panchayat, as is the norm, as it took place on a holiday. She and her husband left for Haryana in a hurry and she does not have a photo of her wedding or even one of her husband and her together. Upon her arrival in Haryana, she discovered that her husband was an alcoholic, and he would regularly abuse her. Thankfully, with the support of her two brothers and her mother, who paid her train fare, Rani was able to keep coming home.

Finally, last year, Rani decided that she had had enough. She fought with her husband and returned to Kerala permanently. Soon after, her husband fell sick and died. When she went back to Haryana and asked for his death certificate, his elder brother convinced her to sign a blank sheet of paper and gave her a photocopy of the death certificate. She realised that the document would be used to cut her off from any claim to her late husband’s house and the little property his family owned, but signed it anyway. True to her fears, she has not heard from them since.

Several other cases show a pattern in the treatment of women in such marriages. In one, a woman tried contacting her Haryana husband’s family after his death, but she was told there was no one by that name. In another, a woman suffering from cancer died in Kerala, but her Haryana husband did not come to see her, either during treatment or after her death. Her mother told us, “We spent on her treatment because she is our daughter. Who else will do it?”

Ticket to a good future

All the families we spoke to said the same thing: that they had agreed to their daughters’ marriage to complete strangers and going away to a distant place so that they would have someone to take care of them in future. This underlined a bitter fact: that marriage in India is still believed to be the only route to a good future for a woman. If the marriage goes well, this wish is fulfilled; if not, she bears the consequences. Many families rush into such marriages with little knowledge about the groom or his circumstances. Some family members rationalised these marriages away as the woman’s ‘destiny’ —“whatever is written in one’s fate is what one gets” said a maternal uncle, whose niece married a Haryana man who turned out to be a different person from the man they saw in the photograph.

In all these marriages, both the family and the woman agree reluctantly to the marriage because the woman is desperate to reduce the “burden” on her family and the family is desperate to find her a good life in the form of a happy marriage. It was distressing to listen to how these women agreed to venture into the unknown, to settle in places where they didn’t speak the local language, where the food was unfamiliar, social norms restrictive, and where discrimination based on skin colour are prevalent. At the same time, their courage is equally startling. The only silver lining was that in some cases, the women managed to come back to Kerala along with their husbands, and both settled down there.

Recent research pointed out that development may have contributed to a rise in the age of marriage in India, but the institution remains strong and is unlikely to break down in the near future. Our study just reinforced this point.

(Sharada Srinivasan is Canada Research Chair in Gender, Justice and Development at the University of Guelph, Canada. Email: sharada@uoguelph.ca. S.Irudaya Rajan is Professor at the Centre for Development Studies, Kerala. Email: rajancds@gmail.com.)

Sustainable development goals: all you need to know

The countdown has begun to September’s summit on the sustainable development goals, with national governments now discussing the 17 goals that could transform the world by 2030

What are the sustainable development goals?

The sustainable development goals (SDGs) are a new, universal set of goals, targets and indicators that UN member states will be expected to use to frame their agendas and political policies over the next 15 years.

The SDGs follow, and expand on, the millennium development goals (MDGs), which were agreed by governments in 2000, and are due to expire at the end of this year.

Why do we need another set of goals?

There is broad agreement that while the MDGs provided a focal point for governments on which to hinge their policies and overseas aid programmes to end poverty and improve the lives of poor people – as well as provide a rallying point for NGOs to hold them to account – they have been criticised for being too narrow.

The eight MDGs – reduce poverty and hunger; achieve universal education; promote gender equality; reduce child and maternal deaths; combat HIV, malaria and other diseases; ensure environmental sustainability; develop global partnerships – failed to consider the root causes of poverty, or gender inequality, or the holistic nature of development. The goals made no mention of human rights, nor specifically addressed economic development. While the MDGs, in theory, applied to all countries, in reality, they were considered targets for poor countries to achieve, with finance from wealthy states. Every country will be expected to work towards achieving the SDGs.

As the MDG deadline approaches, around 1 billion people still live on less then $1.25 a day - the World Bank measure on poverty - and more than 800 million people do not have enough food to eat. Women are still fighting hard for their rights, and millions of women still die in childbirth.

What are the proposed 17 goals?

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1) End poverty in all its forms everywhere

2) End hunger, achieve food security and improved nutrition, and promote sustainable agriculture

3) Ensure healthy lives and promote wellbeing for all at all ages

4) Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

5) Achieve gender equality and empower all women and girls

6) Ensure availability and sustainable management of water and sanitation for all

7) Ensure access to affordable, reliable, sustainable and modern energy for all

8) Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all

9) Build resilient infrastructure, promote inclusive and sustainable industrialisation, and foster innovation

10) Reduce inequality within and among countries

11) Make cities and human settlements inclusive, safe, resilient and sustainable

12) Ensure sustainable consumption and production patterns

13) Take urgent action to combat climate change and its impacts (taking note of agreements made by the UNFCCC forum)

14) Conserve and sustainably use the oceans, seas and marine resources for sustainable development

15) Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification and halt and reverse land degradation, and halt biodiversity loss

16) Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

17) Strengthen the means of implementation and revitalise the global partnership for sustainable development

Within the goals are a proposed 169 targets, to put a bit of meat on the bones. Proposed targets under goal one, for example, include reducing by at least half the number of people living in poverty by 2030, and eradicating extreme poverty (people living on less than $1.25 a day). Under goal five, there’s a proposed target on eliminating violence against women. Under goal 16 sits a target to promote the rule of law and equal access to justice.

How were the goals chosen?

Unlike the MDGs, which were drawn up by a group of men in the basement of UN headquarters (or so the legend goes), the UN has conducted the largest consultation programme in its history to gauge opinion on what the SDGs should include.

Establishing post-2015 goals was an outcome of the Rio+20 summit in 2012, which mandated the creation of an open working group to come up with a draft set.

The open working group, with representatives from 70 countries, had its first meeting in March 2013 and published its final draft, with its 17 suggestions, in July 2014. The draft was presented to the UN general assembly in September.

Alongside the open working group, the UN conducted a series of “global conversations”, which included 11 thematic and 83 national consultations, and door-to-door surveys. It also launched an online My World survey asking people to prioritise the areas they’d like to see addressed in the goals. The results of the consultations should have fed into the the working group’s discussions.

Are governments happy about the proposed 17 goals?

The majority seem to be, but a handful of member states, including the UK and Japan, aren’t so keen. Some countries feel that 17 goals are too unwieldy to implement or sell to the public and would like a narrower brief. Or so they say. Some believe the underlying reason is to get rid of some of the more uncomfortable goals, such as those relating to the environment. Britain’s prime minister, David Cameron, has publicly said he wants 12 goals at the most, preferably 10. It’s not clear, though, which goals the UK government would like taken out if they had the choice.

Some NGOs also believe there are too many goals, but there is a general consensus that it’s better to have 17 goals that include targets on women’s empowerment, good governance, and peace and security, for example, than fewer goals that don’t address these issues.

Is the number of goals expected to change?

Those who have been involved in the process say no, although they do expect fewer targets. Many of the proposed targets are more political statement than measurable achievement at the moment.

In his synthesis report on the SDGs in December, UN secretary general Ban Ki-moon gave no hint that he would like to see the number of goals reduced. In a bid to help governments to frame the goals, Ban clustered them into six “essential elements”: dignity, prosperity, justice, partnership, planet, people.

Amina Mohammed, the UN secretary general’s special adviser on post-2015 development planning, said it had been a hard fight to get the number of goals down to 17, so there would be strong resistance to reduce them further.

Member states will begin formal discussions on the content of the SDGs on 19 January, and are expected to meet each month until September. Any serious faultlines should be evident over the next three to four months.

How will the goals be funded?

That’s the trillion-dollar question. Rough calculations from the intergovernmental committee of experts on sustainable development financing have put the cost of providing a social safety net to eradicate extreme poverty at about $66bn a year, while annual investments in improving infrastructure (water, agriculture, transport, power) could be up to a total of $7tn globally.

In its report last year, the committee said public finance and aid would be central to support the implementation of the SDGs. But it insisted that money generated from the private sector, through tax reforms, and through a crackdown on illicit financial flows and corruption was also vital.

A major conference on financing for SDGs will be held in Addis Ababa, Ethiopia, in July, where it is hoped that concrete financing will be agreed.

When will the new goals come into force?

If member states agree the draft set of 17 SDGs at a UN summit in New York in September, they will become applicable from January 2016. The expected deadline for the SDGS is 2030.

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What is the difference between SDGs and Post 2015 Development Agenda processes?

The Sustainable Development Goals process was agreed at the 2012 UN Conference on Sustainable Development (Rio+20) where Member States agreed to set up an intergovernmental process ‘with a view to developing global sustainable development goals to be agreed by the General Assembly.’ The Post-2015 Development Agenda is a process led by the UN Secretary-General, responding to a mandate from the General Assembly in 2010 following an event to accelerate progress towards achieving the Millennium Development Goals (MDGs), calling on him to lead on work to advance the United Nations development agenda beyond 2015.

What is the High Level Panel for post-2015 and what is its remit?

The High Level Panel of Eminent Persons on the Post-2015 Development Agenda (HLP) is one of the Secretary-General’s post-2015 initiatives created in response to his mandate from the 2010 MDG Summit to advance the United Nations development agenda beyond 2015. It is Co-Chaired by President Susilo Bambang Yudhoyono of Indonesia, President Ellen Johnson Sirleaf of Liberia, and Prime Minister David Cameron of the United Kingdom, and includes 27 leaders from civil society, private sector and government.

Its mandate is to provide recommendations regarding the vision and shape of a Post-2015 Development Agenda. This includes: key principles for reshaping the global partnership for development and strengthened accountability mechanisms; recommendations on how to build and sustain broad political consensus on an ambitious yet achievable post-2015 development agenda around the three dimensions of economic growth, social equality and environmental sustainability; and taking into account the particular challenges of countries in conflict and post-conflict situations.

On the 30th May 2013 the HLP published its report ‘A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development. The report outlines new priorities for development while also drawing on experience gained from implementing the MDGs, both in terms of results achieved and areas for improvement. It also contains an illustrative set of global goals and affiliated targets, however it is important to note that these are for demonstrative purposes only and have not been agreed upon by governments at the UN level. The HLP Report is one of several reports the UN Secretary-General will draw upon to create his own report on post-2015 which will be delivered Member States in September 2013.

When were the processes on the Post-2015 development agenda and SDGs initiated?

Post-2015 Development Agenda - Mandated by the 2010 High-level Plenary Meeting of the General Assembly on the MDGs (paragraph 81). Started activities in late 2011.

Sustainable Development Goals - Mandated by the UN conference on Sustainable Development (para 248) in June 2012. Started activities in 2013.

Who is leading these two processes?

Post-2015 Development Agenda - UN Secretary General.

Sustainable Development Goals - UN General Assembly through the Open Working Group on SDGs (OWG). The OWG has 30 seats which are shared by a group of 70 Member State representatives.

What are the expected outputs of the Post-2015 and SDGs processes?

Post-2015 Development Agenda - In September 2014 the Secretary General will share a synthesis report containing the full range of inputs on the post-2015 development for the consideration of the General Assembly. This report will provide the starting point for intergovernmental negotiations to define and agree the details of the post-2015 development framework, which will likely be defined by a set of global goals to eradicate poverty in the context of sustainable development.

Sustainable Development Goals -The OWG is mandated to present its final report to the General Assembly by the end of its 68th Session (September 2014). Its report should contain a set of SDGs that are universal, limited in number, aspirational, easy to communicate and address the three dimensions of sustainable development in a holistic manner.

How are stakeholders being engaged in the Post-2015 and SDGs processes?

Post-2015 Development Agenda - Several consultations have taken place, others remain on-going:

• 56 National Consultations
• Thematic Consultations
• UN Task Team on UN Post-2015 Development Agenda
• Sustainable Development Solutions Network Consultation
• UN Global Compact Consultations
• High Level Panel consultations:

Sustainable Development Goals - The SDG process is open and inclusive to all stakeholders. The primary official engagement mechanisms are thematic clusters, the SDGs e-Inventory, and morning meetings andintersessionals with the OWG on SDGs.

How will the inputs and recommendations of stakeholders feed into the post-2015 and SDGs processes?

Post-2015 Development Agenda - All official United Nations consultations will feed into the UN Secretary General’ synthesis report to be presented at the 69th General Assembly.

Sustainable Development Goals - The thematic clusters are a primary means for stakeholders to feed inputs and recommendations into the OWG. Currently, the steering committees of the thematic clusters are preparing joint position papers or briefs on 26 key thematic areas for the consideration of the Open Working Group. Interested stakeholders can contribute to the development of the position papers in the following ways:

• Comment and provide input on joint position papers
• Submit relevant material specific to the 26 key thematic areas

How will the Post-2015 and SDGs processes interact?

In September 2014, the SDGs and post-Millennium Development Goals deliberations will officially merge to form a new intergovernmental process to adopt the post-2015 development agenda, which will likely include one set of global goals to eradicate poverty in the context of sustainable development. This process will culminate in a high level summit in September 2015.

Choice Based Credit System

CBCS will not Suppress the Academic Liberal Environment of the Universities, Says UGC

The UGC has clarified that the introduction of Choice Bases Credit System will not in any way hamper the academic liberal environment of the universities. The University Grants Commission (UGC) has been endeavouring to facilitate the introduction of Choice Based Credit System (CBCS) for quite some time. It has made the guidelines for its effective implementation, which were uploaded in the month of November, 2014. The guidelines per se provide a template to the universities to design the CBCS according to their strength while keeping the overall uniformity amongst the universities.

The UGC in order to ensure fairness in assessment and evaluation has also given template of procedures to be followed so that the standards of education are equally maintained. Numerous communications have been sent to the Vice-Chancellors (VCs) of all Universities for effective implementation of the system. Eight Workshops have been held all over India in which VCs of all Central, State and Private Universities participated. The Vice-Chancellors of Central Universities, in the Conference held in February 2015, have given their commitment to the Visitor to implement the same from the academic year 2015-16. This system is already in vogue in numerous private universities and this is an endeavour of the Government of India to bring State Universities and Central Universities at par with international standards so that the pass outs of these universities are not at any disadvantage in comparison to the private universities.

To handhold the Universities, UGC embarked on an extensive exercise of designing curricula for undergraduate course which would assimilate with the provisions of CBCS. The syllabi by the experts have been put in the public domain for feedback and for subsequent modification before they are finalised. The syllabi so finalised will give leverage to the universities to modify the same to the extent of 30% (likely to be enhanced from 20% after feedback) depending upon their areas of specialisation. This is not deviation from the earlier practice where inter-university migration requires a minimum 70% equivalency as such implying that the syllabi all over India in undergraduate level are similar to the extent of 70%. Under the CBCS system the elective subjects so offered will only be from the subjects which are available in the Universities / Institutes. As such the teaching load of the teachers is not likely to increase beyond the norms stipulated by UGC. Also there will be no inter-institute/inter-college migration transfer of teachers. It also will not suppress the academic liberal environment of the university as nothing contrary has been suggested in the template of the syllabi so designed by the experts.

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Union Human Resouce Development Minister attends World Education Forum at South Korea

The Press Briefing on Union Human Resource Development Minister Smt Smriti Irani attending the World Education Forum (WEF) organized by UNESCO in Incheon, South Korea was held here in New Delhi today. The Union HRD Minister was in South Korea from 19th May to 22nd May 2015. The Press release was issued during the Press briefing which was addressed by the Secretary, School Education and Literacy, Ms. Vrinda Sarup. The Press Release on the World Education Forum organized by UNESCO which was attended by the Union HRD Minister is as follows:

The Human Resource Development Minister Smt Smriti Irani attended the World Education Forum (WEF) organized by UNESCO, in Incheon, South Korea. The WEF was a landmark of world education leaders, as they met to draw up the world’s education goals for 2030. The efforts of the world community to provide education for all which began at Jomtien, Thailand in 1990 and then in Dakar in 2000, had now gathered at Incheon, South Korea to shape the next stage of education agenda for the time frame 2015 to 2030.

Education 2030: Towards inclusive and equitable quality education and lifelong learning for all is the 4th Sustainable Development Goal as part of the new SDGs to be finalized by the UN in September 2015. The WEF expressed its vision to transform lives through education recognising the important role of education as a main driver of development and re-affirmed education as a public good, a fundamental human right and essential for peace, tolerance, human fulfilment and sustainable development.

The significance of the WEF 2015 is in that it seeks to focus the efforts of the nations on access, equity and inclusion, quality and learning outcomes within a lifelong learning approach, which recognises education as key to achieve development and poverty reduction. India through its Human Resource Development Minister played a key role in including in the Incheon declaration two very critical elements for further implementation of the Education 2030 goals. First, the Human Resource Development Minister played a leading role in ensuring that the Incheon Declaration and the Framework For Action emerging from it includes flexibilities for UNESCO member states. Smt Irani’s lead won resounding support from majority of the countries present and was duly adopted by the WEF i.e the member states have a contextualised strategy based on their national priorities, resources, capacities and challenges to attain the global benchmarks of Education 2030 in an incremental manner. The Framework of Action would respect the autonomy of member states to plan for and progressively develop annual, intermediate and accelerated targets for meeting the global benchmarks.

The Indian leadership and endorsement of the funding arrangement for the 2030 education goals through a commitment from the developed countries to contribute additional resources (0.7% of GNP) as development assistance to developing countries, especially the least developed countries won wide support and acceptance.

The Minister also participated as a panellist on the thematic debate -- Innovating through technology: Shaping the future of Education wherein the initiatives taken by India to integrate technology in the educational system for ensuring transparency and ease of delivery of educational services were highlighted. The Minister also informed about the portals like Know Your College and School Report Card that provided free critical information regarding educational institutions. The recent initiative of Shaala Darpan that leverages mobile technologies to ensure parents are connected to schools, enabling them to monitor the progress of their children was mentioned along with SWAYAM, the Indian MOOCS platform, and the e-Library and availability of IT-broadband infrastructure in Universities to ensure availability of free world class education for free to anyone interested in learning.

Smt Smriti Irani held several key meetings on the sidelines of the conference in support of the effort to build consensus on the Education 2030 target setting implementation arrangements and monitoring systems. Her initiative saw successful meeting of minds with the E-9 group of the most populous countries, the SAARC group of south Asian countries and the powerful emerging economies in the BRICs group.

With a view to jumpstart India’s commitment and resolve to the new global education agenda, she also held bi-lateral meetings with carefully selected countries with proven success in improving quality in education and learning outcomes, ranging from Japan, Norway, Finland, Brazil etc. for improved science and technology learning, research, teacher education, learning assessment systems and ICT for quality education. 

Summary of ideas posted in response to “Health System in India: Bridging the Gap between Current Performance and Potential” 26 May 2015

Original Article : https://blog.mygov.in/summary-of-ideas-posted-in-response-to-health-system-in-india-bridging-the-gap-between-current-performance-and-potential/

Thank you for your valuable comments on “Health System in India: Bridging the Gap between Current Performance and Potential”. There is a consensus for maximizing gains through strengthening the pillars of health systems. We have aggregated 347 comments received up to 7th May, 2015 into nine discussion themes, that will be launched shortly. You may view your contributions below.

Analysis of the content has revealed that 96% of the comments addressed strengthening the pillars of health systems as tabulated in Table 1.  Ten comments addressed individual diseases/conditions and were prioritized by participants. These are summarized in Box 1. 

Table 1. Thematic Analysis of Comments (in order of popularity)

S. No.	Themes	No. of Comments
1.	Human Resources for Health	87
2.	Service Delivery (i) Access, Continuum and Organization of Care (ii) Tertiary and Emergency Care (iii) Quality of Care (iv) Community Participation and Clients’ Rights	Total = 56 34 11 6 5
3.	Public Health	53
4.	Regulation of Drugs, Food and Medical Practice	46
5.	Stewardship and Governance	45
6.	Increasing Financial Resources	45
7.	Health Information Systems	33
8.	Availability of Drugs, Vaccines and Other Consumables	17
9.	Using Available Financial Resources  as a Tool for Efficiency	4

*42 comments were not related to the discussion

Box 1. Content relating to individual disease based strategies for bridging the gap between current performance and potential

1. Disease specific hospitals must be set up instead of multi-specialty hospitals.
2. There should be newborn screening for birth defects.
3. There should be access to affordable care for persons with disability arising due to accidents or genetic conditions.
4. There should be comprehensive strategies to address mental health problems.
5. There should be increased awareness about organ donation coupled with its facilitation by health professionals.

Summary of content under the pillars of health systems strengthening:

1. Human resources for health (HRH)
Perceived problems:
1. There is a lack of human resources for health, especially in rural areas. This may be attributed to factors such as the lack of services for family members of the health service providers and lack of suitable residential facilities for service providers; contractual employments at low salaries and high work-load. (5229241,5188741,5024261, 5022841, 5023141)
2. There is a high level of absenteeism of doctors in public health facilities, especially in rural and tribal areas. ( 5039641, 5034441)
3. There is a lack of utilization of available HRH qualified in alternate systems of medicine, with a strong bias against practitioners of these systems of medicine as compared to Allopathy. (5229241,5242661, 5189681, 5056101). Also for example, Ayurvedic doctors are barred from performing various procedures like dilatation and curettage, Incision and drainage, excision, and different contraceptive methods like insertion of IUCD (Intra uterine contraceptive devices) for therapeutic and diagnostic purposes (5189921).
4. There is a lack of regulation of medical and para-medical education with respect to cost of education, number of seats and quality standards. (5012041,, 5114421, 5033121, 5033381, 5093401, 5055421, 5055601)
5. There are certain fake institutions which provide degree/diploma similar to BAMS (5189761).
Suggestions:
1. Effective human resource management policy and principles must be in place, with a culture of professionalism, accountability and fairness. (5207261, 5246701, 5193141, 5210561, 5222961, 5129741)
2. The deficit of doctors must be fulfilled to provide a suitable doctor to patient ratio, especially in rural areas. (5198421, 5246621, 5049701, 5028861, 5012001, 5184881, 5029741, 5026301)
3. Expansion of medical college seats is required (5148081, 5092301); All States must be encouraged to set up a medical college and hospital at every district, possibly in PPP mode.(5033881) Alternatively, evening classes may be started in existing medical colleges to increase the number of students graduating each year (5039581). More investments must be made in setting up government medical colleges than private colleges. (5209121, 5207341)
4. Fresh medical graduates, post-graduates and existing Doctors should be incentivized to practice in public health facilities and in rural areas. (5188741, 5022841, 5024721) Measures suggested include:
1. Improve the availability of essential facilities (ex: education for children) to enable doctors to practice in rural areas.(5114421, 5229241, 5023141)
2. Provide an incentive for every year served in a difficult area. (5123161)
3. Rotation of postings may be undertaken so that those posted at districts are also posted at the periphery and district postings may be used as an incentive. (5114421)
4. MBBS and post graduate degree courses can be administered free of cost to students with a legal provision for compulsory rural service for 10 years. (5069461)
5. Regulatory measures: These should be made compulsory for medical students to serve in rural areas to obtain a degree/fresh graduates to serve in rural areas (5121421, 5048881,5031821, 5055081); mandatory for those studying in government medical colleges to serve in rural areas or alternatively, to compensate the government (5069461,                ; limiting admission to post-graduation to those with minimum years of rural practice (5190881); prescribing two years of service to post-graduates before conferring the degree at station of choice (5237301)
6. Internship period may be increased to two years with a regular salary paid in the second year for rural service; all graduates should have a rural internship (5030041, 5213981)
7. Encourage all private doctors to serve in a rural PHC at least once fortnightly. (5132001)
8. The pay-scale of government doctors needs to be improved so as to prevent them from turning to private practice. (5129741, 5029741)
9. There should be a strict policy for transfers. The State may be divided into regions and all doctors would be required to serve in each region for a given number of years. (5123161)
5. Utilize the services of practitioners qualified in AYUSH (Ayurveda Yoga and Naturopathy, Unani, Siddha and Homeopathy) to increase the potential of available human resources. Suggested measures include: bridge courses, exam conducted by Medical Council of India for certification of AYUSH doctors to provide services, internship period under MBBS doctors prior to engaging in allopathic service delivery, defining the level of integration of these services with Allopathic services. (5231421,5242661, 5190261, 5198481, 5082661, 5046561, 5032601, 5061901, 5024721, 5189821)
6. Integrate the vast network of informal health providers in the health workforce through development of a suitable engagement plan; Utilize the services of highly-trained non-physician health providers for the provision of services.(5246701, 5092541, 5061761 )
7. There should be a diploma course to develop medical practitioners who can serve as a first line of care in rural areas (5190761).
8. There is a need to increase availability of nurses and allied health professionals through establishment of a separate regulatory authority to ensure standards in education for the allied health professionals. (5012081)
9. Nursing and pharmacy colleges should tie up with large hospitals in the same and adjoining areas so students may receive training and subsequently contribute to service delivery at the health facilities in the area. (5204101, 5204121)
10. Number of doctors trained in Family Medicine should be increased in comparison to other specialties. (5190881)
11. Doctors providing preventive, curative and administrative services must be efficiently segregated so as to ensure competence at the given task. Administrative posts should not be occupied by highly qualified specialist doctors since this prevents them from utilizing their training appropriately.  (5208581)
12. The Indian medical curriculum should incorporate PHC management training module to ensure capacity building in this area. Alternatively, it is suggested to utilize manpower trained in administration and management within public health facilities to improve the functioning of these facilities. (5163701, 5026301, 5230881)
13. Reasons for the indifference, impatience of doctors towards patients, unwillingness to give sufficient time to each patient during consultation, must be evaluated and addressed. They could be trained to manage stress effectively, especially those working on government hospitals, wherein patient loads are high. (5048881, 5126801, 5088041, 5056801, 5018821)
14. Teaching standards in medical colleges require to be improved. (5056781, 5029741)
15. Regulation of medical education in terms of fee and system of donations in private medical college must be in place. Social audit may also be used to address retention of post-graduation seats in medical colleges. (5012041, 5114421, 5209121, 5033881)
16. Legal notices should be issued to fake institutions providing degrees (5189761).
17. There should be reservation of seats for rural students in Medical colleges whose parents live in villages so that after studying there would be interest to stay close to village and work in those areas (5186961).
18. Provide opportunities for grass-root workers to be promoted to top level posts instead of direct recruitment to top posts so that experience of working at the grass root level is effectively utilized. (5209541)
19. There should be transparency in recruitments and promotions that ensure meritorious students are placed without any corrupt influences. Measures suggested include a central portal to advertise vacancies. (5163701, 5193141, 5207421,)
20. Measures to curb absenteeism must be put in place, for example an account of attendance should be maintained and penalties may be imposed when a certain percentage of days absent has been crossed.  (5022841, 5123161)
21. Skill upgradation of health workers must be carried out regularly and effectively to increase productivity.


2. Service Delivery


1. Access, Continuum and Organization of Care
   Perceived problems:
1. Rural areas require the establishment and running of functional healthcare facilities. (5032221)
2. Existing public sector health facilities are not equipped to provide services to the population for lack of resources. Services are therefore unavailable to the poor. (5010881, 5029741, 5032221, 5036481, 5049701, 5050241, 5120061, 5120061, 5215381, 5099781, 5024261)
3. Available public health facilities do not have capacity for the large number of patients seeking health care services. (5006481, 5167181, 5246841)
Suggestions:
1. A well-established network of health facilities from village to higher levels must be set up, as per geographical factors and population density norms, with adequate resources of infrastructure, human resources and drugs and equipment, providing appropriate levels of health services (primary, secondary and tertiary). (5007741, 5031821, 5049541,5129921, 5153561, 5238161, 5230881  5092301, 5088861)
2. The capacity of existing health facilities require to be expanded for accommodating the large number of patients and reduce waiting times. (5006481)
3. The basic unit of health services, i.e. primary health centres and anganwadi centres must be strengthened first in order to develop a strong healthcare system. (5204061, 5026021)
4. A strengthened grassroots healthcare delivery system must be established comprising the primary health centre with health professionals at different levels including para-clinical, clinical, nurses and physicians  who would be responsible for health outcomes of the population and serve as the first point of contact for the community (5246701)
5. There should be efficient links for referral (with a compulsory referral slip to tertiary health facilities) from strengthened primary and secondary health facilities to tertiary health facilities to avoid duplication and crowding-out of these facilities. (5052581, 5114421)
6. Strengthened networks of primary health care must be integrated with secondary and tertiary care facilities with efficient gatekeeping mechanisms to prevent underuse of primary care and overuse of tertiary care, leading to duplication and crowding out of these facilities.  (5052581, 5061761, 5246701)
7. A suggested method of involving private sector in the provision of universal health coverage is through the organization of private sector health facilities into similar provider networks (primary, secondary and tertiary)  which must be a prerequisite for empanelment in such as system. Cost of care for patients is therefore at the level of the network and would similarly prevent irrational and excessive care and promote primary care and disease prevention. (5061761)
8. A rail-enabled mobile medical unit should be set up for providing health services to rural areas at the railway stations. These may be established for every district and may visit each rural station once in three months. The unit may be linked to the tertiary level hospital of the district for overall management of the service and referral of patients when required. Such as service would be of use in calamity struck regions as well. (5054761)
9. Dispensaries operated on the campuses by educational institutions should be open to the public to increase availability and access to services (such as the banks and post-offices on the premises). (5082621)


2. Tertiary and Emergency Care
Perceived problems
1. The condition of emergency wards in public hospitals is poor.(5048721)
Suggestions:
1. Tertiary level hospitals (providing AIIMS- like services) must be available in all districts/States for access to tertiary care services. District hospitals must be strengthened for this purpose. Capacity and location of these facilities should be adequate as per population and geographical need. (5061861, 5088861, 5208521, 5050241, 5167181, 5237481)
2. Capacities must be build to provide those tertiary level services in India that are currently unavailable. (5124561)
3. A policy for compulsory and immediate emergency care for victims of road accidents should be in place. (5208661)
4. A two-wheeler mobile medical ambulance should be introduced equipped to provide emergency care to accident victims in busy cities until the patient is transferred to a hospital.
5. Air ambulance facilities should be available in cities. Hospitals should be allowed to build helipads for such ambulances (5054761)
6. The need for doctors to wait for the police prior to providing emergency treatment to accident victims should be discontinued. Resident policepersons could be placed in all hospitals to ensure expediting the process.(5063541)


3. Quality of Care
Perceived problems
1. Patients do not have the right to quality of care at public health facilities/Quality of care in public health facilities is the most important concern. (5050241, 5023201)
Suggestions:
1. There should be a measurable standard for quality of care that includes components of patient safety, comfort, satisfaction and clinical outcomes. This must be coupled with systems to motivate providers and ensure adherence to the standards (incentives, capacity building, technical support and institutional arrangements for measurement and certification. (5246701)
2. A ranking system should be developed for all health facilities and this information must be available in the public domain. (5124761)


4. Community Participation and Clients’ Rights
Suggestions:
1. Community based monitoring and planning of health services (CBMP) has been proven to improve the performance of the public health delivery system by promoting accountability, responsiveness of services and peoples’ participation. Experiences in Maharashtra State since 2007 show improved performance by Primary Health Centres with CBMP in the areas of laboratory services, referral services, IPD, OPD and delivery services. (5234221)
2. A grievance redressal cell must be established in all district hospitals to receive complains regarding public and private health facilities (5114421)
3. A register for complains must be available for complains/ suggestions which can be made available online as well for direct access of the Health ministry. (5238161)


3. Public Health
Perceived problems
1. The diseases in rural areas are mainly because of lack of cleanliness (5025621).
Suggestions:
1. Health education and awareness programs and camps should be implemented (5006601, 5027521, 5052561, 5056841, 5129741, 5222961, 5201201, 5218001, 5190261, 5041361, 5238161, 5228541). Health education should be a part of school curriculum (5024081, 5131321, 5041361. Knowledge on household natural remedies and their usage should be included in the school curriculum (5056121).
2. There should be a focus on population control which will help in effective program implementation (5015061, 5018141, 5020141, 5021441, 5078261, 5074641, 5057081).
3. There should be a focus on cleanliness and basic health amenities (5025821, 5027521, 5029741, 5218001, 5184881, 5165881, 5228541)
4. There should be a focus on exercise, proper nutrition and yoga (5027521, 5101001, 5186041, 5184881, 5154021).
5.  There should be fortification of low cost food with nutrients (5049541).
6. There must be regular health check-ups for children in school (5068281).
7. Universal Health Screening should come before Universal Health Coverage and a list of high risk population of each block should be available to the local Medical Officer to act upon (5163701)
8. There must be mass screening for tropical diseases (5233841).
9. The Municipal Corporations should provide bed nets at subsidized rates for prevention of mosquito-borne diseases (5035401).
10. The strengths of alternate systems of medicine must be effectively utilized for health promotion and prevention of disease (5055341).
11. Waste management technologies should be encouraged (5218121).
12. Physical activity must be complemented with food based strategies for improving health outcomes. For example, the Carbon incentive for food energy, a performance based incentive mechanism (5187741).


4. Health Information systems (HIS)
Perceived problems
1. Existing telemedicine cannot scale up to entire rural India because of factors like connectivity and power issues, infrastructure, field implementation and cultural acceptability (5026641).
2. The lack of this single data standard prohibits interoperability between the many evolving information systems in the country (5246701).
Suggestions:
1. Information Communication Technology (ICT) should be effectively used to bridge the gap between performance and potential (5034441).
2. High speed broadband connections should be installed for use of these services in remote areas (5242861).
3. A first step towards a strong information system should be to develop one common data dictionary and strategies for compliance and integration across data sources. This will allow for triangulation of data, and many aspects of governance, monitoring, decision making can be automated. This will also guide more targeted audits (5246701).
4. There should be an integrated Health Management Information System for an area providing data  such as:  characteristics of area (number of villages, number of health facilities, population), different programmes (NRHM, RNTCP etc), health informatics on disease outbreak, health survey, inventory management, human resources (available number and trainings undertaken) (detailed formats provided by participant)(5068841).
5. Aadhar number should be provided to every child and effectively used for various services using HIS. Suggested measures include:
1. To create Electronic Health Records that will be beneficial for migrants to avail services (5012121, 5092301, 5154041, 5149061)
2. SMS alerts regarding vaccination, health camps should be sent to citizens (5054761).
3. To provide health schemes to those who actually need them
6. All records should be digitized in hospitals (5052541).
7. Hospitals should give a provision for obtaining online appointments (5198421)
8. E-Health records sharing should be with patients’ consent as to whether they want it to be shared with all health providers or by some specific providers. Alternatively, there may be a rule to maintain records via public hospitals only (5046821).
9. Rural telemedicine can be made effective by connecting villages to town doctors. Suggested measures include low black and white video-conferencing through internet kiosks, developing multi-parameter diagnostics with neurosynaptic and field deployment experiments with healthcare domain partners. These facilities will help address the deficit in rural doctors as well. (5026641, 5245601).
10. There should be use of internet and mobile technology to provide health related information in rural areas (5026021).
11. Proven innovations in the use of Information Communication Technology by States should be examined for adoption and scalability (ex: mobie kunji, a novel job-aid tool in Bihar). (5245601)
12. There should be a National Database of blood donors, state and city wise (5054261).
13. An independent National e-Health Authority is the best tool to bridge the gap between performance and potential. (5034441,5046821)


5. Regulation of Drugs, Food and Medical Practice
Perceived problems
1. Tie-ups between doctors and pharmaceutical companies makes treatment expensive due to over-investigation and over-prescription (5052061).
2. The sale of counterfeit drugs causes harm to patients (5052061). Such counterfeit drugs and those banned in different countries are being sold in a number of medical shops in our country without any regulation (5123941).
3. Unregulated rise in price of allopathic drugs leads to high levels of out of pocket expenditure for patients (5059281).
4. There is no regulation in the cost of services in the private health sector, for example:
• Surgeries in hospitals (5123941)
• Diagnostic tests and investigations (5012221)
5. There is no regulation on the malpractice done by Medical Officers in Govt. and Private setting (5114421). For example, some government doctors shift to private practice and popularize private hospitals (5227721).
6. Malpractices by doctors are observed such as:
• The doctors in the hospitals refer patients to their clinics (5048721)
• The doctors ask patients for costly tests from their recommended pathology laboratories/ diagnostics (5048721)
7. No rate list of procedures and services provided in nursing homes and/or hospital is available to the public (5114421).
8. The doctors do not provide a diagnosis to patients (5158921).
9. There is no implementation of regulation that prevents liquor shops operating near schools which is detrimental to health behaviours among young populations (5017861).
10. Adulteration of foods remains a problem (5099221).
11. There is cartelization in tenders for health services through powerful suppliers (5039741).
Suggestions:
1. The government must insist on drug prescriptions bearing only generic names (5012181).
2. The pharmaceutical companies need to be better monitored to lower cost of medicines (5062221).
3. With the increasing antibiotic resistance, there needs to be strict guidelines issued for prescriptions and dispensation of antibiotics (5062281, 5123161).
4. The medicines should be sold only through a bar code system. The bar code will have all the details of the medicine including its ‘MRP’ price and expiry date. This will avoid any human error while selling the medicine (5063701, 5066821).
5.  The medicines should be supplied only based on prescriptions of clinic/hospitals, not over-the-counter. (5067861).
6. Medicine distribution should only be made on required dose (5091421).
7. Regulation of cost of medicines, investigations and doctor consultation services is required to make them affordable (5213981, 5123161, 5149321,5028581, 5049721 ). Cost of all services should be nominal in all government hospitals (5020021). Details of charges should be put up in all the corners of the hospitals and clinics, so no extra charges are taken from poor/needy by corrupt intermediaries/staff. (5020021)
8. All hospitals should be brought under a hospital board with yearly audit of medical practice (5012221).
9. There must be surprise inspections in hospitals (5020061)
10. There must be a provision where action can be taken against doctors who refer patients for unwanted investigations (5028581).
11. Every patient should be given receipt by the doctor for the fee taken (5028581).
12. There should be reservation for poor patients in private hospitals (5049721).
13. All cases involving negligence by the MO should be investigated by a committee of retired senior medical doctors and a bureaucrat ruling out any conflict of interest. Time line has to be set up for completion of enquiry into the matter and on proven guilty, license of the medical officer to practice and the institution should be cancelled for a period depending on the severity of case (with a minimum of one year) (5114421).
14. Regulations under Nursing home act/ Clinical Establishments Act should be strictly implemented (5114421).
15. A policy on regulation of private sector must be put into place through consultations with relevant stakeholders. (5210541).
16. There should be a policy for safeguarding medical professionals from unreasonable patient demands.  (5188761).


6. Stewardship and Governance
problems
1. Corruption hampers the enforcement of budget allocations. (5010881)
2. There is lack of cooperation by various departments when public grievances are sent to them. (5020761)
3. Lack of trust in healthcare providers plagues both the public and the private sectors (5246701).
4. The health services in India are suffering because of lack of management (5207021)
5. There is corruption involved in the distribution of medicines (5140021). Government procured medicines are sold to the chemists. (5224741)
Suggestions:
1. Governance and accountability mechanisms should be in place to minimize gap between performance and potential, illustratively:
1. Social audits (5243981, 5011261, 5246701,5169841)
2. Autonomy to public health facilities may be provided to increase accountability for outcomes. Turkey made reforms where primary care providers were made autonomous and held accountable for outcomes (5246701).
3. The state is responsible for assuring the provision of services provided and for monitoring these services. This separation between service delivery and accountability will ensure a professional focus for each. At the governance level, such a system would entail the creation of an autonomous unit that can provide stewardship, oversight, financing, and overall execution of the health system. This unit would be responsible for contracting with private and public providers and ensuring that these providers are regulated effectively. Governing units should also include representation from relevant ministries, independent technical experts, and the community. (5246701)
2. There should be an end to corruption in all hospitals to improve medical facilities, so the citizens can also trust them (5198421, 5179781, 5140021).
3. Tighten the auditing of expenditure accounts which is likely to ensure catching pilferage of resources for personal gain by the administrative staff associated with all Central/State government funded hospitals (5242521).
4. There should be strong administration that should cater needs of every patient at general hospital (5208521).
5. There is a need for provision of basic amenities like clean drinking water. The water resources must be safeguarded from contamination by sewage. All cities and towns should have sewage treatment plant, preferably run by private with some incentive methods or under CSR (5024041, 5025821, 5222881, 5218001).
6. There is an urgency to create public toilets (5027061).
7. Self help groups should be made at Anganwadis to create health awareness (5047441).
8. The quality of mid day meals should be improved (5049701).
9. Associated Ministries should work with the Ministry of Health to improve the condition of water and sanitation and address pollution (5052061).
10. Decentralized, state specific policies to improve health parameters as per local need should be adopted (5006381).
11. There should be increased focus on horizontal integration of programmes with a shift away from vertical planning and implementation of programmes. (5246701, 5245601)


7. Increasing Financial Resources
Perceived Problems:
1. Every year a significant number of people die due to financial scarcity for health (5007441).
2. Existing health insurance schemes are limited in their use to the public. The insurance premiums are low just for sake of competition but the coverage is very limited. Hence there are no benefits to the Insured (5063421).
Suggestions:
1. Affordable health insurance should be provided to all the families especially in rural areas where the poverty levels are high and health facilities weak (5006581, 5010881, 5052561, 5067861, 5108241, 5129741, 5219861, 5183901, 5231421). There should be a low premium health insurance scheme (5029781).
2. It would be better to increase the premium and also its coverage. The Health insurance has to be liberal in coverage (5063421).
3. There is a need for a health savings account to decrease sudden out-of-pocket expenditure on health (5007441, 5071321, 5233221).
4. A nominal amount can be deducted from Jan Dhan account for health (5007221).
5. Diversify and expand funding pools for prepaid health coverage, and target subsidies to the poor (5246701).
6. There should be co-payment for patients for treatment and services used (5231781).
7. There should be ‘Sin’ tax on non-essential health items such as tobacco and alcohol to increase resources for health (5231781).
8. The government should promote corporate social responsibility in various areas for increasing availability of resources. (5091221, 5121421, 5163701, 5012041). We should organize health events from health organizations globally to increase resources (5052561). There should be a provision that each private hospital should contribute towards public health system and resources can be shared on a well defined line of action without financial commitments (5017041).
9. Public-private partnership model should be implemented for establishment of hospitals and other needs in health sector (5031821, 5007741, 5212301, 5246841).
10. The government should organize educational camps to earn money (5091221).


8. Availability of Drugs, Vaccines and Other Consumables
Perceived Problems:
1. There are no dispensaries in remote locations (5010881).
2. Many medicines not available in government stores as per Log Books (5034441). The pharmacies in public hospitals do not have all medicines, requiring patients to purchase drugs at higher cost from private medical stores (5048721, 5048721).
Suggestions:
1. Medical equipments/healthcare products should be locally manufactured to decrease expenditure on these devices. (5012261, 5023621).
2. There may be a provision for government medical shops for below poverty line population (5025221).
3. There should be a provision to open medical shops providing generic medicines in rural areas (5035081).
4. There should be provision for increased production of medicines and health products (5246621, 5184881).


9. Using Finance as a Tool for Increasing Efficiency
Suggestions:
1. NITI Aayog can play a catalytic role in designing incentives that the central government can offer to the states to allocate more resources to health, through mechanisms such as matching contributions, incentivizing states to pursue health sector reforms and policies aimed at greater transparency, improved governance, and health system strengthening (5245601).
2. The center can also seek to maximize efficiencies of scale by focusing central resource spending on public goods in health that have cross-state value – such as disease surveillance, vector control, immunization – and also by financing essential commodities like vaccines, drugs, diagnostics etc. that might benefit from pooled procurement/rate negotiation (5245601).
3. The Government has set in motion the institutional changes necessary for implementing co-operative federalism, redesigning many of the centrally sponsored schemes. This presents an opportunity to direct central funds that can cater specifically to the needs of high priority districts (5163701).