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Why 2 Mbps is not sufficient for telemedicine in rural India?

The COVID-19 crisis has changed how people access medical care and has ushered in the new era of telemedicine. Almost overnight, patients stopped going to hospitals and are, instead, receiving medical care through various online platforms.

New Delhi-based Sitaram Bharti Hospital immediately started telehealth consultation service and emergency ambulance service as soon as the Government of India announced nationwide lockdown due to COVID-19 outbreak. Likewise, Aravind Eye Care Systems in Madhurai could set up a make-shift telehealth consultation option on their hospital website in just two days. On 22 March, a team of 18 doctors at Aravind Eye Care Systems was ready to take the patients’ calls from six different locations across South India. The high number of patients who wanted telehealth consultation service resulted in the hospital setting up parallel windows in each of their eight branches using Google Hangout. It was a right move in the anticipation of a bigger lockdown that was announced a couple of days later. Similarly, Nagarajan Ramakrishnan, a sleep medicine specialist, and director at Nithra Institute of Sleep Sciences, Chennai, is also treating his patients remotely.

At a time when physical distancing is among the major measures used to fight COVID-19 pandemic, face-to-face consultation poses a very serious risk to both patients and doctors. Under these circumstances, remote consultations over the phone or video calls is a new way to help patients get access to healthcare services. On 25 March, the Government of India issued a set of guidelines for telemedicine or remote delivery of medical services [1]. The guideline legitimises the practice of remote consultations.

This is the situation of the urban scenario where telehealth consultations are available and have enough internet bandwidth to extend their capacity for such consultations. But what about rural India that needs healthcare services the most? Are the health centres in rural India with limited healthcare resources providing telehealth facilities during COVID-19?

First, it is important to understand the structure of the rural public health system. It is a tiered structure. At the bottom of the pyramid are health sub-centres, catering to a population of 3,000 to 5,000 each, covering roughly five villages. These health sub-centres are usually manned by an Auxiliary Nurse Midwife (ANM) whose focus is on primitive and preventive healthcare services and to act as a referral to the primary health centres (PHCs) for curative services. PHCs are the first base for doctors, acting as referral units for six health sub-centres. PHCs act as a core and connected to community health centres (CHCs), followed by sub-district and district hospitals. There are over 1.5 health sub-centres, 25, 000 community health centres and 5000 public health centres in India. At the apex, there are medical colleges and advanced research institutes such as the All India Institute of Medical Sciences.

This tired structure looks impressive at first glance; however, the system is broken for large segments of the Indian population. According to Rural Health Statistics by the Ministry of Health & Welfare Services[2] only 11% sub-centres, 13% PHCs and 16% CHCs meet the Indian Public Health Standards. Moreover, a doctor-patient ratio is 1:2000 in India, according to the World Health Organisation (WHO). This means that six lakh villages where 70% of India’s population lives, the number of doctors is only a fourth of those in urban areas.

Thus, in times of COVID-19 crisis, adopting virtual healthcare approaches in rural health centres is essential. However, telemedicine is still a struggling concept in the countryside and even district-level healthcare centres are not able to do so.

Ostensibly, the National Teleconsultation Centre (CoNTeC)[3], an acronym for COVID-19 National Teleconsultation Centre launched by Union Minister of Health & Family Welfare Dr. Harsh Vardhan on 28 March 2020, is not meeting the requirements fully. CoNTeC has eight regional zones, establishing internet connection between medical colleges connected through the National Medical College Network (NMCN) with its National Resource Centre located at SGPGI, Lucknow. Presently, 50 medical colleges are registered under NMCN. It is reported that these medical colleges are connected through the National Knowledge Network (NKN) to provide telemedicine facilities.

However, these medical colleges are not connected with district hospitals and CHCs, which are located in the rural parts of the country. With 159 internet service providers in India, the broadband penetration in rural parts of the country is yet less than 16%, according to TRAI.

According to the Indian Public Health Standards (IPHS) for PHCs, CHCs, sub-district and district hospitals, the internet connectivity is provided for MIS (Management Information System)[4] and not telehealth services. The minimum internet speed allocated to district health centres is 2 Mbps to connect the doctor with the patient via video call. But this also is not available in most of the villages. As a result, the video quality turns out to be bad when district doctors try to connect with patients or health staff members. It thus becomes difficult to organise telehealth consultations. 2

Different sets of healthcare applications need different connection speeds. Table 1 below provides some applications that represent samples of activities typical of healthcare facilities of approximate download times to complete the transmission and download times at different network speeds. Individual healthcare facilities may use all, some, or none of these in addition to other network uses required for their operations (Hu, Wang, & Wu, 2006)[5].

Table 1. File size, transmission and download times at different connection speeds

 File type and size Network transmission speed
Type Size 4 Mbps 10 Mbps 20 Mbps 50 Mbps
High Definition Video

Conferencing

1.9 MBs 23.8

seconds

9.5

seconds

4.8

seconds

1.9

seconds

Tele-Pathology 3 MBs 2.3

seconds

0.9

seconds

0.5

seconds

0.2

seconds

Tele-Diabetic Retinopathy

Screening

5 MBs 6.2

seconds

2.5

seconds

1.2

seconds

0.5

seconds

Mammography 160 MBs 5 minutes 2 minutes 1 minute 24.4 seconds
MRI study 200 MBs 6.3 minutes 2.5 minutes 1.2 minutes 30.5 seconds

According to the Federal Communications Commission (FCC) recommendations, the following minimum bandwidth speeds are required to support electronic health record (EHR) system (Table 2) [6].

Table 2. Recommended bandwidth for healthcare providers

Healthcare service Bandwidth speed Services
Single Physician Practice 4 Mbps
  • Supports practice management functions, email, and web browsing
  • Allows simultaneous use of electronic health record (EHR) and high-quality video consultations
  • Enables non real-time image downloads
  • Enables remote monitoring
Small Physician Practice

(2-4 physicians)

10 Mbps
  • Supports practice management functions, email, and web browsing
  • Allows simultaneous use of EHR and high-quality video consultations
  • Enables non real-time image downloads
  • Enables remote monitoring
  • Makes possible use of HD video consultations
Rural Health Clinic 10 Mbps
  • Supports clinic management functions, email, and web browsing
  • Allows simultaneous use of EHR and high-quality video consultations
  • Enables non real-time image downloads
  • Enables remote monitoring
  • Makes possible use of HD video consultations

 

Tables 1 and 2 clearly indicate that a 2 Mbps connection is not sufficient enough to provide all sorts of telemedicine services such as tele-radiology, tele-surgery, tele-ophthalmology, tele-pathology and tele-ICU services. The absence of infrastructure, internet connectivity, and lack of sufficient technical staff members and medical personnel have impeded the progress of telemedicine in rural parts of the country.

Stimulation wireless network model for telemedicine facility in rural health centres

One way to deal with the bandwidth issue is to create a wireless mesh network that can connect three to five medical colleges with a district health centre. The topology of the network requires that every terminal be connected to every other terminal in the network. The topology incorporates a unique network design in which each hospital on the network connects to every other, creating a point-to-point connection between every device on the network. The purpose of the design is to provide a high level of redundancy. If one network cable fails, the data always has an alternative path to get to its destination and the district health centre and replicating it further to CHCs and PHCs.

Another approach could be to estimate the unused bandwidth available in the region which can further be used for connecting district health centres. Depending upon the availability of the network, different models can be adopted.

Other suggestions that the government can consider are to allocate high-speed wireless frequency band of unused spectrum (V band or 60 GHz, which is like short-range wireless optic fibre) and TV White space for the telemedicine facility and to be used for community services.

To sum up, the coronavirus crisis has made the need for high-speed, reliable internet clear. The current isolation period is a gentle reminder to authorities concerned about the necessity of an adequate internet connectivity and higher bandwidth in rural India that can potentially connect us and enable us to have a better healthcare facility all the time.

References

[1] Telemedicine Practice Guidelines; https://www.mohfw.gov.in/pdf/Telemedicine.pdf
[2] Rural Health Statistics; https://www.thehinducentre.com/resources/article31067514.ece/binary/Final%20RHS%202018-19_0-compressed.pdf
[3] National Telemedicine Portal; https://nmcn.in/about.php
[4] Indian Public Health Standards; https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=971&lid=154
[5] Hu et al. (2006). Mobile telemedicine sensor networks with low-energy data query and network lifetime considerations. Mobile Computing, IEEE Transactions on, 5(4), 404-417; 10.1109/TMC.2006.1599408
[6] HealthIT.Gov; https://www.healthit.gov/faq/what-recommended-bandwidth-different-types-health-care-providers

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Why India need low-cost and high-bandwidth connectivity models in a time of isolation?

The World Health Organisation (WHO) declared COVID-19 as a global pandemic on March 11, 2020, with growing cases getting detected in over 100 countries globally. Subsequently, WHO pushed to take ‘aggressive’ on 17th March 2020 action fearing that some countries may be moving towards community transmission.

To date, 30th March 2020, there are more than 700,00 COVID-19 cases and more than 35000 deaths are reported[1]. The director-general of WHO, Tedros Adhanom Ghebreyesus in conference stressed the vulnerabilities to be faced by ill-prepared ‘weak’ countries that have poor public health systems. South Asia has seen a total of 2000 cases as of 30th March 2020 and over 1100 cases are registered in India.

The steady rise of COVID-19 cases is a huge concern for South Asian countries due to a lack of public health infrastructure and the limited availability of professionals. It can strike a crisis of very high magnitude. In response, governments, corporates, and academic institutions have not only cancelled the public events and gatherings but also closed public spaces including museums, restaurants to avoid the highly contagious pneumonia-like disease to spread from one person to another.

On March 25, the government of India announced nationwide 21 days lockdown till 14 April 2020 closing schools, offices and public transportation. In the scenario of isolation, internet connectivity has never been so important. It is critical to receive up-to-date health information and students must continue their education and working professionals to continue work from their home.

Following the footsteps of Harvard and MIT, Indian academic institutions, including IITs and IIITs also started holding virtual classrooms due to suspension of face-to-face classes. However, slow-speed and irregular connectivity are emerging issues for educational institutes before they even start online classes. For instance, Delhi University professors who are trying to conduct online classes faced the issue of connecting their students[2]. V. Sridhar, Professor at the Centre for IT and Public Policy at the International Institute of Information Technology Bangalore (IIITB), India states even though he has two fixed-line broadband services and 4G enabled mobile connectivity, yet he feels annoyed due to miserable internet connectivity available in the country. The poor status of network infrastructure in the country is amplified due to the exponential demand for connectivity at the household level. This is a scenario of metro cities like Delhi and Bangalore, where institutions like IITs and IIITs are facing the connectivity issue.

India stands at 128 out of 140 listed countries in mobile broadband, according to Ookla Speed Test report[3]. It is even behind some of the South Asian countries, including Pakistan and Sri Lanka and African countries such as Ethiopia and Senegal. Whereas in fixed broadband, the country stands at 69 out of 176 listed countries giving average speed 39.65. India has 19 million fixed-line broadband users which include enterprises and offices and 17 million home fixed-line broadband users.

If we take a closer look at the public infrastructure that is required to be connected with internet connectivity in India. There are 15 lakh schools in the country, out of which over 8.5 lakh schools are located in rural regions. There are over 1.5 health sub-centers, 25000 community health centres and 5000 public health centres in India. Around 20% of rural regions of the country are connected through the internet and most of them are connected through mobile connectivity.

In the time of isolation when we are avoiding cash-payment systems, the lack of proper digital infrastructure including mobile connectivity and broadband communications to a large proportion of the populace makes it more difficult to address authentication challenges, card security infrastructure and last-mile connectivity of Point of Sale (POS) terminals.

Moreover, in this pandemic when thousands of migrant workers are going back home in rural regions of the country, the questions arise whether they will be able to educate their children if schools are closed and not connected through the Internet and able to get basic health facilities or medicines.

The telecom networks that support voice, telephony and broadband data services are critical infrastructures for the country like India much like electricity, water, sewage and road networks. Most of this critical telecom infrastructure is built by private firms using their capital. Though, telecom providers such as Vodafone, Airtel, BSNL, Reliance Jio to activate intra-circle roaming (ICR) and also offering increased bandwidth or data plans to maintain seamless connectivity. It is not only the major telecom providers who are seeing the data traffic spikes in their network but small operators including cable operators’ network are seeing a significant spike in data traffic and demand in new connections. However, as the data traffic will increase it will not be sufficient to cater to the demand.

The situation, however, again highlighted not only the need for deep fiberisation across the country to connect towers but also the need for small community-based network solutions to connect the communities living in far-flung areas of the country. It is the requirement of time when we need an integrated model of centralised and decentralised community-led networks, which operates in both intranet and internet methods.

There are very few community-led social enterprises working for designing or deploying wireless networks catering to rural parts of the country. AirJaldi in Dharamshala, Digital Empowerment Foundation (DEF), GeoMesh Informatics in Tamil Nadu, MojoLab in Dehradun, Uttarakhand, Janastu in Tumkur, Karnataka and GramMarg in Pathardi, Maharashtra are organisations which are providing low-cost internet connectivity, enabling access to information for citizens, particularly living in rural and remote areas. These community-led network solutions are using low-cost wireless devices and unlicensed spectrum bands 2.4 GHz and 5.8 GHz to create community-owned and community-operated wireless networks.

These network providers are using different bottom-up approaches such as generating locally-created content, innovative pricing and marketing approaches to content are gaining traction, providing digital services to information services to sustain these networks. These networks are trying to provide affordable, ubiquitous and democratically controlled internet access in rural regions of the country.

For instance, GeoMio Mesh wireless node that connects the unconnected in the rural villages and power healthcare, education and security with modular software and services. Using two 5GHz radios and sector antennas, GeoMesh is an indoor/outdoor weatherproof 3-radios wireless mesh router that automatically forms a mesh network with another Geo Mesh router within range. GeoMio Mesh creates both intranet and internet networks. It automatically creates hot-spot using the 2.4 GHz radio and creates the local (intranet) network. Thereafter users can easily connect to the local network and if any router on the local network connects to other networks such as the Internet, then users on that local network automatically get access to the Internet through the mesh. Each mesh can relate with the others easily, including peering, allowing users of each network to reach the other network and can transit to get to other networks through one of your neighbours.

Whereas DEF’s Wireless for Communities (W4C) uses 2.4 GHz and 5.8 GHz unlicensed spectrum bands and low-cost wireless devices in the hub and spoke model. In the last nine years, the programme has adopted various models of engagement, ranging from the Hub-and-Spoke and Wireless on Wheels to and Internet-in-a-Box set up. These models have established 178 access nodes in 35 districts across 18 Indian states, engaging men and women equally for its installation and management. Thus, ensuring the social sustainability of the wireless community networks.

Similarly, AirJaldi started as a social, non-profit enterprise established in Dharamshala, Himachal Pradesh, to provide affordable and reliable Internet connectivity using unlicensed spectrum and wireless networks in rural communities. Gram Marg, an incubation of the Indian Institute of Technology (IIT) Mumbai, uses TV white space and now Wi-Fi to provide Internet connectivity in 13 villages of Maharashtra. DEF uses low-cost wireless technology, unlicensed spectrum bands—2.4GHz and 5.8 GHz—and line of sight to support the provision of affordable, low-cost and reliable Internet services in 38 districts of the country.

Connectivity, when combined with the Wi-Fi information hub and spoke model, can help to empower communities and bring holistic development. If people have access to broadband and adequate bandwidth, they could pursue distance education through video conferencing, able to share their local indigenous content with a larger audience. By delaying access to the Internet and not enabling communities with high-speed internet connectivity, we are constantly underutilizing our potentials and, consequently, delaying economic prosperity.

It is high time for the government to take a broader decision on the health of the telecom industry, thereby need to have a new policy for rural ISPs, which can focus on serving underserved communities. Rural ISPs that can become sustainable and commercially viable entities that offer internet connectivity, digital literacy, and other digital services at prices that the bottom of pyramid consumers can afford. The situation of isolation is a polite reminder to have adequate internet connectivity and higher bandwidth that can potentially connect us and also provide economic and business continuity to some extent.

Author: Ms. Ritu Srivastava, representing Jadeite Solutions, has over 14 years of experience in the development sector specifically focusing on the ICT domain, using digital technology towards sustainable development of underprivileged communities / marginalised sections of society and over 8 years of experience in working with community networks.

 

[1] https://www.worldometers.info/coronavirus/#countries

[2] https://www.outlookindia.com/newsscroll/covid19-internet-speed-connectivity-emerging-as-challenges-in-holding-online-classes-du-professors/1785213

[3] https://www.speedtest.net/global-index

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Tribal Health in India

Tribal Health in India

by Dr. Sunil Kumar

Tribal population is an important segment of India’s population living in different parts of the country. One-third of the world’s tribal and indigenous population, which is, more than 104 million tribal population live in India (Census 2011). Perhaps, they are the only native inhabitants of in the country.

There are 705 different tribes, which constitute 8.6 per cent of the total country’s population. Odisha has the largest number of notified Scheduled Tribe (62), followed by Karnataka (50) Maharashtra (42) and Madhya Pradesh has the 4th place with 43 notified tribes.

Figure1
Source: Report of the High-Level Committee on Socio-Economic, Health and Educational Status of Tribal Communities of India 2014

As far as concentration of ST population is concerned, Madhya Pradesh has 14.7 per cent (over 153 lakh) of total ST population, which is the largest concentration of ST population in terms of numbers in any Indian state,  followed by Maharashtra (over 10 million), Odisha and Rajasthan (over 9 million each).

Figure 2
Source: Report of the High-Level Committee on Socio-Economic, Health and Educational Status of Tribal Communities of India 2014

The concentration of tribal population mainly located in different regions in the country. Predominantly, it was highly concentrated in North-Eastern region apart from the numbers, Mizoram has 94.43 per cent tribal population in the state, followed by Nagaland (86.47%), Meghalaya (86.14%) and Arunachal Pradesh with 68.78 per cent tribal population.

Figure 3
Source: Report of the High-Level Committee on Socio-Economic, Health and Educational Status of Tribal Communities of India 2014

However, Lakshadweep was leading in tally with 94.80 per cent tribal population but its actual representation is less than 65 thousand in numbers, whereas Mizoram’s tribal population was more than 10 lakhs.

Tribal Health

Tribal people in India commonly called as Adivasi, the term Adivasi made up from two words Adi (from the beginning) and Vasi (inhabitant), derives from the Hindi, which means a set of people or group living from the beginning. There are few other terms as Vanavasi (“forest dwellers) or Girijan (“hill people”), by which tribal people identified.

The above terms to tribal population given on the bases of their primitive existence and geographic location of inhabitation. Forest and hilly region are the favourite place for the tribal population; they largely associate with forest ecosystem and try to fulfil their need and requirement within the same. Out of total tribal population (104.30 lakhs), only 10.03 per cent living in urban area, an overselling majority of the tribal population (89.97%) still living in the rural and remote periphery, as per Census, 2011.

In many ways, the tribal population in India struggling with many development indicators. Altogether, 40.6 per cent ST population lived below the poverty line as against 20.5 per of the non-tribal population in the county, by and large poverty is main obstacle to get quality health services, accessibility to health services are second. Tribal population largely filed to manage at both the fronts.

 

Health Indicator among tribal population

Largely, statistics on the health conditions of different tribal communities are not available, whatever the data available evidencing the health status of Scheduled Tribes is available at the aggregate level.

IIPS conducted a study, in which they estimated the life expectancy of the tribal and non-tribal population in India, shows ST population in India has 63.9 years, as against 67 years life expectancy for the general population. The Rapid Survey on Children 2013-14 reveals that more than 30 per cent ST women get married before they turn 18. It is much noticeable that near about 50 per cent adolescent ST girl (between 15 to 19 years) are underweight and high prevalence anaemia cause to death for 17 to 46 per cent of maternal cases deaths. According to NSSO 2014, 27 per cent of tribal women still delivers at home, which is the highest among all population group.

Figure 4
Source: Tribal Health in India-2018

Figure 4 shows, 40 per cent illness happen to tribal population due to some or other type of infection, followed by respiratory diseases (18 %), Non-communicable and Musculoskeletal diseases (10 % each). Mental illness and neurological disorder (5%) also increased significantly in the tribal population.

Malaria usually transmitted the bite of an infected Anopheles mosquito and it is a life-threatening disease. The 20 per cent of country’s population living in tribal, hill, hard-to-reach or inaccessible areas, constitute almost 80 per cent of malaria case. India accounts for 8 per cent of the tribal population and contributes to 30 per cent of malaria cases.

Animals Attacks

As, it is already discussed in the inception of tribal health that they are inherently habitant of the forest ecosystem, where chances to conflict with the animals are always higher. India has highest snakebite mortality in the world, which is between 45 to 50 thousand annually or about 125 people per day.

 

Health infrastructure

In India, there are 0.7 physicians per thousand people and a majority of the Indian need to travel about 20 km to access the services of the hospital. As per the Ministry of Health, there are around 6 to 6.5 lakh medical practitioners available in India, which need to be double by 2020 to maintain the required ratio of one doctor per thousand population.

Figure 5
Source: Rural Health Statistics 2017 as analysed by NHSRC
*Shortfall means ‘required’

Figure 5, shows that there is a shortfall of 6646 sub-centres in tribal areas across the country.   More than 12 hundred PHCs need to establish and at least 300 other CHCs will be helpful to cater the need tribal population in India.

Figure 6
Source: Rural Health Statistics 2017 as analysed by NHSRC
*Shortfall means ‘required’

As far as a shortfall of human resources is concerned, figure 6 shows that there were 85 per cent specialists lacking at CHCs in tribal areas until the year 2007, which is not decreased much (82.30%) in 2017. The need for specialists at CHCs almost similar across India during the year 2017. There was a need of 50 per cent Staff Nurses at PHCs and CHCs in 2007 in tribal areas, which subsequently reduced to 27.90 per cent. In the corresponding category, they need 20.20 per cent of staff nurses in all India in 2017.

 

As per the Report: Tribal Health India-2018, following ten burdens of tribal health in India

  1. Communicable diseases, Maternal and child health problems and malnutrition continue to prevail
  2. Non-communicable diseases including mental stress and addiction are rapidly increasing
  3. Injuries due to accidents, snake and animal bites and violence in conflict situations
  4. Difficult natural conditions arising due to geographic terrain, distances and harsh environments
  5. Worse social-economic determinants, especially in education, income, housing, connectively, water and sanitation
  6. Poor quality and inappropriate health care service with low access and coverage, low output and outcomes
  7. Severe constraints in health human resources at all levels; the professionals from outside are unwilling to serve in tribal areas, and the local potential human resources are not trained and utilized by the health system.
  8. The legitimate and needed financial share for tribal health not allocated or used in most of the states. There is a lack of transparent accounting of the actual expenditure of tribal health.
  9. Lack of data, monitoring and evaluation that masks the above-mentioned problems.
  10. Political disempowerment of tribal people from the individual to the national level that exacerbates these problems. There is little inclusion of tribal people in the planning, priority setting and in execution.
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CSR funds and social development in India

CSR funds and social development in India

The roots of Corporate Social Responsibly (CSR) are much deeper than the inception of section 135 of the Companies Act, 2013, which known as Corporate Social Responsibility Policy. This act governed to certain companies, which qualify to such conditions as mentioned under Sub-Section 1 of Section 135 to comply mandatory Corporate Social Responsibility to solve India’s complex issues of development.

The term ‘CSR’ can also be understood as a corporate initiative to assess and take responsibility for the company’s effects on the environment and the impact on social welfare. CSR should not be seen as a charity or mere donations, it is also a way of conducting business by which an organization understand and evolved its relationship with stakeholders for the common good, and demonstrate its commitment by adopting appropriate business process and strategies.

CSR applicable for the companies, whose;

  • Net worth of INR 500 crore or more

Or

  • Turnover of INR 1000 crore or more

Or

  • Net Profit of INR 5 crore or more during any financial year

As per the data available on the website (https://csr.gov.in/CSR/) designed to disseminate Corporate Social Responsibility related data and information filed by the companies registered with it, shows that rupees 13465 crores spent during the year 2016-17 on different developmental projects under CSR head. This amount was less 901 crore which spent under same head last year 2015-16.

Figure 1
Source: https://csr.gov.in/CSR

As far as register companies with the website are concerned, figure 2 shows that more than 21 thousand companies were registered with portal during the year 2015-16 which subsequently declined to around 20 thousand companies in next financial year.

Figure 2
Source: https://csr.gov.in/CSR

Out of total register companies (19933) to the portal, only 12 per cent (2347) companies are listed and available of trade on the stock exchange. There are a majority of companies still unlisted to stoke exchange and contributing to CSR funds.

Figure 3
Source: https://csr.gov.in/CSR

Figure 3 shows, more than 21 thousand CSR projects were running in different states and UTs in India under 29 different development section during the year 2016-17. Despite decreasing spent CSR and registered companies, the number of running CSR project regularly increasing every financial year. This clearly shows, the projects are unentrapped in the development sector and have significant liquidity in the sector.

The finance minister of India, Mr Arun Jaitley himself announced recently that CSR funds worth rupees 8,314 crores remained unspent over three financial years.

Figure 4
Sources: https://www.financialexpress.com/economy/corporate-social-responsibility-csr-funds-worth-rs-8314-cr-remained-unspent-over-three-financial-years/1417941/

He disclosed that in 2014-15, the prescribed CSR amount was Rs 15,251.32 crore but Rs 5,185.39 crore remained unspent. In 2015-16, the figure was Rs 15,256.20 crore whereas Rs 889.91 crore was not spent, the data showed. In 2016-17, the prescribed amount was Rs 15,705 crore, while Rs 2,238.78 crore remained unspent.

Top CSR contributors of India

India has a vast network of companies that are working in different domains nationally and internationally. It is also important to analyze CSR contribution company wise figure 5 shows that Reliance industries were on the top for CSR contribution with 649.26 crores followed by Oil and natural gas corporation (504.91 cr.) and TCS.

Figure 5
Source: https://csr.gov.in/CSR

Details of spent CSR amount (development sector wise) for 2016-17 given in figure 6, which shows that 38 per cent of national CSR amount spent for education, differently abled and livelihoods programs. Second highest development sectors are health, eradication hunger, poverty and malnutrition where 25 per cent of CSR amount spent to run the different development programs. There were 11 per cent amount specifically spent on rural development programs. However, Clean Ganga fund is showing zero per cent in respect to the total amount, but rupees 24 crores were spent for this initiative during the year 2016-17.

Figure 6
Source: https://csr.gov.in/CSR

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Only altruistic surrogacy legal in India

Only altruistic surrogacy legal in India

Growing instances of infertility among couples encouraging them to explore other options (medical and non-medical) to have a child. One out of every six couples is dealing with the issue of infertility due to various reasons as per the Indian Society of Assisted Reproduction. In India, approximately 27.5 million couples are suffering from infertility who are trying to conceive.

Increasing instances of infertility rate and medical advancement paved the way to surrogate mothers or surrogacy. The word ‘surrogate’ means ‘substitute’, surrogate-mother described as an arrangement where a woman (the surrogate mother) agrees to become pregnant and bear a child for another person or persons (the commissioning parents) to whom the custody of the child will transfer directly after birth.

Surrogacy flourished as a multi-million-dollar industry in India attracted couples dealing with infertility across the word, the absence of defined surrogacy law and cheap medical treatments helped this industry to flourish most in India.

A study conducted by Centre for Social Research entitled ‘Surrogate Motherhood Ethical or Commercial’ says that majority of surrogate mothers were working as house-maids or domestic helper and earring rupees 1000 to 3000 per month, living in a nuclear family in a rented house. These statistics clearly indicate that poverty and low earning capacity are the driving factors for women to commercial surrogacy.

In many views, surrogacy is similar to baby selling and that a law comparable to the one prohibiting the sale of human organs should apply to the sale of childbearing.  The unregulated surrogacy explored many dark sides of surrogacy and it is another form of slavery.

Keeping the consequence and possible threats of commercial surrogacy in mind, which potently harmed the rights of poor women and forced them for surrogacy, a surrogacy (Regulation) Bill proposed in 2016 and passed in 2018.

 

Salient points of surrogacy (Regulation) bill 2016

  • As per the passed bill, only Indian couples, who have been married for at least 5 years can opt for surrogacy, provided at least one of them have been proven to have fertility-related issues.
  • Only close relatives, not necessarily related by blood, will be able to offer altruistic surrogacy to the eligible couples.
  • A woman can become a surrogate mother only for the altruistic purpose and under no circumstances, she will be paid for it, although payment can be made towards medical expenses.
  • Commercial surrogacy, abandoning the surrogate child, exploitation of surrogate mother, selling/import of human embryo have all been categorised as violations that are punishable by a jail term of at least 10 years and a fine of up to Rs 10 lakh.
  • Surrogacy clinics will be allowed to charge for the services rendered in the course of surrogacy, but the surrogate mother cannot be paid.
  • The new Bill has put a complete ban on commercial surrogacy.
  • It also bans unmarried people, live-in couples and homosexuals from opting for altruistic surrogacy. Now, foreigners, even Overseas Indians, cannot commission surrogacy.
  • Surrogacy regulation board will be set-up at both Central and State-level.
  • The law will be applicable to the whole of India, except for the state of Jammu and Kashmir.
  • All Assisted Reproductive Technology (ART) clinics will need to be registered.
  • The surrogate child will have the same rights of as that of a biological child.
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Status of households in Delhi

Status of households in Delhi

A housing unit is an essential dream of any family, after food and clothing, it is the most desired thing for humans. Rapid urbanization already ignited the process of migration; people are attracted towards the urban centres in the search for better employment opportunities, education and health service.

Natural growth and migration from different states to Delhi, changing the demography of both the places, which leads the shortage of housing in urban centres. Delhi is the most densely populated state in India, on average 11,320 people (2011) living in a square kilometre area.

As per the Census of India- 2011, 1.68 crores, people are living in more than 33 lakh households in Delhi. Out of which 98 per cent households were, urban and only 2 per cent was rural.

Figure 1
Sources: Census of India 2011

Figure 1 shows that the majority of households in rural areas owned by the dwellers, only 16 per cent of household dwellers were living in a rented house. Household ownership picture significantly changes in urban areas where 68 per cent of households owned by dwellers and 28 per cent living in a rented house.

Figure 2
Sources: Census of India 2011

Not many differences observed in the number of dwelling rooms in the urban and rural area of Delhi. Figure 2 shows that around 60 % of Delhi’s families were living in one or two rooms houses.  Less than 10 per cent people manage to afford five or more rooms to live in Delhi. Around a per cent households unable to afford even a single room in both the periphery.

Figure 3
Sources: Census of India 2011

Figure 3 shows that about half of the households had four or five members in their families, 30 per cent of rural households have six to eight members in their families, in urban households; it is limited to 25 per cent. 3 to 4 per cent households have a single member family in both the areas.

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Leading coconut producing states in India

Leading coconut producing states in India

Coconut is an important species mostly grown in humid tropical conditions. It is one of the main cash crop protecting millions of small and marginal farmers. In India Kerala, Karnataka, Tamil Nadu and Andhra Pradesh are the leading states in coconut farming. However, Kerala has a maximum area under coconut farming and contributing alone 31 per cent to total coconut production but Tamil Nadu has the highest per hectare nuts productivity. Tamil Nadu produced 13775 nuts per hectare where Kerala’s productivity was only 9664 nuts per hectare last year (2016-17).

Figure 1
Source: Horticulture Division, Dept. of Agriculture & Cooperation, Ministry of Agriculture & Farmers Welfare, Government of India.

The above figure 1 clearly indicates that Kerala has a maximum area under coconut farming with 770.79 thousand hectares followed by Karnataka and Tamil Nadu. Majority of the area (84%) under coconut cultivation contribute by Kerala, Karnataka and Tamil Nadu in India.

 

Figure 2
Source: Horticulture Division, Dept. of Agriculture & Cooperation, Ministry of Agriculture & Farmers Welfare, Government of India.Figure 2 shows (same as figure 1) that Kerala is leading coconut-producing state followed by Karnataka and Tamil Nadu. Kerala alone producing more than 30 per cent of the total coconut production in India. Kerala, Karnataka and Tamil Nadu collectively contribute to about 87 per cent to total coconut production.

Coconut productivity per hectare has opted altogether a different phenomenon from coconut farming area and coconut production. Figure 3 shows Tamil Nadu is more productive from Kerala and Karnataka. Tamil Nadu producing more than 14 thousands nuts per hectare whereas Kerala and Karnataka producing 9664 and 13181 coconuts nuts per hectare respectively.

Figure 3
Source: Horticulture Division, Dept. of Agriculture & Cooperation, Ministry of Agriculture & Farmers Welfare, Government of India.

Even Gujrat and West Bengal have higher productivity nuts per hectare then Kerala. Gujrat and West Bengal subsequently producing 13775 and 12641 nuts per hector separately.

India’s huge domestic market has been the main consumer of coconut and coconut products. The domestic price of coconut oil has so far been higher than the international price. Therefore, India has not had any significant role in world trade. However, with the increase in the price of edible oils at the global level, the difference between the domestic and international price has been substantially reduced.

 

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Regional languages and changing trends of internet users

REGIONAL LANGUAGES AND CHANGING TRENDS OF INTERNET USERS

India is the home of 1.21 billion people (Census 2011), speaking 30 languages with 1600 dialects. It is the third largest country in-term of internet users in the world after USA and China. Internet users are growing with every passing second, extensive reach of Internet made it possible for India. As per KPMG in India’s analysis, April 2017, 78 per cent internet users accessing internet through their mobile phones. Despite these statistics, India still has the potential to perform exceptionally in the number of Internet users in the world. Standard language (English) to use internet holding the number of Internet users.

Language barrier 

Language is one of the prominent barriers that is restricting the number of internet users mainly from rural India. As per W3Techs estimation until September 2018, more than 53 per cent of the website’s homepages found in English and language ranked first. Whereas, the website available with Hindi homepage found a position at 39th place with 0.1 per cent.

Source: W3Techs.com

Language preference

As per KPMG in India’s analysis, April 2017, out of 521 million Hindi speakers 254 million users prefer the Hindi language over English to read, write and converse with each other. Other insight details of different languages illustrated in the figure given below.

Source: KPMG in India’s analysis, April 2017
*These 8 languages have been considered as Indian languages for the purpose of this report
** Indian languages users are Indian language literates who prefer their primary language over English to read, write and converse with each other

There were 110 million internet users in 2011 in India. Majority of internet users (62%) were using internet in the English language, there were only 38 per cent internet users using internet in different Indian languages. In the year 2016, the picture had changed, a number of internet users have grown to 409 million from 110 million in 2011. Internet users using internet in Indian languages subsequently grown to 57 per cent (234 million).

Source: KPMG in India’s analysis, April 2017

As per the report, Internet penetration in India expected to grow 52 per cent by 2021 and the number of internet users would be around 735 million. Out of total internet users in 2021, 73 per cent would be using it in Indian languages.