Health, education & human resources

Despite food self-sufficiency, NFHS-5 (2019–21) found 36 per cent of children under five stunted, 32 per cent underweight and more than half of children and women anaemic: a burden that reaches far beyond clinics.

Public health concern

• Undernutrition, micronutrient deficiency and rising overweight coexist; anaemia raises maternal and child mortality risk.

Social equity

• Prevalence is highest among Scheduled Tribes and Castes, the poorest households and rural areas; girls and women often eat last and least.
• Its determinants are social: unsafe water, poor sanitation, early marriage, low maternal education and weak care practices.

Human development

• Stunting in the first 1,000 days impairs cognition, schooling and adult earnings, passing disadvantage across generations.
• Nutrition is thus a capability question, the base on which investment in education and skills rests.

Welfare governance

• India has the instruments — ICDS, PM POSHAN, Mission Poshan 2.0, fortified rice through the PDS, the Poshan Tracker — but outcomes depend on convergence.
• Gaps: weak anganwadi infrastructure and staffing, patchy data quality, and poor coordination among health, women and child development, and water departments.
• The test is delivery at the last mile: whether the anganwadi worker, ASHA and school kitchen serve the same child together.

Tackling malnutrition needs a life-cycle, convergent approach centred on the first 1,000 days and the most deprived groups: a measure of governance quality as much as of health care.

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The 86th Amendment (2002) made elementary education a fundamental right (Article 21A), while NEP 2020 frames education as the engine of a knowledge economy: two readings of the same public good.

Education as a welfare obligation

• Case: the RTE Act (2009), mid-day meals and scholarships treat schooling as an equaliser owed to every child, especially girls, Dalits, Adivasis and the poor.
• Strength: universality; a right cannot be rationed by market value or by a child's expected productivity.
• Risk of a welfare-only lens: inputs over outcomes; enrolment has risen, but learning surveys repeatedly find children years behind grade level, and quality becomes secondary to access.

Education as strategic investment

• Case: skilled human capital, research and innovation decide competitiveness; India's research spending stays below 1 per cent of GDP, far behind advanced economies.
• Strength: it ties education to growth, jobs and technological sovereignty, and justifies funding for universities, skills and R&D; a young population makes this urgent, since the demographic dividend pays only if schooling produces skills.
• Risk of a strategy-only lens: elite capture and commercialisation; resources flow to institutions of excellence and fee-paying streams while the poorest learners are neglected.

Do the two conflict?

• In budgets, yes: universal schooling and frontier research compete for limited public money.
• In logic, no: no knowledge economy stands on a population that cannot read; foundational literacy (NIPUN Bharat), skills and research funding (ANRF) serve equity and competitiveness together.
• Verdict: welfare is the foundation and strategy the superstructure; the sequence matters more than the choice.

Education is both a right and a strategic investment; a strong, well-funded public foundation is what makes a globally competitive, knowledge-driven nation possible.

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The 1991 reforms moved the State from producer to enabler, but its spending on social services — education, health, water, sanitation, housing and welfare — has gone through squeeze, expansion and re-targeting.

Pattern and trend

• 1990s: fiscal correction squeezed social budgets; outlays stagnated at low levels, and States, which fund most schooling and health, carried the burden.
• 2000s: a rights-based expansion — SSA, NRHM, MGNREGA (2005), RTE (2009), NFSA (2013) — lifted outlays and widened coverage.
• Post-2014: re-targeting through JAM and direct benefit transfers, with big pushes on housing, toilets, piped water and PM-JAY hospital insurance.
• Level: the Economic Survey 2023-24 records social-services spending rising from 6.7% of GDP in 2017-18 to 7.8% in 2023-24.
• Composition: education dominates; public health spending stays below the National Health Policy 2017 goal of 2.5% of GDP; States now spend the larger share.

Consonance with inclusive growth

• Substantially yes: multidimensional poverty has fallen, enrolment is near-universal, sanitation and financial inclusion have widened, and DBT has improved targeting.
• But only partly: learning outcomes lag enrolment, out-of-pocket health costs stay high, informal workers lack social security, and poorer States spend far less per head — so inclusion is uneven.

Spending has moved the right way but not far enough on health and learning quality; protecting these outlays, tying funds to outcomes and building State capacity would let growth reach the bottom quintile.

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Poverty restricts diets, care and sanitation; malnutrition in turn lowers learning, productivity and earnings, so deprivation passes to the next generation. Article 47 makes nutrition and public health a primary duty of the State.

The cycle and its cost

• Undernourished mothers bear low-birth-weight children; stunting in the first two years impairs cognition and schooling; adults enter low-wage work and stay poor.
• Scale: NFHS-5 (2019–21) found about 35.5% of children under five stunted, with anaemia widespread among women and children.

Steps to break it

• First 1,000 days: POSHAN Abhiyaan, anganwadi services, maternity benefit, fortified rice through the PDS and PM POSHAN school meals.
• Nutrition-sensitive: safe water and sanitation through the Jal Jeevan Mission and Swachh Bharat, girls' education, and diet diversity including millets and kitchen gardens.
• Health: community management of severe acute malnutrition, deworming, immunisation and ante-natal care through Ayushman Arogya Mandirs.
• Income: MGNREGA, SHG-based livelihoods and social protection raise household purchasing power for food and care.
• Governance: convergence across ministries, Poshan Tracker monitoring, behaviour-change campaigns and community participation.

Breaking the cycle requires converging nutrition, health, water and livelihoods on the first 1,000 days — human capital is built before a child reaches school.

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Enacted in February 2024 and in force from June 2024 after repeated paper leaks, the Public Examinations (Prevention of Unfair Means) Act, 2024 is the first central law against organised malpractice in public recruitment and entrance examinations.

Aims and objects

• Restore credibility: transparency, fairness and credibility in public examinations, so that youth can trust that sincere effort will be rewarded.
• Target the network, not the candidate: it punishes leak gangs, colluding service providers and impersonators, while candidates stay under the rules of the conducting body.
• One national framework, so that a leak in one state cannot undermine an all-India test.

Key provisions

• Coverage: a 'public examination' is one conducted by an authority in the Schedule — UPSC, SSC, Railway Recruitment Boards, IBPS, central ministries and departments, and the National Testing Agency — or any other authority the Centre notifies.
• Offences: leaking papers or answer keys, tampering with answer sheets or computer systems, impersonation, manipulating seating or shifts, and fake websites or examinations; all are cognisable, non-bailable and non-compoundable.
• Penalties: three to five years' imprisonment and a fine up to ₹10 lakh; a service provider may be fined up to ₹1 crore and charged the examination's cost; organised crime attracts five to ten years, a fine of at least ₹1 crore and attachment of property.
• Enforcement: investigation by an officer not below Deputy Superintendent of Police; the Centre may refer a case to a central agency; a national technical committee to secure computer-based testing.

Are university and state board examinations covered?

• Not by themselves. The Act extends to the whole of India, but its Schedule lists only central authorities, so university examinations and state board examinations fall outside it unless the Central Government notifies the conducting body.
• State recruitment commissions are likewise outside it; several states enacted their own laws in 2024, among them Uttar Pradesh and Odisha.
• Entrance tests such as NEET, JEE and CUET are covered because the NTA conducts them.

The Act gives the Centre real teeth against organised leak networks in its own examinations; lasting fairness also needs secure testing technology, NTA reform and state laws matching its standard.

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Healthcare in India is delivered largely by private providers and paid for largely out of pocket: NHA estimates show that out-of-pocket spending was still 39.4% of total health expenditure in 2021-22, even after a steep fall. Markets deliver care to those who can pay, not to those who need it most.

Why the State must contain marketisation

• Catastrophic costs: out-of-pocket payments push households into debt and poverty, and the poor forgo or delay treatment.
• Skewed supply: hospitals and specialists cluster in cities, leaving rural and tribal areas underserved.
• Perverse incentives: over-treatment, unnecessary diagnostics and induced demand, with weak regulation of quality and pricing.
• Public goods neglected: prevention, sanitation, immunisation and disease surveillance yield no private profit yet decide population health.
• Constitutional duty: Article 47 makes public health a primary duty of the State; the National Health Policy 2017 set a target of 2.5% of GDP for public health spending.

Measures to reach the grassroots

• Primary care first: make Ayushman Arogya Mandirs deliver comprehensive primary care — screening for chronic disease, free essential medicines and diagnostics — with assured referral links.
• People: fill vacancies in PHCs and CHCs, expand community health officers and mid-level providers, incentivise rural service through bonds and career paths, and strengthen ASHAs with fair pay and training.
• Financing: move public health spending towards the 2.5% target with a larger share for primary care; use PM-JAY for hospital care while empanelling and monitoring public hospitals.
• Regulation: implement the Clinical Establishments Act in every state, standard treatment guidelines, price control of essential medicines and devices, and Jan Aushadhi stores for generics.
• Infrastructure and surveillance: PM-ABHIM for block public health units and district laboratories; integrated disease surveillance.
• Technology: eSanjeevani tele-consultation linking sub-centres to specialists; the Ayushman Bharat Digital Mission for portable records.
• Community voice: village health, sanitation and nutrition committees, Rogi Kalyan Samitis and social audits to keep facilities answerable.

The State need not replace the market, but it must anchor the system: strong public primary care, adequate funding and firm regulation keep healthcare a right at the grassroots rather than a commodity for those who can pay.

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Human resource development turns population into a productive workforce through health, education and skills. India's public spending on these has stayed below its own targets, and the demographic dividend will pass if the gap persists.

Where attention fell short

• Learning outcomes lag enrolment; child stunting and anaemia persist; few workers hold formal skills; women's participation in work is low.

Measures

• Foundational learning: universal early-childhood care and foundational literacy and numeracy under NEP 2020, better teacher training and infrastructure, and outcome tracking through learning surveys.
• Health and nutrition: raise public health spending towards 2.5 per cent of GDP (National Health Policy 2017), strengthen primary care through health and wellness centres, and fight stunting and anaemia through Poshan Abhiyaan and school meals.
• Skills and jobs: industry-aligned curricula, vocational education from school, more apprenticeships, and Skill India training judged by placements.
• Inclusion: scholarships, hostels and residential schools for girls, SCs, STs, minorities, persons with disabilities and remote areas.
• Financing and governance: move education spending towards the 6 per cent of GDP goal reaffirmed by NEP 2020, public-private partnership with accountability, decentralised planning through panchayats, outcome monitoring with data.
• Lifelong learning: digital and distance platforms, re-skilling for technological change, and workplace policies such as creches and safe transport that raise women's participation.

Human capital is India's largest asset; success should be measured by outcomes in learning, health and jobs, not by spending or enrolment alone.

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Skill programmes have widened the pool of trained workers, but income comes only when learning, skills and demand meet. Education, skills and employment form one chain: a weak link anywhere wastes investment in the others.

What skilling has achieved

• Skill India, the Pradhan Mantri Kaushal Vikas Yojana, apprenticeship promotion and sector skill councils have created certified workers for construction, retail, logistics, healthcare and IT-enabled services, and the National Skills Qualification Framework made certificates comparable.

The linkages

• Education as foundation: foundational literacy, numeracy and reasoning decide how fast people learn skills; weak schooling lowers the return on later training and traps workers in low-skill jobs.
• Skills as bridge: vocational and technical training translate general learning into job-ready competence, and re-skilling keeps workers employable as technology changes.
• Employment as demand: skills earn only when firms create jobs; educated-youth unemployment shows that supply has run ahead of demand and of the skills employers actually want.
• Feedback loop: good jobs raise the returns to education, which raises enrolment and quality; jobless growth breaks the loop and devalues certificates.

Where the links break

• Curricula lag industry needs; vocational streams carry low status and rarely re-enter mainstream education; placement after certification remains weak.
• Industry engagement is shallow: few firms take apprentices or co-design courses; training is judged by numbers trained, not by jobs and wages.
• Structure of work: a large informal sector, low female participation and gig work leave trained talent under-used, and migration makes matching harder.

Strengthening the chain

• Integrate vocational education into schools and colleges under NEP 2020, with credit mobility through the National Skills Qualification Framework.
• Industry-led curricula and assessment, more apprenticeships, district skill plans aligned to local demand, and outcome-based funding tied to placements and wages.
• Labour-market information systems, portability of certificates, and support for women's participation such as creches and safe transport.

Skilling has fixed the supply side; the demand side, quality schooling and jobs, must now be planned together so that certificates become careers.

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Longer life is a public-health success, but it changes the disease profile: the share of people aged 60 and above reached 10.1% in 2021 and is projected at 13.1% by 2031, and the added years bring more chronic illness and care needs.

Newer health challenges

• Chronic disease: diabetes, hypertension, heart disease and cancers, often several together, replace infections as the main burden.
• Degenerative conditions: dementia, arthritis, vision and hearing loss, falls and disability that need long-term care rather than cure.
• Mind and society: depression, loneliness, neglect and abuse as joint families thin; older women, who live longer, are more often widowed and dependent.
• System gaps: few geriatric specialists, high out-of-pocket costs, medicine overuse, weak palliative care and thin pensions.

Steps needed

• Primary care: screening for chronic disease at Health and Wellness Centres, expansion of the National Programme for Health Care of the Elderly, geriatric wards, and home-based and palliative care.
• Financing: hospital cover under Ayushman Bharat PM-JAY, wider pensions and incentives to save for old-age care.
• Prevention: healthy lifestyles, adult vaccination and early screening to compress the years spent in illness.
• Social support: community day-care, age-friendly public spaces, trained caregivers and enforcement of the Maintenance and Welfare of Parents and Senior Citizens Act, 2007.

The aim is to add life to years and not only years to life, through prevention, affordable elder care and communities that keep the old included.

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The RTE Act, 2009 gives every child aged 6 to 14 a legal right to free and compulsory elementary education under Article 21A. Enrolment rose, but a right on paper does not by itself bring a child to school, keep her there or make her learn.

The Act's design: supply-side

• It sets school norms and teacher standards and reserves 25 per cent of entry-level seats in private schools for disadvantaged children (Section 12(1)(c)).
• It obliges the State to provide schooling; it does little to pull families towards it.

The incentive gap

• The Act itself offers no incentives; separate schemes fill the gap: the mid-day meal, free textbooks and uniforms, and scholarships for girls and disadvantaged groups.
• Where these are weak or delayed, the cost of schooling in lost child labour and wages outweighs its perceived value for poor families.

The awareness gap

• Many parents do not know entitlements such as the private-school quota, school management committees and grievance channels, so uptake is low.
• Poverty, child labour, migration, early marriage and disability keep children out, and the Act does not cover children below 6 or above 14.
• Learning: ASER surveys record weak reading and arithmetic in elementary grades, and teacher vacancies and poor infrastructure limit quality despite the norms, so parents see little return from schooling.

Making the right real

• NEP 2020 extends the ambition to ages 3 to 18 and to foundational literacy through NIPUN Bharat; Samagra Shiksha integrates support.
• Awareness drives through school management committees and panchayats, incentive packages tied to attendance, drop-out tracking, and better teacher training.

Law creates the right; incentives bring children to school, awareness keeps families committed, and quality makes the years count. The Act needs all three around it.

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Primary health care is most citizens' first point of contact; Article 47 makes improving public health a primary duty of the State, and the right to health is read into Article 21.

A moral imperative of the Welfare State

• Duty: Articles 47 and 21 make health a core obligation, not charity; a Welfare State that abandons the poor to costly private care fails its purpose.
• Equity: free primary care reaches women, children and the rural and tribal poor who cannot afford hospitals.

A precondition for sustainable development

• Human capital: healthy people learn and work better, raising productivity and incomes.
• Poverty prevention: cheap early care spares households the debt that out-of-pocket health spending causes.
• Cost-effectiveness: immunisation, maternal and child care and early management of chronic disease avoid expensive hospital admissions.
• Global goals: SDG 3 and universal health coverage rest on primary care, as the Alma-Ata (1978) and Astana (2018) declarations stressed.

Gaps in India

• Shortages of doctors and specialists, weak infrastructure, low public spending, inter-State disparities and reliance on private providers persist despite the National Health Mission, ASHAs, Health and Wellness Centres and the National Health Policy 2017.

Way forward

• Higher public spending on primary care, a stronger workforce and referral links, digital records and panchayat oversight.

Investing in primary health serves justice and growth together; without it, gains in education, income and environment stay fragile.

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'Earn while you learn' combines paid work with structured training, as in apprenticeships and Germany's dual system, so that learners gain skills, income and job experience together.

Why it matters

• Employability: India's skill mismatch persists because classroom training rarely matches shop-floor needs; work-integrated learning closes that gap.
• Access: a stipend lets poor youth stay in training instead of leaving for wages, and gives vocational paths dignity.
• Employers: firms get workers trained in their own processes at lower hiring cost.

Present framework and gaps

• Framework: the Apprentices Act, 1961 (amended 2014), the National Apprenticeship Promotion Scheme (2016) with stipend support, ITIs, the NSQF and Skill India; NEP 2020 targets vocational exposure for at least 50 per cent of learners by 2025.
• Gaps: low apprenticeship numbers, reluctance of small firms, thin stipends, weak training quality and certification, poor reach among women, rural youth and informal enterprises, and stigma against vocational routes.

Strengthening it

• Simpler compliance and incentives for MSMEs, minimum stipends with insurance, industry-designed curricula, credit transfer between apprenticeships and degrees, and digital tracking of placement outcomes.

Scaled with industry ownership and fair pay, 'earn while you learn' can turn vocational education from a fallback into a preferred route to decent work.

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Access to schooling, services, markets and welfare now runs through digital channels; where rural citizens lack devices, connectivity and skills, this shift has widened old inequalities rather than closed them.

How the divide has hindered development

• Evidence: the NSS 75th round (2017-18) found only 4.4 per cent of rural households with a computer and 14.9 per cent with internet facility, against 23.4 and 42 per cent in urban areas.
• Education: online classes during Covid-19 left rural, poor and girl students behind for want of devices, data and digital skills, deepening learning loss.
• Welfare and governance: DBT, e-KYC, CoWIN and e-governance portals demand skills; those who cannot use them face exclusion errors or pay intermediaries.
• Health and farming: telemedicine (e-Sanjeevani), weather and price advisories, e-NAM and digital payments help only those able to use them.
• Finance and enterprise: UPI widens inclusion, but low digital literacy exposes users to cyber-fraud and keeps artisans and small producers out of e-commerce.
• Social gaps: women, older people and tribal communities own fewer devices and use the internet less, so the digital divide compounds gender and regional divides.

Counter-view and response

• Progress: Digital India, BharatNet for panchayat-level broadband, PMGDISHA (approved in 2017 to make 6 crore rural households digitally literate), Common Service Centres, PM-WANI hotspots and DIKSHA have narrowed the gap, and cheap data and smartphones spread fast.
• Yet the hindrance remains: connectivity without skills, and skills without local-language content, still leave services under-used.

Way forward

• Last-mile fibre and reliable power, affordable devices and data, local-language and voice interfaces, community digital champions (especially women) and strong grievance and anti-fraud safeguards.

Digital illiteracy and poor ICT access have indeed slowed rural socio-economic development; bridging the divide through connectivity, skills and trust is now a precondition for inclusive growth.

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India carries risk at both ends of life: maternal mortality was 113 per lakh live births in 2016–18 (SRS), and the elderly, 8.6% of the population in Census 2011, are a rising share.

Why these two fields matter

• Maternal health decides child survival, nutrition and schooling, and so the human capital behind the demographic dividend; a mother's death impoverishes a family.
• Elderly health decides whether ageing brings dignity or dependency: chronic illness, out-of-pocket spending and lost caregiver earnings push households into poverty.

What policy offers

• Maternal: Janani Suraksha Yojana (2005), Janani Shishu Suraksha Karyakram (2011), Matru Vandana Yojana (2017) and 26 weeks' maternity leave; MMR fell from 130 (2014–16) to 113 (2016–18) and, since then, to 97 (2018–20).
• Elderly: the National Programme for Health Care of the Elderly (2010–11), PM-JAY (2018), the Senior Citizens Act 2007 and (since then, in 2024) Ayushman Vay Vandana cover for those aged 70 and above.

Gaps

• Maternal: wide State gaps, over half of pregnant women anaemic (NFHS-5), and thin emergency obstetric care in remote districts.
• Elderly: few geriatric specialists, weak primary care for chronic and mental illness, no long-term care, heavy out-of-pocket costs.

Comprehensive primary care with geriatric and obstetric services, and public spending raised to 2.5% of GDP (National Health Policy 2017) would protect both the next generation and the dignity of an ageing society; sound policy here is social development itself.

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SDG 4 seeks inclusive, equitable quality education and lifelong learning for all by 2030; NEP 2020 states that it aims at a system aligned with those goals while building on Indian traditions, so the claim of conformity is the policy's own and must be tested against its provisions and its prospects.

Conformity with SDG-4

• Access (Targets 4.1, 4.2): universal schooling from ages 3 to 18, including pre-primary, with 100% school GER by 2030 and 50% higher-education GER by 2035.
• Quality (4.1, 4.c): foundational literacy and numeracy by Grade 3, a four-year integrated B.Ed. and 50 hours of professional development a year for teachers.
• Equity (4.5): home-language medium wherever possible till at least Grade 5, a Gender Inclusion Fund and Special Education Zones for disadvantaged regions.
• Skills and lifelong learning (4.3, 4.4): vocational exposure from Class 6, multiple entry and exit in degrees and an Academic Bank of Credits.

Restructuring and reorientation

• School: 5+3+3+4 stages replace 10+2, bringing early childhood care into the system.
• Higher education: multidisciplinary institutions, a single regulator, a national research foundation and a National Educational Technology Forum.

Doubts

• Funding: the 6% of GDP goal, recommended since the Kothari Commission in the 1960s, remains unmet; without it the targets stay aspirations.
• Federalism: education is a Concurrent subject, so States must adopt the policy; the three-language formula is contested, and the RTE Act's legal guarantee still covers only ages 6–14, short of the 3–18 promise.
• Implementation: teacher vacancies and training, weak learning outcomes, dropouts among girls and marginalised groups, and a digital divide that online learning can widen.
• Equity risk: multiple exits may become early exits for the poor, and fee-driven higher education can price out the disadvantaged.

In goals and architecture NEP 2020 conforms closely to SDG-4 and proposes a genuine reorientation; whether it delivers depends on public money, State cooperation, teacher capacity and honest monitoring of learning and equity outcomes.

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Comprehensive National Power (CNP) adds up a nation's economic, military, human and cultural strengths; ethics and values decide whether that strength is productive, trusted and cohesive. Education is how a nation passes those values on, which is the test NEP 2020 must meet.

(a) How ethics and values enhance human capital, soft power and social harmony

• Human capital: skills create value only when joined to honesty and discipline. Gandhi's Young India (1925) printed knowledge without character among seven social sins; integrity in schools, clinics and offices turns public spending into real capability.
• Soft power through culture: culture attracts when it is shared, not imposed. India proposed the International Day of Yoga, which the UN proclaimed in 2014 after a record 175 member states endorsed the draft.
• Soft power through policies: credibility comes from consistency. Panchsheel (1954), the five principles of peaceful coexistence, shaped India's image as a non-aggressive power; double standards at home erode influence abroad.
• Social harmony: the Preamble's fraternity and the duty in Article 51A(e) to promote harmony "transcending religious, linguistic and regional or sectional diversities" are values before they are laws; impartial officers and tolerant citizens keep diversity from turning into division.

(b) NEP 2020: education as a pervasive tool, not an injunction

• All-round development: NEP 2020 wants education to develop "good human beings capable of rational thought and action, possessing compassion and empathy, courage and resilience", with sound ethical moorings; the 5+3+3+4 structure, foundational literacy and numeracy, and the mother tongue in early years lay that base.
• Choice, not command: learners may choose their own paths, with no hard separations between arts and sciences, curricular and extra-curricular activities, or vocational and academic streams; multidisciplinary higher education extends this freedom.
• Social transformation: it aims at citizens for "an equitable, inclusive, and plural society"; a Gender Inclusion Fund, and ethics, constitutional values and service in the curriculum, carry that aim into classrooms.
• Where delivery may fall short: public spending on education is about 4.43% of GDP, below the 6% envisaged since the 1968 policy; teacher shortages, the digital divide, language politics and centralisation in a Concurrent List subject could hollow out the vision.

Ethics multiplies every element of national power, and education is how a nation passes it on. If public spending finally reaches the 6% of GDP promised since 1968, and teachers model the values they teach, NEP 2020 can become the pervasive, transformative tool the statement describes.

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India ranked 130th of 189 countries on UNDP's Human Development Index in 2018 (129th in the 2019 report), far below what its growth rate would suggest: output has risen without matching gains in health and learning.

Why development stays uneven

• Low investment in people: health spending lags the 2.5 per cent of GDP target of the National Health Policy 2017 and education the 6 per cent target reaffirmed in NEP 2020, so families pay for private services.
• Jobless pattern of growth: capital-intensive industry and skill-intensive services create few jobs, leaving most workers in low-productivity farming and informal work.
• Regional divides: southern and western States outperform Bihar, Uttar Pradesh and Odisha, so national averages hide lagging regions.
• Social exclusion: Scheduled Castes and Tribes, women and the rural poor have weaker access to land, credit, markets and schooling.
• Health and nutrition deficits: stunting, anaemia and preventable maternal and child deaths persist where primary care and sanitation are weak.
• Learning crisis: ASER surveys show poor foundational learning, dropouts and skill mismatch, wasting the demographic dividend.
• Delivery failures: leakages, weak local institutions and poor monitoring dilute schemes meant for the excluded.

Way forward

• Raise and target social spending, strengthen primary health and school learning, promote labour-intensive manufacturing, empower panchayats and focus on aspirational districts.

Growth is necessary but not sufficient; inclusive development needs sustained investment in people, especially in lagging States and excluded groups.

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'Health for All', the Alma-Ata goal of 1978, rests on primary care close to homes, because most illness and its causes arise, and can be prevented, at community level.

Why community care comes first

• Reach and cost: local workers reach remote and poor households early, prevent costly hospitalisation and cut out-of-pocket spending.
• Disease profile: maternal, child and communicable illness, and now hypertension and diabetes, are best prevented and screened locally; the Health and Wellness Centres (2018) aim at such comprehensive primary care.
• Social determinants: nutrition, sanitation, safe water and women's education are managed locally by Panchayats, Anganwadis and schools; the Eleventh Schedule lists health and sanitation as Panchayat subjects.
• Participation: community monitoring, social audits and Gram Sabha oversight improve attendance and drug supply, and local knowledge fits interventions to needs.

India's delivery and gaps

• ASHAs under the National Rural Health Mission (2005), village health committees and Rogi Kalyan Samitis link households to services; SEARCH's home-based newborn care in Gadchiroli showed local action saves newborns.
• Gaps and needs: weak referral links, staff and drug shortages, ASHAs on honoraria, and low public spending (the National Health Policy 2017 targets 2.5 per cent of GDP by 2025) call for stronger Health and Wellness Centres, trained community workers, telemedicine and convergence with nutrition and sanitation through PRIs.

Community-level care is necessary but not sufficient: 'Health for All' also needs referral hospitals, adequate public financing and action on the social determinants of health.

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WASH (water, sanitation and hygiene) programmes such as the Swachh Bharat Mission, launched on 2 October 2014, and rural drinking water schemes serve Sustainable Development Goal 6; their real outcomes are health, dignity and use, not structures built.

Why targeting and outcomes must match

• Segments differ: girls need working toilets in schools to stay in class; slum dwellers need shared facilities and drainage; persons with disabilities need accessible designs; SC and ST habitations need assured water sources.
• An outcome such as fewer diarrhoeal deaths follows only if the households that carry the disease burden are the ones covered and actually use the facility.
• Targeting errors break the chain: lists that miss migrants, tenants and informal settlements leave out the neediest; uniform designs ignore local scarcity or contamination.

What synchronised WASH implementation needs

• Define the outcome first (usage, water quality, girls' attendance, child nutrition), then map who must be reached for it.
• Behaviour change: handwashing, safe storage and menstrual hygiene need communication and community champions, not hardware alone.
• Convergence: source, toilet, waste and sewerage planned together, with funds and responsibility for operation and maintenance.
• Verification: independent checks of use, water quality testing and social audits tied to outcome indicators.

Structures counted are not outcomes achieved; WASH succeeds when the right people are identified for the right result, and the result rather than the asset is measured.

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Sen treats basic education and health as both ends of development and means to growth, and argues that India's neglect of both has held back its people and its economy.

Sen's diagnosis

• Schools that enrol but do not teach, absent teachers, and public clinics so weak that even the poor pay private providers.
• Low public spending and a public debate that ignores both; development is the expansion of capabilities, not income alone.

Primary education

• Teachers: fill vacancies, curb absenteeism through school management committees under the Right to Education Act 2009, and invest in continuous training.
• Learning, not enrolment: make early-grade reading and arithmetic the goal and measure them; use mid-day meals to keep children in school.
• Money and equity: raise public education spending towards the 6 per cent of GDP first proposed by the Kothari Commission (since then, restated in the National Education Policy 2020), with support targeted at girls and disadvantaged groups. Article 21A gives the effort constitutional footing.

Primary health care

• Facilities: staffed sub-centres and primary health centres with doctors, nurses, medicines and diagnostics, backed by ASHAs, immunisation and maternal and child care.
• Financing: raise public health spending from just over 1 per cent of GDP and cut out-of-pocket costs (since then, the National Health Policy 2017 set a target of 2.5 per cent of GDP by 2025).
• Prevention: sanitation, nutrition and safe water, public goods that markets undersupply and that Sen places at the centre of health.

Accountability

• Give Panchayats and users a say, publish facility-level data, run social audits, and reward schools and clinics that perform.

Sen's case is that public investment in schools and clinics, made answerable to the people who use them, yields the largest and most lasting gains in human capability, and in growth.

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The National Policy for Children, 2013 replaced the 1974 policy and treats every person below 18 as a rights-holder, building on the Directive Principle in Article 45 and on India's commitment to the UN Convention on the Rights of the Child.

Main provisions

• Guiding principles: children are not a homogeneous group; non-discrimination, the best interests of the child, and special care for children with disabilities, from SC, ST and minority communities, migrants and those in conflict-affected areas.
• Four priority areas: survival, health and nutrition; education and development; protection from violence, abuse, labour and trafficking; and participation of children in decisions affecting them.
• Machinery: a National Plan of Action and State plans, inter-ministerial coordination led by the Ministry of Women and Child Development, and the NCPCR and State commissions to monitor rights.

Status of implementation

• Legal and programme gains: the RTE Act 2009, POCSO Act 2012, Juvenile Justice Act 2015 and the 2016 amendment banning child labour below 14 years; ICDS, mid-day meals and immunisation drives for survival and nutrition.
• Persisting deficits: NFHS-4 (2015-16) found 38.4 per cent of under-fives stunted (since then, NFHS-5 (2019-21) recorded 35.5 per cent); child labour, trafficking and child marriage continue, and learning outcomes lag enrolment.
• Weak links: many States lack funded plans of action; budgets for children remain a small share of spending; convergence across departments and monitoring at the block and village level are thin, and the NCPCR has limited staff and enforcement power.

The policy sets a rights-based direction, but rights become real only through funded State plans, convergent delivery and community-level monitoring of every child's survival, learning and safety.

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India's young age structure is an opportunity, not a guarantee: a demographic dividend is earned only when the young are healthy, educated and skilled enough to find productive work. Government measures span each of these links.

Education

• The Right to Education Act 2009, Sarva Shiksha Abhiyan and RMSA for elementary and secondary schooling, with mid-day meals to keep children in class; RUSA to fund State universities and NIRF to benchmark quality.

Skills

• Skill India Mission (July 2015) under the National Policy for Skill Development and Entrepreneurship 2015; Pradhan Mantri Kaushal Vikas Yojana for certified short-term training; NSDC's partnerships with industry; DDU-GKY for placement-linked training of rural youth.

Employment and enterprise

• Make in India (2014) to create manufacturing jobs; MUDRA loans (2015) for micro-enterprises; Start-up India (2016) to support innovation-led ventures and creative risk-taking.

Health and nutrition

• The National Health Mission, immunisation and ICDS improve early-life outcomes that decide later learning and productivity.

Awareness and inclusion

• Digital India and the National Digital Literacy Mission spread digital access; Beti Bachao Beti Padhao promotes girls' survival and education so that half the workforce is not left out.

Where gaps remain

• Learning quality lags enrolment; skill courses are short and weakly matched to industry needs; formal jobs are scarce, and female workforce participation stays low.
• Creativity needs freedom to experiment, but higher education still rewards rote learning over research and problem-solving.

The measures cover schooling, skilling, health and enterprise; the dividend will be realised only when the quality of learning and the pace of job creation catch up with the numbers, especially for young women.

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