Indian railways

In a bid to go corporate, the Indian Railways is set to scrap its Rs 30,000-crore social subsidy

The railways, which recovers only 57% of its passenger services cost, is in talks with two financial institutions for a third-party study.

To move to a more corporate mode of functioning, the Indian Railways is looking for ways to do away with its social sector subsidies of about Rs 30,000 crores a year.

According to sources, it is in talks with two financial institutes to conduct a study on this.

The strategy of a more corporate way of functioning is based on a report by a panel chaired by Bibek Debroy, a member of the NITI Aayog, in 2015. One round of discussion has happened between the National Institute of Public Finance and Policy and Indian Railways officials on how to proceed.

“We are in talks with two financial institutes, regarding a study on ways to reduce or do away with the subsidies. If the railways is a commercial entity, social obligation should not be a baggage for it,” said an official source.

Late last year, Railway Minister Suresh Prabhu had written to his finance counterpart that social sector subsidies should be borne by the ministries concerned. The Indian Railways recovers only 57% on the cost of passenger services; on suburban rail, around 40%.

“Once the reports are submitted, we will approach the finance ministry. The idea is, if we are giving a subsidy to, say, a defence person, it should be absorbed by the ministry concerned,” said the official.

This comes after the Central government merged the Railway Budget with the General Budget, doing away with a 92-year-old tradition. The Debroy panel had recommended this, as a way of easier segregation of the railways’ social responsibility from its operational finances. Another item on Prabhu’s agenda is the government’s clearance to his proposal for a sector regulator, a Rail Development Authority. This entity is to decide on rates and equitable treatment for stakeholder investment in the railways, setting efficiency and performance standards, and dissemination of information.

This comes as the Indian Railways posted its worst operating ratio (money spent to earn every Rs 100) in 16 years, at 96.9 in 2016-’17. This was mainly due to the social burden and implementation of the pay commission report. It has already appointed a foreign consultant to come up with a performance index other than the operating ratio.

“Despite all this, our loading has increased from 1,104 million tonnes in 2015-’16 to 1,109 million tonnes in 2016-’17. We are also giving extra focus on non-fare revenue. The major concern for us is the increasing subsidy burden, while the pay commission impact will also be there in 2017-’18, of about Rs 15,000 crores,” said another official.

Key social service obligations

  • Non-suburban passenger services: Concessions to various categories of passengers. Senior citizens, students, recipients of gallantry awards and national sports awards, participants of national and state sports tournaments, Shram awardees, war widows, patients suffering from cancer, TB, other serious diseases, handicapped persons, press correspondents, concessions to military personnel the Northeast.
  • Sub-urban passenger services: Fares of various classes of tickets lower than system costs, season ticket concessions to suburban passengers.
  • Goods services: Carriage of essential commodities at concessional rates, concessions to postal traffic, military traffic, registered newspapers and magazines, Northeast.
  • Uneconomic branch lines: Continued operations of uneconomic branch lines

This article first appeared on Business Standard.

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.