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More women than men say yes to AYUSH

A survey shows that, across all economic statuses, more women than men go in for AYUSH systems.

The much-publicised International Day of Yoga has had a significant impact on raising awareness and promoting the adoption of AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy) as vital health interventions. Government initiatives, along with efforts from other agencies, have fostered the acceptance of AYUSH systems in India. As it gains momentum, its integration into modern health practices will mark a significant shift towards holistic and traditional health interventions, promoting a more inclusive approach to well-being.

The first comprehensive all-India survey on AYUSH was conducted between July 2022 and June 2023, covering 181,298 households (104,195 in rural areas and 77,103 in urban areas). Its results unveiled fascinating and thought-provoking insights: An impressive 95.1 per cent of respondents reported awareness of AYUSH systems, with slightly higher awareness in urban areas and no significant gender divide. Around 95.1 per cent of men and 95.2 per cent of women stated that they are aware of the system

The survey further revealed that over half of the respondents (53.1 per cent) had used AYUSH treatments within the last 365 days when the survey was conducted. The usage was for treating or preventing diseases and ailments based on the advice of a medical practitioner or instructor. It also encompassed home-based remedies, self-medication and self-treatment.

While general awareness of AYUSH systems showed no gender divide and rising age did not hinder its adoption, it’s intriguing that adoption rates among females were higher at 56.3 per cent compared to only half among males. Delving further, it was observed that adoption rates among females across all age groups surpassed those among males. The gender gap was more pronounced in younger age groups (peaking in the 26-35 years age group) and gradually tapered in higher age groups.

Remarkably, the data also showed that across all economic statuses, females exhibited higher adoption of AYUSH systems compared to males. Among males, adoption rates ranged from 43.5 per cent in the lowest quintile (poorest) to 59.3 per cent in the highest quintile (richest), while for females, the corresponding range was 49 per cent to 64.4 per cent.

The pattern didn’t end there. A look at the adoption or usage rate across educational levels revealed that women had a higher rate. Even illiterate females showed a much higher adoption or usage rate than males who were graduates and above.

The reasons

So, are females more receptive to adopting or using AYUSH systems? Data has proven so, but there are no straightforward reasons that this pattern could be attributed to. Even on closer examination of the survey data, we found that the survey attempted to elicit information on the ‘reasons for not using AYUSH systems’ from the respondents. But, after analysing the data, it pointed to no perceptibly strong factors to arrive at a definite conclusion. However, data showed that males exhibited more faith in allopathy across all age groups as compared to females. Could we infer an inverse relationship between lower faith in allopathy and higher adoption and usage of AYUSH systems among females? Suffice it to say that it would not be a safer bet to rely solely on this factor; it is at best one of the several contributing factors.

Contrary to common perception, there is a notable trend of greater usage and acceptance of AYUSH systems among females compared to males. This pattern holds true across all age groups, educational levels, and income brackets. A deeper look at the present survey did not quite reveal any distinct features that would lead us to conclusively pinpoint any specific reasons or factors.  This pattern and phenomenon presents a new perspective that warrants further investigation, and hence the need for adequate and relevant information.

Palash Baruah is Associate Fellow at the National Council of Applied Economic Research; D L Wankhar is a retd government officer. Views are personal.

India Policy Forum 2023

The 20th India Policy Forum 2023 Volume comprises papers and brief details of the proceedings of IPF Conference held during July 6-7, 2023. Apart from presentation of five papers, the IPF Conference also included the 5th  T.N. Srinivasan Memorial Lecture, titled, “Poverty and Inequality in India: An Exploration of Undercurrents at the Village Level”, delivered by Professor Peter Lanjouw, VU University, and the IPF Lecture, titled, “Monetary and Macroprudential Policies with Global Financial Cycles”, delivered by Professor Helene Rey, London Business School. In addition, the 2023 IPF featured a Policy Roundtable titled “The World in a Polycrisis”.

2023, Volume 20, Papers

The complete set of IPF Volumes, can be viewed and downloaded here.

What matters is not the number, but the safety net

India’s growing economy is lifting families out of poverty but often onto a precarious perch. A single disaster can push them right back. Policy, obsessed with counting the poor, ignores the question of helping ‘newly poor’

Two decades ago, controversies around the measurement of in National Sample Surveys set off what became known as the Great Indian Poverty Debate. We seem to have come full circle with new controversies about poverty measurement, leading to the Great Indian Poverty Debate 2. But is counting the exact number of individuals whose incomes fall below the poverty line, located around ₹1,900, as important as understanding the nature of poverty decline and its implications for social policy?

Some estimates based on Household Consumption Expenditure Survey (HCES) place poverty under 5%. Newly collected Wave 3 of India Human Development Survey (IHDS) places it at about 8.5%. HCES probably underestimates poverty due to a change in methodology, while IHDS probably overestimates poverty due to its reliance on an older sampling frame that omits newly growing peri-urban areas. However, both suggest that poverty is declining. The multidimensional poverty index released by Niti Aayog also documents improvements in the conditions under which households live.

But due to an obsession with estimating the exact number of individuals in poverty, implications of this change for the provision of social safety nets are ignored.

India’s approach to social protection was developed when most of its population was impoverished. Unequal access to productive resources such as infra, land and education led to endemic poverty among some sections of the society (such as SCs and STs) and some areas (such as poorest districts like Dahod, Gadchiroli, and Dhubri). Hence, the primary focus was on designating the poorest sections of society as BPL and providing them various benefits, including food grains.

As the economy grows, it presents both opportunities and challenges. rural residents find work as skilled masons, and urban slum-dwellers become drivers for delivery services. While this is a step out of abject poverty, it also places them on a precarious perch where a single accident, natural disaster, or epidemic could push them back into poverty.

IHDS, organised by National Council of Applied Economic Research and University of Maryland, followed more than 40,000 households between 2004 and 2024. Its results suggest that poverty decline is closely coupled with increasing vulnerability. Between 2004-05 and 2011-12, of the total 22.4% who were poor, 8.5% were newly poor.

That is, if BPL cards were given based on poverty in 2004-05, they would miss out on nearly 40% of the individuals who were poor in 2012. This proportion grew between 2011-12 and 2022-24, although overall poverty declined. Of the 8.5% poor in 2022-24, 5.3% are newly poor, reflecting a decline in chronic poverty and growth in transient poverty.

Whereas accidents of birth largely shaped the fortunes of Indian citizens in the 20th century, the 21st century has seen a rising importance of accidents of life. The challenge is that we cannot easily predict this descent into disaster. While the death of a wage earner brings debt and misery to one widow, the other may be able to get a loan from a bank to set up a small shed for raising pigs and support herself, yet another may have a son who is grown up and can help his mother.

Our public discourse must acknowledge and celebrate movement out of poverty, but it must also recognise the precarity of this achievement and work towards building safety nets that protect against unforeseen disasters. This involves developing social policies that provide risk insurance and strengthening institutions that can be mobilised to deliver assistance when needed.

Illness and death pose tremendous risks for vulnerable households. Hence, strengthening public health services and building an efficient health insurance programme are critical. Present programmes such as Ayushman Bharat cover only hospital expenditures, which can easily lead to escalating public expenditures as individuals who can be treated in outpatient clinics resort to hospitalisation because they lack the funds to pay OPD fees.

Dealing with emergencies also requires building sustainable institutions. During the pandemic, PDS ensured that grains could be distributed despite price rises and transportation challenges. This helped avert hunger and starvation while highlighting the exclusion of migrants who did not have proof of residence, giving impetus to setting up the One Nation, One Ration Card programme. Similarly, immediate cash needs during flooding or other disasters can be met through an infusion of funds if we have access to registries that link people’s current residential locations with their bank accounts.

We must move past the futile debate about estimating the exact number of poor individuals and accept that poverty is declining, requiring re-envisioning of our social protection programmes to ensure we don’t fail those who need help the most. 

The writer is Professor at National Council of Applied Economic Research & University of Maryland. Views are personal.

The power of the private sector: boosting climate resilience

How the IMF is channelling capital to the developing world

Climate finance has been a global priority for decades, with significant milestones such as the Green Climate Fund being established under the United Nations Framework Convention on Climate Change in 2010. Between 2021 and 2023, private sector investments in climate resilience escalated and institutions like multilateral development banks and the Green Climate Fund have been central to this growth.

The Resilience and Sustainability Trust, launched by the International Monetary Fund in April 2022, was set up as an international initiative for channelling climate finance to at risk nations. It aims to help low-income and vulnerable middle-income countries tackle long-term structural challenges, including climate change and pandemic preparedness. The RST’s potential to attract private capital is a core element of its design. With IMF funds in play, private investors could be more willing to take risks and collaborate with these countries to meet their climate finance needs.

The RST offers longer-term financing with a significant grace period, making it an attractive option for private investors who seek reduced financial risks associated with long-term climate projects. The accompanying Upper Credit Tranche programme buttresses macroeconomic and financial stability, improving investor confidence. This potential for private sector involvement is a reason for optimism in climate finance.

Promising results with private sector engagement

The RST is beginning to show results in addressing long-term climate and sustainability challenges. Its full impact, particularly in leveraging private capital, will become more apparent as institutional mechanisms and blended financing structures are adopted, more projects come to the pipeline and innovative public-private risk-sharing instruments evolve.

Eighteen countries have started using RST funds to address their structural challenges, enhance resilience and support sustainable development initiatives. Some countries have explored options to crowd private investments through blended finance structures. These countries, including Barbados, Rwanda and Costa Rica, are inspiring examples of commitment to reform and building a healthy long-term investment climate.

Barbados secured B$141.8m (around $183m) in special drawing rights under the RST to enhance climate resilience and support sustainable development. The government partnered with private companies to expand renewable energy infrastructure and promote sustainable tourism practices. However, attracting significant private investments remains challenging due to procedural hurdles and the need for more substantial policy reforms.

Rwanda is using $319m from the RST’s Resilience and Sustainability Facility to improve resilience against external sector shocks. The government has collaborated with private agri-tech companies to introduce climate-resilient farming techniques and technologies. While Rwanda’s efforts are commendable, the challenge lies in scaling these initiatives to a national level and ensuring that private investments consistently align with long-term sustainability goals.

Costa Rica secured the maximum funding under the RST ($710m) and has catalysed further climate financing from the official and private sectors. The private sector has launched green bonds and sustainability-linked loans supported by RST-backed government policies. Costa Rica’s ambitious goals face potential hurdles, such as the need for robust monitoring and evaluation frameworks to ensure the effectiveness and accountability of private sector contributions.

Private sector cautiousness

Despite the strides made by the RST, the private sector remains cautious about fully committing to providing substantial capital. Private investors seek vital assurances and improvements: policy stability and predictability, regulatory clarity and simplification, enhanced risk mitigation mechanisms, transparency and accountability and project scalability.

MDBs’ involvement in providing guarantees, co-financing and other risk mitigation tools enhances investor confidence. MDBs provide the necessary assurances and risk mitigation tools that private investors seek, encouraging their participation in the IMF’s RST.

Private investors want to see structural and policy reforms supported by RST funding. However, no clear-cut assurances are possible at this stage. The IMF’s ‘Interim Review of The Resilience and Sustainability Trust and Review of Adequacy of Resources’ has highlighted limitations and areas needing improvement. Some countries need help implementing policy reforms quickly enough to attract private capital. Bureaucratic hurdles and insufficient risk mitigation mechanisms remain significant obstacles. Additionally, the alignment between public and private sector goals is still evolving, requiring more robust frameworks for collaboration.

Efforts to boost climate resilience

To attract the private sector, IMF Managing Director Kristalina Georgieva has emphasised the need for the RST to support countries in achieving their climate goals and align the IMF’s operations with the 2015 Paris agreement. This alignment is crucial for mobilising private capital and driving sustainable investments.

In his speech at the European Investment Bank Group Forum 2023, Bo Li, the IMF’s deputy managing director, underscored the role of RST in providing long-term affordable financing and the necessity of private sector participation to meet the vast climate financing needs of developing countries. He highlighted the importance of policies that redirect investment flows towards climate-friendly opportunities and the need for stronger institutional partnerships.

The IMF’s RST is a significant step forward in mobilising climate finance, focused on leveraging private sector involvement. It could become a multilateral initiative success story if it can help foster a stable investment climate through policy reforms, a deep and liquid market for innovative financing instruments and partnerships with multilateral development banks.

The early signs from Barbados, Rwanda, and Costa Rica suggest a robust partnership between the public and private sectors, crucial for sustainable and resilient development worldwide. By learning from the RST’s successes and challenges, other international efforts can enhance their strategies to attract private capital, creating a more sustainable and resilient global economy.

Udaibir Das is the former Assistant Director and Adviser of the Monetary and Capital Markets Department at the International Monetary Fund. He is a Non-Resident Fellow at the National Council of Applied Economic Research and a Senior Non-Resident Adviser at the Bank of England.

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