Introduction to Demography
The term ‘demography’ is composed of two Greek words demos which means people and graphein means describe, both of which together imply a description of people. In other words, demography is a systematic study of population.
In demography we basically study the trends and processes associated with population which includes; changes in population size, patterns of births, deaths and migration, and the structure and composition of the population. Thus, it can be said that all demographic studies are based on the process of counting or enumeration involving a systematic collection of data.
There are two types of demography:
(i) Formal : It is primarily concerned with the measurement and quantitative analysis of population growth and change, rural and urban data etc. It is a wholly quantitative analysis which has intense mathematical methodology.
(ii) Social : It focuses on the social, economic and political aspects of populations. It also enquires into the wider causes and consequences of population structure and changes. It is based on the belief that social processes and structures regulate demographic processes.
Demography and Sociology
Demography plays a major role in the establishment of sociology as an academic discipline. This development took place in the latter half of 18th century in Europe where we can see two prominent changes:
- Formation of nation-states as the principal form of political organisation.
- Beginnings of modern science of statistics.
With these two processes, the modern state started expanding its role and function. It now took active interest in the formation of public health management, policing and maintenance of law and order, economic policies, etc. This new expanding sphere of state activity required a systematic and regular collection of social statistics or quantitative data of the population and economy.
The practice of the collection of social statistics by the state is in itself much older, bit it acquired its modern form towards the end of eighteenth century. The American census of 1790 was the first modern census and the practice was taken up in Europe in the early 1800s.
In India, the modern census began between 1867-72 as an initiative of the British Indian Government and since 1881 it has been conducted in every ten years. The Indian census is the largest such exercise in the world with the latest census taken in 2011.
The social statistics or demographics data are important as they help in the planning and implementation of state politics. But apart from it, social statistics also provide a strong justification for sociology.
The concept of Aggregate statistics or numerical characteristics that refer to a large population offers a concrete argument for the presence of social phenomenon. For example, the data of death rate are made up by aggregating individual deaths. However, death rate itself is a social phenomenon that must be explained socially.
A famous study by Emile Durkheim elucidates this fact. According to him, suicide is a social phenomenon. Thus, the rate of suicide has to be explained by social causes even though each suicide may involve a particular personal reason.
Some Theories and Concepts in Demography
Some theories and concepts associated with demography that are central to the discipline of sociology are given below.
The Malthusian Theory of Population Growth
Thomas Robert Malthus (1766-1834) was an English political economist who worked as a professor of history and political economy at the training centre for the officers recruited in Indian Civil Service. Malthus in his Eassy on Population (1798) presented a theory of population growth.
The key features of a Malthus’ arguments are:
(a) Human population tends to grow at a much faster rate than the rate at which the means of human subsistence (e.g. food, clothing, agricultural products) can grow. Therefore, humanity is condemned to live in poverty.
(b) The rise in population can be understood in terms of geometric progression (i.e. like 2, 4, 8, 16, 32 etc) and agricultural growth in terms of arithmetic progression (i.e. like 2, 4, 6, 8, 10 etc).
(c) In order to balance the social order and to increase prosperity, we need to control population growth. However, human beings only have a limited ability to voluntarily reduce the growth of population, through preventive such as postponing marriage, practicing sexual abstinence or celibacy, etc.
(d) Positive checks to population growth in the forms of famines and diseases are inevitable. They are nature’s way of dealing with the imbalance between the food supply and increasing population.
Criticism of Malthusian Theory
Malthus’s theory of population growth was highly pessimistic. It was also challenged by theorists who believed that economic growth could outstrip population growth.
The Malthusian theory was crticised and refuted on the following basis:
(a) In the European countries the growth pattern of population showed a drastic change in late 19th century and early 20th century. Birth rate had declined and epidemics were under control. With this drastic change, Malthus’s prediction failed because both food production and standards of living continued to rise despite the growth in population.
(b) Liberal and Marxist scholars also criticised Malthus for stating that poverty was caused by population growth. They believed that problems like poverty and starvation were caused by the unequal distribution of economic resources. According to them, the unjust social system allowed the wealthy people to live in luxury while the others i.e. the vast majority were forced to live in poverty.
The Theory of Demographic Transition
Demographic transition theory suggests that population growth is linked to overall levels of economic development. According to this theory every society follows a typical pattern of development related to population growth.
The theory of demographic transition states that every society goes through three basic phases of population growth. They are:
(i) First Stage : Faces a low population growth in a society that is underdeveloped and technologically backward. In this stage, growth rates are low as both the death rate and birth rate are very high, so that the difference between both (or the net growth rate) is low.
(ii) Second Stage : This is a phase of transition from underdeveloped or backward to developing stage finally leading to the advanced developed stage. This stage is characterised by very high rates of population growth.
(iii) Third/Final Stage : This stage also shows low population growth rate but in developed countries, where both rate and death rate have been reduced.
Population Explosion
An important term related to the theory of demographic transition is population explosion. The major reason for ‘population explosion’ is the death rates which are brought down relatively quickly through advanced methods of disease control, public health, better nutrition and unchanged reproductive behaviour. This kind of transition was seen in Western Europe during the late 19th and early 20th century.
In India, demographic transition is not yet complete as the mortality rate has been reduced by the birth rate has not been brought down to the same extent.
Common Concepts and Indicators
Demographic concepts are expressed in rates or ratios involving two numbers,. Among the two numbers, one number shows the particular statistic that has been calculated for a specific geographical-administrative unit; while the other number provides a standard comparison.
Keeping this in mind some key concepts are:
(i) Birth Rate : Birth Rate can be defined as the total number of live births per 1000 population. The calculative formula for birth rate is the total number of live births divided by the total population of that area in thousands.
(ii) Death Rate : Similar to birth rate, death rate can be expressed as the number of deaths in a given area during a given time per 1000 population. These statistics depend on the reporting of births and deaths by the families in which they occur.
In most countries including India, people are required by law to report births and deaths to the appropriate authorities, the local police station of primary health centre in the case of villages or the relevant municipal office in the case of towns and cities.
(iii) Rate of Natural Increase : Also known as the growth rate of population, it refers to the difference between the birth rate and the death rate. When this difference is zero or very small then we say that the population has stabilized or reached the replacement level. The replacement level is the rate of growth required for new generations to replace the older ones that are dying out.
Many countries like Japan, Russia, Italy and Eastern Europe experience negative growth rate such that their fertility level is below the replacement rate. While, some countries high growth rates especially when going through demographic transition.
(iv) Fertility Rate : It refers to the number of live births per 1000 women in the child bearing age group, usually taken to be 15 to 49 years.
The fertility rate like other rates is a crude, rough average of the entire population. It does not take differences across age groups which can sometimes be very significant. Thus, demographics also calculate age-specific rates.
(v) Total Fertility Rate : It refers to the total number of live births that any woman would have at the end of her reproductive age (15-49). This rate is estimated on the basis of the age-specific rates observed during a given period.
(vi) Infant Mortality Rate : It is a number of deaths of babies before the age of one year per 1000 live births.
(vii) Maternal Mortality Rate : It is the rate that keeps a count of the number of women who die in childbirth per 1000 live births.
High infant and maternal mortality rate are the key indicators of backwardness and poverty while good medical facilities and levels of education, awareness are the indicators of development.
(viii) Life Expectancy : It is an estimated number of years that an average person is expected to survive. This calculation is based on age-specific death rates in a given area over a period of time.
(ix) Sex Ratio : It refers to the number of females per 1000 males in a given area at a specific time period. Despite the fact that slightly more males are born than female ones, historically, there are slightly more females than males. In other words, sex ratio favours females. This is because of two factors :
- Girl babies have high resistance to diseases in infancy.
- Women tend to outlive men in most societies. So, there are more old women than men. As a result, there are 1050 females per 1000 males.
However, in many countries like China, India and South Korea, the sex ratio is declining. This is because of the social norms that leads to ‘son preference’ and a relative neglect of the girl babies.
(x) Age Structure of the Population : It refers to the proportion of people in different age groups relative to the total population.
The age structure of any society changes in response to the changes in the levels of development and the average life expectancy. Initially, the lack of proper medical facilities and the prevalence of diseases led to a relatively short life span. But with development, the quality of life improves and life expectancy increases.
As a result of developmental changes, a smaller proportion of population belongs to younger age groups while larger proportions are found in older age groups. This phenomenon is referred to as the ageing of the population.
(xi) Dependency Ratio : It is a measure comparing the portion of a population composed of dependents (i.e. elderly people and children who cannot work) with the population that is in the working age group (15-64 years). It is calculated by dividing the population below 15 or above 64 with the population in the 15-64 age group. The resultant ratio is represented in percentage.
A rising dependency ratio is a cause of worry in countries that are facing an ageing population. This is so because it becomes difficult for a smaller proportion of working age people to carry the burden of providing for a relatively larger proportion of dependents.
On the other hand, a falling dependency ratio can be the source of economic growth and prosperity due to the larger proportion of workers relative to non-workers. Because of the falling dependency ratio, benefits start flowing.
This benefit is also referred to as demographic dividend. However, this benefit is only temporary as the large pool of working population will lead to a large proportion of non-working population.
Size and Growth of India’s Population
India is the second most populous country, following China, with a total population of 121 crores (or 1.21 billion) as per the 2011 Census of India. However, the growth rate of India’s population has not been very high.
India’s Population Growth Rate
India’s population growth rate can be understood by studying the following statistics:
- 1901-1951 shows a modest rate of growth as average growth rate did not exceed 1.33%
- 1911-1921 This period shows a negative rate of growth of 0.03%. This was because of the influenza epidemic (during 1918-19) which killed 5% of the Indian population i.e. 12.5 million people.
- 1961-1981 After independence the growth rate of population substantially increased going up to 2.2%
- After 1981 The annual growth rate has decreased it remains one of the highest in the developing world.
Birth and Death Rate in India
The impact of demographic transition can be clearly seen between 1921 to 1931. Before 1931, both death and birth rate were high, whereas after transitional movement there was a sharp fall in death rate while birth rate fell only slightly.
Reasons for this decline are:
(i) Decline in the death rate after 1921 was because of the increased control over famines and epidemic diseases including plague, small pox and cholera.
(ii) Massive improvement in medical cures, programmes for mass vaccination, and efforts to improve sanitation helped to control epidemics. Today, diseases like malaria, tuberculosis, diarrhoea and dysentry continue to kill people but their numbers are relatively very low.
(iii) Famines were the major reason for the increased mortality. It is generally agreed that famines are caused by high levels of continuing poverty and malnutrition in an agroclimatic environment that was very vulnerable to variation in rainfall.
However, lack of adequate means of transportation and communication along with inadequate efforts of the state also result in famines. Many scholars like Amartya Sen also believe that famines were not necessarily due to fall in food grain production but also because of the inability to buy or obtain food (failure of entitlements).
Substantial improvement in agricultural productivity with the expansion of irrigation, improved means of communication and many relief as well as preventive measures by state had drastically reduced the death rate from famine. Yet, starvation deaths are still reported from some backward regions.
The Mahatma Gandhi National Rural Employment Guarantee (MNREGA) is the latest state initiative that functions to tackle the problem of hunger and starvation in rural areas.
(iv) Unlike, death rate, the birth rate has not registered a sharp fall. This is because birth rate is a socio-cultural phenomenon that is relatively slow to change. Increased levels of prosperity always exert a downward force on birth rate.
As the infant mortality rate declines, there is increase in the levels of education and awareness. With awareness, the family size begins to fall. There are very wide variations in fertility rates across Indian states.
In states like Andhra Pradesh, Himachal Pradesh, Punjab, Tamil Nadu and West Bengal, the Total Fertility Rates (TFR) is 1.7 (2016) each.
Kerala’s TFR is below replacement level meaning that their population is going to decline in future.
States like Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, have very high Total Fertility Rate (TFR). In 2016 the TFR of these states were 3.3, 2.8, 2.7 and 3.1 respectively.
According to the Economic Survey 2018-19, India’s total birth rate was 22.4. (Where rural birth rate was 22.4 and urban birth rate was 17.3).
The highest birth rate in India is of Uttar Pradesh (25.9) and Bihar (26.4). It is estimated that these states account for 50% to the additions to the Indian population upto the year 2041. Uttar Pradesh alone is expected to account about 22% of this population increase.
Age Structure of the Indian Population
India has a very young population. Due to majority of population being young the average age is also less than that for most other countries.
| Age Composition of the Population of India, 1961-2026 Age Group | ||||
|---|---|---|---|---|
| 0-14 years | 15-59 years | 60+ years | Total | |
| 1961 | 41 | 53 | 6 | 100 |
| 1971 | 42 | 53 | 5 | 100 |
| 1981 | 40 | 54 | 6 | 100 |
| 1991 | 38 | 56 | 7 | 100 |
| 2001 | 34 | 59 | 7 | 100 |
| 2011 | 29 | 63 | 8 | 100 |
| 2026 | 23 | 64 | 12 | 100 |
This table shows that the total population of he people under 15 years of age has come down from its highest level of 42% in 1971 to 35% in 2001. The share of 15-60 age group has slightly increased from 53% to 59% while 60+ age group is very small yet increased from 5% to 7% in 2001 to about 12% in 2026.
Age Group Pyramids
Age group pyramid provides us with a detailed version of the kind of age group data. The data presented in given charts has separate columns for males and females with a relevant 5 years age group in the middle. The age groups begin from 0-4 years group at the bottom of the pyramid and go on to the 80 years and above age group at the top. There are four different pyramids for the years 1961, 1981, 2001 and estimated projection for 2026.
The pyramids show the effect of a gradual fall in the birth rate and rise in the life expectancy. More people begin to live to an older age, the top of the pyramid goes wider. And as relatively fewer new births take places, the bottom of the pyramid grows narrower.
But, the birth rate is slow to fall because of which there isn’t much change. The middle of the pyramid grows wider as total population increases. This will create a bulge in the middle age group 2026. This is called demographic dividend.
State Oriented Pyramid
As with the fertility rate, there are wide regional variations in the age structure. While a state like Kerala is beginning to acquire an age structure like that of the developed countries, Uttar Pradesh shows high proportions in the younger age groups and low proportions among the aged. India as a whole lies somewhere in the middle as it includes states like Kerala as well as Uttar Pradesh.
The Declining Sex Ratio in India
The sex ratio is an important indicator of gender balance in the population. We understand sex ration in terms of number of females per 1000 males which has generally been somewhat higher than 1000 as clearly evident in the table. India has been facing a decline in sex-ratio. From 972 females per 1000 males at the turn of the 20th century, the sex ratio has declined to 943 at the turn of 21st century.
| The Declining Sex Ratio in India 1901-2011 | ||||
|---|---|---|---|---|
| Year | Sex Ratio (all age groups) |
Variations Over Previous Decade |
Child Sex Ratio (0-6 years) |
Variation Over Previous Decade |
| 1901 | 972 | – | – | – |
| 1911 | 964 | -8 | – | – |
| 1921 | 955 | -9 | – | – |
| 1931 | 950 | -5 | – | – |
| 1941 | 945 | -5 | – | – |
| 1951 | 946 | +1 | – | – |
| 1961 | 941 | -5 | 976 | – |
| 1971 | 930 | -11 | 964 | -12 |
| 1981 | 934 | +4 | 962 | -2 |
| 1991 | 927 | -7 | 945 | -17 |
| 2001 | 933 | +6 | 927 | -18 |
| 2011 | 943 | +10 | 919 | -8 |
Age Specific Ratio
The various demographers, policy makers, social activists, and concerned citizens are alarmed because of the drastic fall in the child sex ratios. As a matter of fact, the age specific sex ratio began to be computed in 1961.
The sex ratio of 0-6 years age group (known as juvenile or child sex ratio) has generally been substantially higher than the overall sex ratio for all age groups but it has been falling sharply.
The decade 1991-2001 represents an anomaly in that overall sex ratio has shown an increase of 6 points from 927 to 933. But the child sex ratio had dropped from 945 to 927.
In 2011 Census, the child sex ratio again decreased by 13 points and now it is 919.
State-Wise Sex Ratio
The state-level child sex ratio offers a greater cause for worry. The major statistics of the states are:
As many as nine States and Union Territories have child sex ratio of under 900 females per 1000 males.
Haryana has worst child sex ratio of 793 , followed by Punjab, Jammu and Kashmir, Delhi, Chandigarh, Uttarakhand and Himachal Pradesh.
States like Uttar Pradesh, Daman and Diu, Himachal Pradesh , Lakshadweep and Madhya Pradesh fall under the category of 925.
Large states like West Bengal, Assam, Bihar, Tamil Nadu, Andhra Pradesh and Karnataka are above the national average of 919 but below 970.
Kerala has the sex ratio of 964.
The highest sex ratio of 972 is found in Arunachal Pradesh.
Responsible Factors for Declining Sex Ratio
Demographers and sociologists have offered several reasons for the decline in the sex ratio in India. For many the declining sex ratio seemed to be dependent on the maternal mortality rates.
However, with developmental factors such as nutrition, general education and awareness, and medical and communication facilities, maternal mortality rates have declined. Therefore, social scientists shifted their attention towards the differential treatment of girl babies. The one reason that was highlighted was selective child abortion or female infanticide.
Selective sex abortion or female infanticides prevent girl babies form being born due to religious and cultural practices. This problem had been existing in many regions of India with the increasing modern techniques such as sonogram by which the gender of the baby can be determined.
The regional pattern shows that such a practice is most prevalent in the most prosperous regions of India such as Maharashtra, Punjab, Haryana, Chandigarh and Delhi. This points to the fact that the problem is not a resultant of poverty, ignorance or lack of resources.
The reason behind such a trend can be seen because of the reason that economically prosperous families decide to have a fewer children. As a result of such a decision, they might want to select the sex of their child which is possible through ultra sound technique. Keeping the trend of female infanticide in mind, the government has passed strict laws banning the practice.
It imposed heavy fines and imprisonment as punishment to the offenders. One such act known as the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act was enforced in 1996 and strengthened in 2003.
However, such problems depend more on social attitudes even though the laws can help. Recently, the Government of India has launched the ‘Beti-Bachao, Beti-Padhao’ campaign as an important policy to increase the child sex ratio in the country.
Literacy
Literacy as a prerequisite to education is an instrument of empowerment. The more literate the population, the greater the consciousness of career options and participation in knowledge economy. Literacy can lead to health awareness and fuller participation in the cultural and economic well-being of the community. Post-independence , there is a considerable improvement in literacy with almost two-third of our population being illiterate.
Literacy varies across gender, regions and social groups. As compared to men, women literacy rate is 16.3% less.
As per the table given below, the female literacy rate rose by about 10.4% as compared to the 7.6% growth amongst males between 2001 and 2011. Thus, female literacy has been growing at a much faster pace.
Literacy rate also vary by social groups. Historically, Schedule Tribes and Schedule Castes show lower literacy rate with even less female literacy rates. Regional variations are also prevalent in the country with states like Kerala approaching universal literacy and states like Bihar lagging far behind. The inequality in literacy rate is a matter of concern as this tends to produce inequality across generations.
Rural-Urban Differences
A large part of India’s population has always lived and continues to live in rural areas. According to 2011 Indian Census, the population has increase with 68.8% of the total population living in rural areas and 31.2% living in urban areas. There has been a steady growth in the urban population from 11% at the beginning of the 20th century to about 28% at the 21st century. This is not a question of numbers alone, processes of modern development ensure that the economic and social significance of the industrial-urban way of life.
Agricultural Contribution
Agriculture is the largest contributor of country’s total economic production, but today it only contributes about one-sixth of the gross domestic product. Agriculture production has fallen drastically as people in the village are no longer working in agriculture. Rural people are more engaged in non-farm rural occupations like transportation services, business enterprises or craft manufacturing.
Phase of Transition
The process of urbanisation began as the mass media and communication channels became popular. The process of urbanisation can be seen in following ways:
(a) It brought images of urban life styles and patterns of consumptions into the rural areas. As a result the urban norms and standards become well known in even the remote villages creating new desires and aspirations for consumption.
(b) With urbanisation, towns and cities became the magnet for the rural population. If people do not find work in rural areas they go to the city in search of work.
(c) The migration accelerated the decline of common property resources like ponds, forests and grazing lands. These common resources allowed villagers with no or little land to survive. Now, these resources have become private property or have exhausted because of which people cannot access these resources. As a result, the things that they got for free are now available for a price. Thus, along with the limited opportunity for earning cash income, their hardships increases.
(d) Cities are also preferred because of the anonymity it offers. The interaction with strangers as offered by the city is advantageous. For example , the oppressed groups like SCs and STs may gain some partial protection from the daily humiliation that they may suffer in villages because of their caste.
(e) The anonymity also allows the socially dominant groups to engage in low status work that they might not be able to do in a village.
While urbanisation is rapid, the big cities or metropolises have been growing the fastest. There are now 5,161 towns and cities in India, where 286 million people live. More than two-thirds of the urban population lives in 27 big cities with million plus population.
The metros attract people from rural areas as well as towns. As a result, the face of India is becoming more and more urban. Yet one cannot deny that with respect to the political power dynamics in the country, the rural areas remain a decisive force.
Population Policy in India
Population dynamics is an important matter that is crucially affecting the developmental process of a nation as well as the health and well-being of its people.
India is the first country that explicitly announced the population policy in 1952. The policy of population took the correct and concrete form in the form of National Family Planning Programme (NFPP).
The key objectives of the National Family Planning Programme were:
(a) To try to influence the rate and pattern of population growth in socially desirable directions.
(b) To slow down the state of population growth and through the promotion of various birth control methods, improve public health standards and increase public awareness about population and health issues.
Changes in Family Planning Programme
The Family Planning Programme suffered a setback in the year 1975-76, in which National Emergency was declared. During this programme, the government tried to intensify the effort to bring down the growth rate of population by introducing a coercive programme of mass sterilisation. The term ‘sterilisation’ refers to medical procedures like vasectomy (for men) and tubectomy (for women) which prevents conception and childbirth. Vast numbers of mostly poor and powerless people were forcibly sterilised and there was massive pressure on lower level government officials to bring people for sterilisation in the camps that were organised for this purpose. This policy was heavily opposed by the people and the new government elected after emergency abandoned it. The National Family Planning Programme was renamed as National Family Welfare Programme after the emergency and coercive methods, were no longer used.
This programme has a broad-based set of socio-demographic objectives. As a new set of guidelines were formulated as a part of the National Population Policy of 2000. In 2017, a new National Health Policy was incorporated with new targets. After the successful implementation of this programme, it is clear that most economic social and cultural change.
Important Goals of National Health Policy 2017
- Increase in health expenditure by Government as a percentage of GDP from existing 1.15% to 2.5% by 2025.
- Increase in Life Expectancy at birth from 67.5 to 70 by 2025.
- Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
- Reduction of TFR to 2.1 at national and sub-national level by 2025.
- Recue Under Five Mortality to 23 by 2025 and Maternal Mortality Rate from current levels to 100 by 2020.
- Reduce neo-natal mortality to 16 and still birth rate to ‘single digit’ by 2025.
- Achieve global target of 2020 which is also termed as target of 90:90:90 , for HIV/AIDS , i.e., 90% of all people living with HIV know their HIV status , 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression.
- Achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to each elimination status by 2025.
- Reduce the prevalence of blindness to 0.25/1000 by 2025 and disease burden by one-third from current levels.
- Reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
- Increase utilisation of public health facilities by 50% from current levels by 2025.
- More than 90% of the newborn are fully immunised by one year of age by 2025.
- Meet need of family planning above 90% at national and sub national level by 2025.
- 80% of known hypertensive and diabetic individuals at households level maintain ‘controlled diseases status’ by 2025.
- Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
- Reduction of 40% in prevalence of stunning of under-five children by 2025.
- Access of safe water and sanitation to all by 2020.
- Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.
- Increase State sector health spending to >8% of their budget by 2020.
- Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25% by 2025.
- Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm is high priority districts by 2020.
- Increases community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025.
- Establish primary and secondary car facility as per norms in high priority districts (population as well as time to reach norms) by 2025. Ensure district-level electronic database of information on health system components by 2020.