TABLE OF CONTENTS
A.GS1 Related SOCIAL ISSUES 1. Uptick for India on sanitation in UN report B.GS2 Related POLITY AND GOVERNANCE 1. 15 more Finance Ministry officials get marching orders INTERNATIONAL RELATIONS 1. U.S. deploys more troops to West Asia C.GS3 Related ECONOMY 1. India to be most populous by 2027: UN 2. E-com firms take up data localisation issues with Goyal D. GS4 Related E. Editorials POLITY AND GOVERNANCE 1. An idea whose time may not have come 2. Preventing violence ECONOMY 1. Building confidence, BIT by BIT 2. Doctors and patients deserve better 3. A long-term vision for universal eye-care F. Tidbits G. Prelims Facts 1. Foreign Contribution Regulation Act (FCRA) H. UPSC Prelims Practice Questions I. UPSC Mains Practice Questions
A. GS1 Related
A monitoring report by United Nation organisations released recently shows that there has been absolutely no growth in the population with access to piped water facilities over the period where India’s progress with respect to providing basic sanitation facilities accounts for almost two thirds of the 650 million people globally who have stopped practising open defecation between 2000 and 2017.
- India has made great gains in providing basic sanitation facilities since the start of the millennium.
- The percentage of households getting piped water has remained stagnant at 44% over the 17-year period.
- As for drinking water, the Joint Monitoring Programme report by UNICEF and WHO shows that India has increased the percentage of its population with access to a protected drinking water source less than 30 minutes away, from 79% in 2000 to 93% in 2017.
- In addition, large inequalities remain between rural and urban areas in terms of access to piped water facilities.
- With regard to sanitation, India’s record has been better.
- India is responsible for almost single-handedly dragging the world towards achieving Sustainable Development Goal of ending open defecation.
- Including India, the South Asian region, accounted for almost three-fourths of the population who stopped defecating in the open between 2000 and 2017.
- Of the 2.1 billion people who gained access to basic sanitation services over this time period globally, 486 million live in India.
- India’s Swacch Bharat Mission has set an example to many other regions of the world.
- Political leadership, public financing, partnerships and people’s participation are believed to be the four reasons for the success of the program.
- The millions of new toilets which mark the progress of the Swachh Bharat mission are, producing large amounts of solid and liquid waste and India does not have the ability to treat and dispose it off safely.
- According to the report, only 30% of the country’s wastewater is treated at plants providing at least secondary treatment, in comparison to an 80% global average.
- The human right to sanitation implies that people not only have a right to a hygienic toilet but also have a right not to be negatively affected by unmanaged faecal waste.
- It is most relevant to poor and marginalized groups who tend to be disproportionately affected by other people’s unmanaged faecal sludge and sewage.
- Solid and liquid waste management must be the focus of Swachh Bharat phase 2.
- A roadmap and strategy must be carefully designed to achieve the desired objectives and ensure its penetration to the length and breadth of the country.
B. GS2 Related
Fifteen senior Finance Ministry officials of Central Board of Indirect Taxes and Customs (CBIC) have been sent into compulsory retirement, as a part of the action aimed at cleaning up the government service.
- Clause (J) of Rule 56 of the Fundamental Rules says: “The Appropriate Authority shall, if it is of the opinion that it is in the public interest to do so, have the absolute right to retire any government servant by giving him notice of not less than three months in writing or three months’ pay and allowances in lieu of such notice.”
- It was decided by the president to remove the officials with immediate effect rather than giving them a three months’ notice.
- Orders issued by the Finance Ministry have quoted clause J of rule 56 of the Fundamental Rules. Based on this rule, the President retires these officials in public interest with immediate effect on completing 50 years of age.
- The move comes a week after orders were issued for the retirement of twelve senior officials of Income Tax Department by the President under the pretext of alleged corruption, extortion and sexual harassment.
- On a quarterly basis, a review is carried out on including of officials and employees facing serious allegations of corruption.
- If the allegations are found to be true by the review committee, it recommends compulsory retirement and the order is then signed by the President.
- The compulsorily retired officials will be paid a sum equivalent to their pay and allowances for three months, calculated at the same rate at which s/he was drawing them immediately before retirement.
- Such an action is considered as a penalty and the government believes that it will act as a deterrent for others.
- At present, the retirement age is 60 years. The loss of 10 years of service means loss in terms of the benefits and perks for that period and, more importantly, a lifelong loss of honour.
The U.S. has announced its decision to deploy 1,000 additional troops to West Asia for defensive purposes to address air, naval, and ground-based threats.
- The tensions between the U.S. and Iran have heightened with the U.S. tightening sanctions.
- The U.S. has also blamed Iran for recent attacks on two tankers in the Gulf of Oman, a charge Tehran denies as baseless.
- Iran has said it would surpass its uranium stockpile limit set under the nuclear deal i.e, Joint Comprehensive Plan of Action (JCPOA) with world powers.
- The U.S. says that it does not seek conflict with Iran but the action had been taken to ensure the safety and welfare of the military personnel working throughout the region to protect their national interests.
- It was said that the military would continue to monitor the situation and make adjustments to troop levels accordingly.
- Iran however, insisted that Tehran would not wage war against any nation.
- “Despite all of the Americans’ efforts in the region and their desire to cut off our ties with the entire world and their desire to keep Iran secluded, they have been unsuccessful,” Iran’s President, Mr. Rouhani said.
- Russia and China have called for restraint, warning the U.S. about escalating West Asian tensions.
- China urged all sides not to take any actions to provoke the escalation of tension in the region. It has also urged the U.S to change its practice of extreme pressure.
- The UK, France and Germany have warned Iran not to violate the 2015 deal, stating that they would have no choice but to impose sanctions on Iran if it would not oblige to the limits set under the nuclear deal.
C. GS3 Related
According to the recently released World Population Prospects 2019 report, India is expected to add 273 million people by 2050, which will be the largest national increase in the world.
- India is set to overtake China as the most populous country by 2027 and will have almost 1.64 billion inhabitants by 2050, says the United Nations report.
- It says that South Asia’s opportunity to reap the demographic dividend will peak by 2047.
- While India may have the highest absolute increase in numbers, its rate of growth is slowing.
- The rate of population growth is the highest in sub-Saharan Africa, where the fertility rate stand at 4.6 births per woman over a lifetime. The region is expected to double its population by mid-century.
- Health economists claim that the major implications of population growth will be increase in young and older population that will face a lack of resources in future.
- India is still among the countries where the working-age population (25-64 years) is growing faster than other groups, creating an opportunity for accelerated economic growth.
- Globally, people aged above 65 are the fastest growing age group, putting pressure on social protection systems as the proportion of the working-age population shrinks.
- By 2050, almost 50 countries are expected to have less than two working-age people to support every person above 65.
- These low values underscore the potential impact of population ageing on the labour market and economic performance as well as the fiscal pressures that many countries will face in the coming decades as they seek to build and maintain public systems of health care, pensions and social protection for older persons
- The major implication for India, will be on the demographic dividend.
- The country will have more young people as well as older people. T
- he employment rates are going down in India and with more younger people, India wont’ be able to absorb them in workforce and won’t be able reap it the benefits of its demographic dividend.
- There could be a rise in equality, and the country will have to work out a mechanism to tackle these problems.
- A high population with no jobs may become a threat to the economy and the current challenges will become harder.
Measures taken to control population growth:
- For curbing population growth, the union health ministry in 2017 launched mission Parivar Vikas to increase access to contraceptives and Family Planning services in 146 high fertility districts.
- The current basket of choice has been expanded to include the new contraceptives viz. Injectable contraceptive, Centchroman and Progesterone Only Pills (POP).
- Also, the sterilization compensation scheme has been enhanced in 11 high focus states (8 Empowered Action Group (EAG), Assam, Gujarat, Haryana).
- The government has been looking for private sector to help in the cause.
- Government has also been looking at the private sector, in the form of CSR for supporting its family planning program.
- India needs to design solid strategies to generate sufficient employment opportunities to reap the benefits of the demographic dividend and prevent the growing population become a demograph8ic disaster.
- Investment in health care sector must increase
- Investing in a skilled health workforce can both draw dividend from the youth segment while meeting the health needs of the elderly.
- There is a need for more investment in education and women empowerment as they are the key contributors both to slowing down population growth and accelerating development.
- A meeting was held by the Commerce Minister Mr. Piyush Goyal in order to understand the concerns of E-commerce firms and take their suggestions towards building a robust data protection framework that will achieve the dual purpose of privacy and innovation; strengthen India’s position as a global tech leader with focus on trust and innovation.
- The draft national e-commerce policy has proposed setting up a legal and technological framework for restrictions on cross-border data flow and also laid out conditions for businesses regarding collection or processing of sensitive data locally and storing it abroad.
- The ministry is in the process of finalising a national e-commerce policy.
- The meetings are expected to deliberate upon threats from large foreign competition, level playing field and impact of anti-competitive practices such as predatory pricing and other discriminatory practices.
- E-commerce companies have voiced their concerns about the Reserve Bank of India’s data localisation norms.
- Some of the companies also raised concerns about the draft e-commerce policy released by the government, especially provisions related to treatment of data.
- Concerns have been raise that the provision that the government should have the sovereign right over all data at all times is unviable.
- The other issue was the government’s demand for data from companies, where the companies argued that the data should be shared only for law and order and investigation situations.
- The third data-related issue raised was that companies cannot share their data with their group companies.
- The argument made was that if a start-up is acquired by a multinational company, then it becomes a part of that company. And that if the start-ups cannot share its data with the parent company, then there would apprehensions in buying Indian start-ups.
D. GS4 Related
Nothing here for today!!!
What’s in the news?
- Experts point out that not even a month after the world’s largest elections in history were over, the debate around “one nation, one election” has been resurrected.
- As a matter of fact, Prime Minister Narendra Modi, who had continued to flag the issue for the last five years, has now called for a meeting on the subject with leaders of other political parties.
What did the 2014 manifesto of the ruling Bharatiya Janata Party (BJP) say?
- The 2014 manifesto of the ruling Bharatiya Janata Party (BJP) read: “The BJP will seek, through consultation with other parties, to evolve a method of holding Assembly and Lok Sabha elections simultaneously. Apart from reducing election expenses for both political parties and Government, this will ensure certain stability for State Governments.”
- As a matter of fact, in an interview with a news channel in January 2018, the Prime Minister had rightly highlighted the demerits of the country being in constant election mode.
- “One election finishes, the second starts,” he said. He argued that having simultaneous Parliament, Assembly, civic and Panchayat polls once every five years and completed within a month or so would save money, resources and manpower.
- This, he pointed out, happened on account of a large section of the security forces, bureaucracy and political machinery having to be mobilised for up to 200 days a year on account of electioneering.
- It is important to note that the BJP’s 2019 manifesto also mentions that simultaneous elections for Parliament, State Assemblies and local bodies to “ensure efficient utilisation of government resources and security forces and… effective policy planning”.
- The manifesto also goes on to say that the party “will try to build consensus on this issue with all parties”.
- It is in this spirit of reform and consensus building that the Prime Minister has revived this debate, calling an all-party meeting for discussions on June 19th, 2019.
Voices in support of the idea of simultaneous elections:
- The re-elected Chief Minister of Odisha, Naveen Patnaik, has already welcomed the idea, saying, on June 15th, 2019 that frequent elections affect the development climate, and hence it is better to have simultaneous elections in the country.
- The Law Commission had recommended simultaneous elections to Lok Sabha, Vidhan Sabha and the local bodies as far back as in 1999.
- The BJP’s L.K. Advani also supported the idea back in 2010 in an eloquent blog post.
- The matter was examined by a Parliamentary Standing Committee in December 2015, and was also referred to the Election Commission of India (EC). Both supported it in principle.
Potential Benefits of simultaneous elections:
- Reducing Costs:
- The concerns raised are indeed genuine, and the idea is worth debating.
- Firstly, it is becoming more and more difficult to contest elections.
- The 2019 general election was the most expensive on record; a whopping ₹60,000 crore was reportedly spent on the whole exercise.
- Given that there is no cap on the expenditure incurred by political parties, they spend obscene amounts of money in every election.
- It is argued that simultaneous elections would help reduce this cost.
- Reducing Disruption to Civic Life:
- Secondly, frequent elections hamper the normal functioning of the government and disrupt civic life.
- This happens because the Model Code of Conduct (MCC) comes into operation as soon as the EC announces the election dates.
- This means that the government cannot announce any new schemes during this period.
- This results in what is often referred to as a policy paralysis.
- The government cannot make any new appointments or transfer/ appoint officials.
- The entire government manpower is involved in the conduct of elections.
- Some experts also opine that elections are the time when communalism, casteism and corruption are at their peak.
- Frequent elections mean that there is no respite from these evils at all.
- This has directly resulted in the souring of the political discourse, something that was on full display during the 2019 general election.
- Furthermore, from the point of view of Election Commission of India, simultaneous elections make perfect sense because the voters for all three tiers are the same, polling booths are the same and staff/security is the same — the suggestion of “one nation, one election” seems logical.
Some Obstacles in the Way of Simultaneous Elections:
- There are some obstacles in the way. As a matter of fact, several important questions arise.
- How will “one nation, one election” work in case of premature dissolution of the Lok Sabha, for instance, as happened in late 1990s when the House was dissolved long before its term of five years was over?
- In such an eventuality, would we also dissolve all State Assemblies?
- Similarly, what happens when one of the State Assemblies is dissolved? Will the entire country go to polls again? This sounds unworkable both in theory and in the practice of democracy.
Some nuanced perspectives:
- As for the implementation of schemes of the government during the MCC period, only the new schemes are stopped as these could be tantamount to enticing/bribing voters on the eve of elections. All ongoing programmes are unhindered.
- Even new announcements that are in urgent public interest can be made with the prior approval of the EC.
- Additionally, experts point out that frequent elections are not so bad for accountability. They ensure that the politicians have to show their faces to voters regularly.
- Furthermore, creation of work opportunities at the grass-root level is another big upside.
- The most important consideration is undoubtedly the federal spirit, which, inter alia, requires that local and national issues are not mixed up.
- Now, as the debate has been rekindled, wider deliberation on the need for a range of reforms must be considered.
- Till the idea achieves political consensus, there are two alternative suggestions to deal with the problems that arise due to frequent elections.
- Firstly, the problem of uncontrolled campaign expenditure can be remedied by introducing a cap on expenditure by political parties.
- State funding of political parties based on their poll performance also is a suggestion worth considering.
- Private and corporate fund collection may be banned.
- Some experts have also suggested that the poll duration can be reduced from two-three months to about 33 to 35 days if more Central armed police forces can be provided.
- The problems associated with a multi-phased election have been getting compounded, with more issues being added to the list with every election.
- Next, violence, social media-related transgressions and issues related to the enforcement of the MCC which are unavoidable in a staggered election will vanish if the election is conducted in a single day. All that needs to be done is to raise more battalions. This will also help in job creation.
- In conclusion, it is undeniable that simultaneous elections would be a far-reaching electoral reform.
- However, if it is to be implemented, there needs to be a solid political consensus, and an agenda of comprehensive electoral reforms should supplement it.
- The pros and cons need to be appropriately assessed and practical alternatives sincerely considered.
- Lastly, it is good that the government continues to encourage a debate on the subject rather than forcibly pushing it through.
What’s in the news?
- In a recent development, West Bengal Chief Minister Mamata Banerjee ended the week-long strike by junior doctors in the State after calling a meeting with the agitating medicos. Post this, a credible assurance was given that their safety was a priority for her government.
- The attack on a junior doctor on June 10th, 2019 over the death of a patient had sparked the agitation, which spread to other parts of the country when it appeared that the State government was reluctant to negotiate with the striking doctors.
- Experts opine that now that Ms. Banerjee has reached out to young doctors and conceded that their demands are genuine, the government, in West Bengal and elsewhere, must focus on addressing the deficiencies afflicting the health-care system as a whole.
- It is important to note that reprisal attacks on doctors by agitated relatives of patients who die during treatment are known to happen.
- Such violence is invariably the result of systemic problems that adversely affect optimal attention to patients, such as infrastructural and manpower constraints.
Conditions under which doctors work:
- It is apparent that doctors work in stressful environments, sometimes under political pressure with regard to admissions.
Steps taken to protect doctors:
- Several States have enacted laws to protect doctors and other health-care personnel from violence.
- Recently, Union Health Minister Harsh Vardhan wrote to State governments highlighting the need for stringent action against anyone who assaults doctors.
- He also asked States that do not have a law to protect doctors against violence to enact one, and circulated a 2017 draft of a law that envisaged imprisonment besides recovery of compensation from perpetrators for loss or damage to property.
- Having said this, an important question arises: Is such a law really effective?
- Ironically, West Bengal, which is at the epicentre of a strike that involved nearly the entire medical fraternity across the country, has such a law too.
- Like the law in most other States, the West Bengal Act provides for a three-year prison term and a fine, which could go up to ₹50,000, to anyone indulging in violence against any “medicare service person”, which covers doctors, nurses, medical and nursing students and paramedical staff.
- The offence is cognisable and non-bailable.
- It also provides for recovery of compensation for loss.
- It is important to note that many other States have similar laws, with the one in Tamil Nadu providing for a prison term that could go up to 10 years.
- It is clear that having this law did not prevent the incident that sparked the latest agitation.
- There are no figures available on how many times the medical service person protection law has been invoked.
- In any case, causing simple or grievous injuries to anyone is a criminal offence under the Indian Penal Code. Lastly, treating the issue as a law and order problem is just one way.
- The real solution may lie in improving health infrastructure, counselling patients about possible adverse treatment outcomes, and providing basic security in medical institutions.
- Experts opine that as Minister of Finance and Corporate Affairs Nirmala Sitharaman gets ready to present the first budget of the 17th Lok Sabha, she faces enormous challenges.
A Look at some of these challenges:
- Currently, the GDP growth rate is at a five-year low, domestic consumption is sinking, the business confidence index has plunged, and India has recorded its highest unemployment rate in the last 45 years.
- To add to this list of woes is a claim made by Arvind Subramanian, India’s former Chief Economic Adviser, that India’s GDP has been overestimated.
- Foreign direct investment (FDI) equity inflows to India in 2018-19 contracted by 1%, according to the government’s own data.
- After an increase of 22% and 35% in 2014-15 and 2015-16, respectively, FDI equity inflows began tapering off since 2016-17 with the growth rate falling to 9% and then to 3% in 2017-18.
A More Closer Look:
- Experts point out that this contraction in FDI inflows comes at a time when global supply chains are shifting base as a result of the ongoing trade war between the U.S. and China.
- As a matter of fact, India has failed to attract firms exiting China.
- Many of these supply chains have relocated to Vietnam, Taiwan, Malaysia and Indonesia.
- India has not been the natural/first option for these firms for a host of reasons. These include:
- Poor infrastructure,
- Rigid land and labour laws,
- A deepening crisis in the banking sector and
- A lack of structural economic reforms.
Perspective on India terminating bilateral investment treaties (BITs):
- As a matter of fact, the decline in the FDI growth rate, despite the well-advertised improvement in India’s ease of doing business rankings, interestingly, has coincided with India’s decision, in 2016, to unilaterally terminate bilateral investment treaties (BITs) with more than 60 countries. This is around 50% of the total unilateral termination of BITs globally from 2010 to 2018.
- Critics have opined that unilateral termination of BITs on such a mass scale projects India as a country that does not respect international law.
- India also adopted a new inward-looking Model BIT in 2016 that prioritises state interests over protection to foreign investment.
- Experts point out that in the absence of empirical evidence, one cannot conclude that termination of BITs and adoption of a state-friendly Model BIT adversely impacted FDI inflows.
- Nonetheless, since studies have shown that BITs positively impacted foreign investment inflows to India, an examination of the link between the two should be a high priority for the Ministry of Finance and Corporate Affairs. The Ministry of Finance and Corporate Affairs is also the nodal body dealing with BITs.
- It is also important to note that the decision to terminate BITs and adopt a state-friendly Model BIT was a reaction to India being sued by several foreign investors before international arbitration tribunals.
- The government concluded that these claims were an outcome of India’s badly designed BITs, signed in the 1990s and 2000s that were based on a laissez faire template.
Case of Bad regulation? An Insight:
- It is true that India’s BITs gave extensive protection to foreign investment with scant regard for state’s interests — a characteristically neoliberal model. However, experts point out that this design flaw could have been corrected by India negotiating new balanced treaties and then replacing the existing ones with the new ones instead of terminating them unilaterally, which has created a vacuum.
- Importantly, the design flaw was not the real reason for the increasing number of BIT claims.
- As a matter of fact, critics opine that a large number arose either because the judiciary could not get its act together (an example being inordinate delays in deciding on the enforceability of arbitration awards) or because it ruled in certain cases without examining India’s BIT obligations such as en masse cancellation of the second generation telecom licences in 2012.
- Likewise, experts point out that the executive — the Manmohan Singh government — got the income tax laws retrospectively amended in 2012 to overrule the Supreme Court’s judgment in favour of Vodafone and cancelled Devas Multimedia’s spectrum licences in 2011 without following due process, thus adversely impacting Mauritian and German investors.
- These cases are examples of bad state regulation. Critics point out that they also reveal an absence of full knowledge of India’s obligations under BITs by different state entities.
- Thus, experts suggest that the Ministry of Finance and Corporate Affairs should invest extensively in developing state capacity so that the Indian state starts internalising BITs and is not caught on the wrong foot before an international tribunal.
- In correcting the pro-investor imbalance in India’s BITs, India went to the other extreme and created a pro-state imbalance as evident in the Model BIT.
- Correcting this imbalance should be high on the reform agenda of the government.
- As a matter of fact, ‘Progressive capitalism’ (channeling the power of the market to serve society, as explained by Nobel laureate Joseph Stiglitz) provides the right template.
- Further, Indian BITs should strike a balance between interests of foreign investors and those of the state.
- Also, a certain degree of arrogance and misplaced self-belief that foreign investors would flock to India despite shocks and surprises in the regulatory environment should be put to rest.
- In conclusion, continuity and transparency in domestic regulations and a commitment to a balanced BIT framework would help India project itself as a nation committed to the rule of law, both domestically and internationally, and thus shore up investor confidence.
- As the 2019 World Investment Report confirms, since India is fast becoming a leading outward investor, balanced BITs would also help in protecting Indian investment abroad.
A Brief Look at the recent turn of events:
- Junior doctors in a state-run hospital in Kolkata were attacked by the angry relatives of a patient who died there, junior doctors across West Bengal went on strike, outraged senior doctors paid lip service to their cause, medical associations went on a token strike, and there were calls for stricter laws and for increasing security for doctors.
- Some experts opine that it was the usual narrative involving lumpen mobs, allegations of political instigation, unrealistic expectations from patients, overworked doctors, and calls for increased security, which included bizarre demands for bodyguards and even bouncers.
Important Questions that arise:
- Will punitive action, new laws or increased security change this scenario?
- Will we never see an incident like this if such measures are taken?
- These are questions worth examining.
Examining the setting and the triggers of a potential flashpoint:
- The setting in which a majority of such incidents have taken place offer some clues.
- The most common scenario is that of a patient being brought to the casualty ward of a public hospital in a critical condition by family members or neighbours.
- If the patient does not survive, there is the reality or perception that treatment was not administered to him or her in time. The tipping point is when the staff in hospitals display insensitivity when they are questioned about delays.
- It is true that the emergency wards of India’s public hospitals are chaotic, disorganised and resemble conflict zones.
- While there are several factors that contribute to this, the complete absence of the globally recognised protocol of ‘triage’ is a big reason.
- Triage involves a rapid examination of a patient to determine whether he or she needs instant care, early care, or care that can wait.
- Experts point out that the absence of this protocol means that emergency wards are often occupied by patients with all sorts of minor injuries.
- Data reveals that in certain hospitals, more than 90% of patients frequenting the casualty ward over a two-year period had minor injuries which could have been easily treated in a smaller setting.
- In India, when people go to the police with a complaint of an assault, they are advised to go to a government hospital even if they have very minor injuries, to record them to strengthen their legal case.
- All these patients come to the casualty ward adding to the crowd and the burden of the hospital staff. Experts opine that if the staff have to treat only 10% of the load of critical patients, they would do a much better job and perhaps even save lives.
- It is important to note that the huge workload in large teaching hospitals in cities, such as in Kolkata’s Nil Ratan Sarkar Medical College and Hospital, is also the result of the poor capacity of suburban and rural hospitals to handle sick patients. This uneven scenario is due to excessive centralisation of funds, staff and equipment.
A growing chasm:
- Experts point out that there is also a dangerous argument that is being put forth in the aftermath of such attacks: that people’s expectations have increased.
- As a matter of fact, it is hard to understand what this means in a system where the bar has been set very low. For example, are people who see huge delays, rickety ambulances and lack of equipment or malfunctioning equipment not supposed to respond? Isn’t it possible that common citizens who see swanky private hospitals delivering quick, organised care wonder why they get such a raw deal?
- In other words, is the realisation that there is a more effective way of care, which the common man is being denied because of his or her inability to pay for it, the cause for anger which periodically explodes in a perverse manner?
The Psychology behind Attacks:
- One reason why laws are unlikely to work is that patients and their families or friends do not come to a hospital with a plan to attack.
- As a matter of fact, attacks are impulsive responses in an emotional moment.
- What may work instead is softening the blow on families by examining how, where and who delivered the bad news to them.
- If family members in moments of intense grief are now regularly donating organs to their near and dear ones, there must be something that we are doing right.
- This is happening probably because the news is broken to them in a planned and organised manner by a trained transplant coordinator, usually in the sanitised setting of an intensive care unit of a large private hospital.
- Experts opine that members of the medical profession, who have been trained in the method of science, can do better than imitate the impulsive, inappropriate responses of those who attack the first doctor in sight, as well as the political class.
- As a matter of fact, several structural and policy changes in the way India’s hospital systems work can reduce, if not eliminate, the perception that there is negligence in caring for patients.
- Medical associations need to take the lead in demanding policy change.
Note to the Students:
- This analysis is taken from the Hindu Business Line, published on the 19th of June, 2019.
- In 2015, member nations of the World Health Organization set about achieving universal health coverage (UHC) as one of their targets when adopting the Sustainable Development Goals (SDG).
- UHC is defined by three components: healthcare access for all individuals and communities, comprehensive care, and financial protection.
- Since access is foundational to building comprehensive and affordable healthcare, primary healthcare (PHC) is recognised as a key strategy to ensure that everyone in need of care is able to get into the system.
- It is important to note that until recently, PHC was confined to maternal, child health, and common illnesses.
- However, since becoming a signatory to the global initiative to address non-communicable diseases, India has expanded the scope of PHC to include hypertension, cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.
Need for changes in policies and regulations:
- Experts opine that while new strategies and technologies are being put in place to realise the aspirations of UHC, there is an urgent need for new or changes in policies and regulations to enable such initiatives to become effective.
- The current, often decades’ old regulations that were relevant then, now have to undergo a paradigm shift, both to accommodate the technological advances and enable the new initiatives
Perspective on Eye-Care:
- When it comes to eye care, the strategy for providing screening and some level of primary care at the community level in India (and most developing countries) is essentially limited to periodic community outreach events like eye camps, typically conducted once a year in a given community.
- A study done in South India in the late 1990s showed that less than 7 per cent of those who already felt they needed an eye care intervention attended an eye camp, even when it was in the same or a nearby village.
- On a population coverage basis, this was under 0.25 per cent, while an estimated 20-25 per cent of the general population would have some eye care need.
- In hindsight, it’s clear that an eye camp that happens once a year for five to six hours is unlikely to cater to the needs of all, reinforcing the need for permanent, year round primary eye care services.
Note on a recent case study:
- A team of researchers conducted a case study to demonstrate the feasibility and policy changes that have to be enacted to make this UHC goal an effective reality.
- As the first step, they broke down primary eye care conditions into case findings, treatments, and follow-ups.
- With the advent of technologies like broadband, telemedicine, and low-cost imaging, they chose to set up telemedicine and information technology-enabled primary eye care centres (vision centres) with simple user interfaces.
- The first vision centre was launched in 2003. Since then, 75 such centres have come up across rural Tamil Nadu, covering a population of over six million. The average population coverage is around 25 per cent — going as high as 50 per cent in older centres (half the population had visited the vision centre one or more times for some eye condition).
- About 90 per cent of the patients visiting vision centres receive complete care — diagnosis, treatment advice, and medicines or prescribed spectacles.
- Further, it is important to note that while patients pay for these, they are priced affordably and everyone receives them immediately. As necessary, some of the patients are referred to the base hospital for surgery or more advanced care.
- Patients’ compliance to referrals is very high since referrals are limited to those with advanced conditions requiring surgery or specialised investigations.
- Here, they have the option of getting the services at the hospital at subsidised rates or for free. This combination of high coverage, addressing all eye conditions, and being affordable meets the three components of UHC.
- As a matter of fact, this scaled working model of universal eye health has widespread potential and its underlying principles and technologies could be replicated across all disciplines of healthcare.
- Within eye care, scaling has happened across the States of Tripura, Chhattisgarh and Tamil Nadu, and quite extensively in Bangladesh.
- However, several policy gaps are preventing this from being scaled to its full potential.
- A lot of the policies and regulations were formulated at an era when the current technologies were not present and the services were largely urban-centric. Two major policy areas, in particular, need to be addressed.
- Telemedicine and remote diagnosis have been around for over a decade now and have many applications from radiology interpretation to cardiac consultation based on ECG.
- The government has, in fact, been promoting telemedicine since 2001 with the Indian Space Research Organization providing connectivity to remote rural areas.
- On the other hand, a lack of policy guidelines gives rise to situations such as the one reported by The New Indian Express in September 2018, in which a doctor couple who provided remote consultation was charged with medical negligence by a Bombay High Court, declaring such consultations as illegal, leading to a negative impact on the teleconsultation industry.
- Experts opine that UHC can become a reality only through a PHC approach. And comprehensive PHC can be successful only through the deployment of digital technologies like tele-health and artificial intelligence. This requires enabling policies.
A Perspective on Drug supplies:
- A patient’s health condition doesn’t improve unless the patient is able to get the prescribed medicines and use them as directed.
- When medications are prescribed for speciality conditions (like ophthalmology) at the village level, such medications are not available in local pharmacies, even if they exist, which often is not the case.
- The patient then has to go to the nearest town, at considerable expense and effort, to get the medication and in most instances this doesn’t happen.
- As a result, the patient’s condition doesn’t improve and often deteriorates.
- The Pharmacy Act stipulates certain minimum physical infrastructure and qualified pharmacists to dispense the medications. This works fine in urban settings where the scale of operations can support such staffing and infrastructure.
- However, at the grassroots level, the current regulations will obstruct patients from getting medications in a timely and affordable manner. This necessitates appropriate policy changes (such as innovations like the Nuka System of Care in Alaska).
- The current policy and regulatory framework doesn’t work at the primary level, which happens at a much lower scale.
- Similarly, policies need to be cognisant of technological advances and their demonstrated potential, as well as redefine what staff at the primary level can do with technological support.
- Such changes will help drive the primary care approach, which is fundamental to achieving universal healthcare.
Nothing here for today!!!
G. Prelims Facts
- The FCRA was enacted in 1976 in order to maintain strict control over voluntary organisations and political associations that received foreign fundings.
- In the year 1984, an amendment was made to the act requiring all the Non-Governmental Organisations to register themselves with the Home Ministry.
- In 2010, the act was repealed and a new act with strict provisions was enacted. It is a consolidating act passed by the Government of India.
- It seeks to regulate the foreign contributions or donations and hospitality (air travel, hotel accommodation etc) to Indian organizations and individuals and to stop such contributions which might damage the national interest.
- It is an act passed for regulating and prohibiting the acceptance and utilization of foreign contribution or foreign hospitality by companies, associations or individuals for such activities that could prove to be detrimental to the national interest and for matters connected therewith or incidental thereto.
- Since the Act is internal security legislation, despite being a law related to financial legislation, it falls into the purview of Home Ministry and not the Reserve Bank of India (RBI).
H. Practice Questions for UPSC Prelims Exam
Q1. Consider the following statements with respect to Seva Bhoj Yojana?
- It is a programme of the Ministry of Culture.
- The scheme envisages lessening the burden of such Charitable Religious Institutions who provide food without any cost.
Which of the given statement/s is/are incorrect?
a. 1 only
b. 2 only
c. Both 1 and 2
d. Neither 1 nor 2
Q2. Consider the following statements with respect to Pariwartan Scheme:
- Under the scheme, there is a focus on warehousing stressed power projects to protect their value.
- This scheme will be implemented by the Ministry of Ministry of Power.
Which of the given statement/s is/are correct?
a. 1 only
b. 2 only
c. Both 1 and 2
d. Neither 1 nor 2
Q3. Consider the following statements:
- During the Vajrayana phase of Buddhism, worship of the female form was seen.
- The goal of spiritual practice within the Vajrayana traditions is to become a fully awakened Buddha.
Which of the given statement/s is/are correct?
a. 1 only
b. 2 only
c. Both 1 and 2
d. Neither 1 nor 2
I. UPSC Mains Practice Questions
- One nation – one election is a mirage in the desert of electoral politics. Discuss with special emphasis on practical alternatives to the idea. (15 Marks, 250 Words)
- The nation-wide doctor’s strike has flagged the fault lines in the doctor-patient relationship. It underscores the need for institutional initiatives to restore the relationship. Elucidate. (15 Marks, 250 Words)
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