Table of Contents: PUBLIC GRIEVANCE REDRESSAL
1. Effective Grievance Redressal: Heart of Good Governance
2.Public Grievance Redressal: Governance Challenge
3.Private Service Providers: Redressal Mechanism
4.Grievance Redressal Mechanisms for women
5.Role of Behaviour Change Communication in Achieving a Swachh Bharat
6.Citizen’s Charter in India
7.Addressing Grievances in Health Care
8.Innovative Financing for Health System
Effective Grievance Redressal: Heart of Good Governance
Good Governance is the key to a Nation’s progress. It is the simplification of procedures and processes in the Government so as to make the entire system transparent and faster. Further, the ever expanding provision of Citizen-centric Online Services is one of the most important aspects of an efficient and effective public administration system as it leads to transparency and accountability in governance and also fosters equitable growth. Technology is, thus, both an empowering tool for citizens and a measure of accountability for the Government.
Besides the change in procedure and processes and use of the empowering nature of technology, it is important to note that public grievances redress is equality a very important component of a responsive administration. The grievance redressal mechanism of an organisation is its instrument to measure efficiency and effectiveness as it provides important feedback on the working of that organisation.
Public Grievance Mechanism in India:
Public redress of grievances as a cornerstone of ‘Minimum Government, Maximum Governance’ is a key aspect of New India 2022. In accordance with the estimates made by the National e-Governance Division (NeGD) of the Department of Electronics and Information Technology (DeitY) there are more than 3500 different e-services being offered by various Central Ministries and State Governments.
- The Government of India has established an internet based Centralised Public Grievances Redress and Monitoring System (CPGRAMS) to facilitate all citizens to lodge grievances for redressal.
- CPGRAMS is a platform based web technology which aims to enable submission of grievances by the citizens from anywhere, anytime to the Ministers/Departments/Organisations.
- Tracking grievances is also facilitated on this portal through a system generated unique registration number.
- The system also enables Ministries/Departments to take appropriate action and upload the Action Taken Report (ATR).
- The CPGRAMS is nationally linked to all the State Government. The CPGRAMS with local language interface, has so far been launched in 9 State Governments/Union Territories, namely, Haryana, Odisha, Rajasthan, Mizoram, Meghalaya, Uttarakhand, Jharkhand, Punjab and Puducherry.
- A person can lodge a grievance on the PG portal through the Common Service Centre located in his area by paying a nominal fee.
- The Public Grievance Mechanism of the Prime Minister’s Office (PMO), the President’s Secretariat, the Directorate of Public Grievances (Cabinet Secretariat), Department of Administrative Reforms & Public Grievances (DARPG) as well as the Pensioners’ portal have been integrated through the CPGRAMS. This enables grievances lodged at any of these entities to be transferred to the Central Ministries/Departments and State Governments, online through CPGRAMS.
- The DARPG is the policy making, monitoring and coordinating department for public grievances. These rules have allocated the work relating to (a) Redressal of public grievances in general and (b) Grievances pertaining to Central Government agencies to DARPG.
- The DARPG has developed a framework called ‘Sevottam’ which essentially means Excellence in Public Service Under this scheme, every Government Department must have a Citizens Charter outlining the main services with services standards and timelines, a Public Grievance Redress Mechanism and a system with assessment and improvement of public service delivery standards.
- The DARPG is also doing its part at being innovative by launching schemes such as the Public Grievances Call Centre, Twitter Seva and even a new version of CPGRAMS with additional features.
- A Mobile App which grievances on android based mobiles was launched in October 2015 and it’s a new Mobile App with some added features has been developed which is more user-friendly. This has been integrated with Unified Mobile Application for New-age Governance (UMANG)
- MyGov in is a unique and cutting edge participatory governance initiative. It provides citizens a voice in the governance process of the country and creates grounds for them to become stakeholders across the board, including in implementation through actionable tasks.
5.Online platforms created by several State Governments for the citizens to register complaints:
- Lokvani project in Uttar Pradesh, which helps citizens make their grievances related to government services in an easy manner.
- Jansunwai or e-Samvad Portal fully dedicated for grievance redress in Uttar Pradesh through e-Governance.
- The Andhra Pradesh online portal ‘aponline.com’ is one of the most comprehensive State Government set ups for an e-interface between the Government and citizens. The Channel is called people first or ‘www.meekosam.ap.gov.in and a People Frist mobile app was Launched in September 2017.
- e-Pariharan has been launched in Kerala to facilitate online lodging of complaints.
- The Integrated Grievance Redressal Mechanism (INGRAM) is portal launched by the Department of Consumer Affairs to create a platform to allow consumers to ledge complaints regarding consumer dissatisfaction.
- Other arrangements:
- Nodal Officers for Public Grievances have been identified in each Ministry Department. In addition, all Ministries/ Department have been advised to ensure that a well-reasoned speaking order is given while disposing off a grievance.
- Each Ministry/Department/Organisation should also have a Director of Public Grievances. Whom an aggrieved citizen can approach for redressal.
- Prime Minister also monitors/reviews the pending grievances of one or more Ministry/Department every month under the Pro-Active Governance and Timely Implantation (PRAGATI) platform.
- Public Grievance Call centre has been made operational with effect from February 2016 for reminding concerned officials of the top 40 Ministries/Department/ Organizations receiving bulk of the grievances, for expeditious disposal of grievances pending for more than two Months.
During the last three years, disposal rate of grievances has also improved. For effective public grievance redressal, an important tool is regular analysis of public grievances received in order to help identification of the problem areas in which modification of policies and procedures could be undertaken. A Grievance Analysis Study was conducted through Quality Council of India for identifying grievance prone areas, recommend systemic reforms in respect of top 20 grievance receiving Ministry/Departments/Organizations listed on the CPGRAMS portal. A Project Management Unit (PMU) has been put in place for monitoring the reforms.
Notable reforms introduced:
- Automatic refunds on cancellation of Railway Tickets
- Single Window Pension through disbursing Banks
- Intensive Mechanized cleaning of coaches
- C-Verification of Income Tax Returns
- The DARPG has also launched and Award Scheme as an incentive for recognizing outstanding performance in redressal of public grievances through the issue of Certificate of Appreciation on a quarterly basis.
- The Scheme not only takes into consideration the number of grievances disposed by the Ministries/Departments/Organizations, but also the feedback of the petitioners whose grievances have been closed.
What is it?
The Citizen’s Client’s Charter is another tool for good governance. It is a written declaration by a Government department that highlights the standards of service delivery that it subscribes to, the availability of choice for consumers, avenues for grievance redressal and other related information.
It is a set of commitments made regarding the standards of service which it delivers.
Is it enforceable in the court of law?
It is not enforceable is a Court of Law, is intended, to empower citizens and clients so that they can demand committed standards of service and avail remedies in case of non-compliance by service provider organisation.
Public Grievance Redressal: Governance Challenge
Public discontent, summers in the vortex of grievances. As grievances breed, discontent grows too, Public grievances, therefore, present the most domineering challenge before any government. But this challenges is complex and its resolution requires multi-dimensional focus and multi-layered interventions necessitating
(a) Timely capture of grievances by creating spaces for their expression
(b) Effective redressal of existing grievances by creating robust redress mechanism; and
(c) Accomplishing grievance free governance by addressing the root cause working on alternate policies or institutional reforms, where necessary.
Evolution of Public Grievance Redressal of Mechanisms:
Administrative reforms to reduce public grievances became a significant element of political discourse by the mid-sixties. However, the drive to set up public grievance redressal mechanisms gained momentum following the Chief Ministers’ Conference in 1987 and the adoption of Action Plan for responsive and citizen-centric administration. What followed was a concerted effort to put in place three key mechanisms – citizen charters, information and facilitation counters and public grievance redressal machinery in all ministries, departments and organisations of government of India and state governments.
The Emerging Scenario:
On account of rapid spread of information technology, growing internet access and increasing awareness about the mechanism, the utilisation of CPGRAMS has grown manifold. There is a renewed interest in strengthening the technology interface, through other support mechanisms like PRAGATI. Besides DARPG and DPG, PMO has also become an important nodal agency for receiving grievances. The overall disposal rate has been quite high though there is some variation in respect of overall disposal rate as well as the duration taken for disposal across various Departments. An analysis of this variation and its reasons can throw light on many possibilities for reform.
Redressal versus Disposal:
In their eagerness to comply with these instructions, grievances are increasingly being disposed by some departments or organisations simply with the suggestion to approach another office. In some cases, the grievance is being re-sent to the agency against which the complaint is made and in some others, the online grievance is being disposed with the advice to take the grievance to the portal of the agency or some complaint committee. Departments and organisations need to address the real issues involved in redressal. It needs to be ascertained whether redressal was to the satisfaction of the aggrieved or it was a mere reiteration of the official position. It also issued instructions to give valid reasons for closure.
Recent analysis of some grievances received n CPGRAMS revealed that in several of these cases, the petitioner was asked to approach the State government and the grievance was disposed rather than forwarded. There was no redressal. It is important to ensure that CPGRAMS plays the facilitator role for the public without impinging on the nature of federalism.
Private Provision of Public Service:
Where service delivery has moved to the private providers on account of changing perspective on governance accountability mechanisms need to be put in place to ensure that rights of service users are not at stake and grievances can be addressed at appropriate level to offer effective redressal to the aggrieved.
Many of the grievances also involve complex issues and overlapping jurisdictions, necessitating disentanglement and clarity over rules, regulations, processes, jurisdictions and appropriate mechanisms for redress. There is the issue of coordination across multiple authorities in case of many grievances. Rather than letting these issues and the aggrieved be kept revolving between multiple authorities, creation of appropriate mechanisms for such ordinated responses is desirable. It is important that mechanisms for grievance redressal are created at appropriate levels so that access and effectiveness issues are addressed appropriately. The centralised online mechanism can address this challenge and reduce the plight of the citizen to run back and forth between different authorities, while facilitating transparency and enabling the monitoring. Its effectiveness, however, is still conditioned on (a) how the issues of access to technology and ability to read and write are addressed (b) how accountability mechanisms can be built in to ensure that disposal of public grievance is not simply presumed to imply redressal. There is need, therefore, to simultaneously utilise other mechanisms like lok adalats, jan sunwais, social audit mobile apps etc to ensure inclusion of those who may not have access to CPGRAMS
It is important to also take note of grievances received through informal channels of communications which can also help arrive at a better state of governance.
Ultimate challenge is to work towards a state of governance, which does not deliver grievances, it is important to ensure the institution of multiple mechanisms for the timely capture and effective redressal of the grievances that may emerge and the course correction that may result after careful analysis of their reasons and possible remedies or prevention strategies.
Private Service Providers: Redressal Mechanism
Though the current government has digitised many grievance redressal mechanisms and introduced newer ones as well for empowering citizens to raise complaints against the government ministries, departments etc their effectiveness remains debatable. Also there still exists a gap in an effective regulatory mechanism for grievances against private service providers, due to the absence of ombudsman in many sectors such as telecom, etc. This highlights the need and role of the respective sectorial regulatory bodies such as Telecom Regulatory Authority of India (TRAI) etc. in being empowered to become individual public grievance redressal platform.
Challenges in lodging complaints for redressal:
- Firstly complainants are unaware about the available platforms for resolving their grievances.
- Secondly even if they do know the appropriate redressal platform access to the same becomes a major impediment in filing their grievance.
- Thirdly, even if an aggrieved person is able to lodge a grievance with an appropriate government platform, they risk high chances of it remaining unresolved.
Steps taken to address these challenges:
- To empower all citizens with a convenient grievance redressal mechanism, the government led by the vision of implementing ‘ART for Government’, I.e, Accountability, Responsibility and Transparency has not digitised the existing public grievance mechanisms operational in the country. The ART model of governance will be put to test for overcoming the threefold challenges faced by consumers, in getting their grievances redressed
- Several new platforms have been launched, such as the Railway Ministry’s Nivaran, Ministry of Petroleum, Oil and Natural Gas’s e-Seva, Pro-Active Governance and Timely Implementation (PRAGATI) – a multi-purpose grievance redressal platform, etc. the third challenge, i.e, action on grievances till remains largely unaddressed.
Grievance Redressal Mechanisms for Women
At the apex level, there are primarily two designated nodal agencies in the Central Government for handing grievances:
- The Department of Administrative Reforms and Public Grievances, Ministry of Personnel, Public Grievances and Pensions, and
- The Directorate of Public Grievances, Cabinet Secretariat Standing Committee of Secretaries for Grievance Redressal, headed by the Cabinet Secretary conducts review of grievance redressal mechanism of different Ministries/Departments of Government of India
The Government has gone a long way in bringing out many initiatives to redress the grievances of women both at work and at home. In alignment with Convention on Elimination of all forms of Discrimination Against Women (CEDAW), Millennium Development Goals (MDG) National Policy for Empowerment of Women, and Sustainable Development Goals (SDGs) for a gender inclusive society, many schemes have been initiated by the Government resulting in a positive impact while addressing gender needs.
Department of Women and Child Development and Ministry of social Justice and Empowerment:
- Provide care and protection for children, women, senior citizens, and third genders through various schemes like Working Women Hostels, One Stop Center, Short Stay Homes and Old Age Home Women, Child and Elder Helplines etc.
- Implement Social Legislations Like Domestic Violence Act, 2005, Dowry Prohibition Act, 1961, Child Marriage Prohibition Act, 2006 Protection of Women from Sexual Harassment at Work Place Act 2013 and Maintenance and Welfare of Parents and Senior Citizen’s Act, 2007 to ensure the safety and rights of women, children and senior citizens as guaranteed under the Indian Constitution.
Role of Behaviour Change Communication in Achieving a Swachh Bharat
Rural areas of seven States (Sikkim, Kerala, Himachal Pradesh, Arunachal Pradesh) and two Union Territories (Chandigarh and Daman & Diu) have become Open Defecation Free (ODF)
The Prime Minister himself has been at the helm of affairs, being the communicator in chief of the Swachh Bharat Mission (SBM). This has been a game changer for the Mission, and is one of the primary differentiators between the SBM and previous sanitation programs through a change in attitudes and inculcated behaviour traits as results of age old customs.
- Interpersonal Communication (IPC) is a crucial component of SBM in this regard.
- Swachhagrahis are the foot soldiers of Swachhta. Swachhagrahis are of all ages, sexes and creeds. Children in particular are among the most enthusiastic sanitation Champions Vaanarsena (army of monkeys) a team of small kids who people do not resort to open defecation are seen in districts across the country. They engage in playful and childlike measures like blowing whistles, singing songs, taking out awareness drives to make people aware of the ill-elects of open defecation.
- Community itself identifying Champions from within the communities is a better motivator and influencer than a top-down chain of command.
- The Ministry of Drinking Water and Sanitation has come up with an aggressive new campaign called Darwaza Band. Darwaza Band symbolically stands for shutting the door on open defecation.
- The mass entertainer ‘Toilet – EK Prem Katha’ was a seminal case of mainstreaming the Swachhata message, while also spreading awareness about ground realities and the kind of work being done by the Mission in the field. Since the launch of the Swachh Bharat Mission, women fighting for their right to a toilet have become a recurring theme in rural India.
- In the ‘Swachhta Hi Seva’ fortnight shramdaan for Swachhata, pledged Swachhata Shapaths, wrote essays and made paintings and films on cleanliness, inspiring such a spike in citizen engagement serves as a platform for the way forward.
- The sanitation programme in Bikaner district for example, located in the heart of the arid Thar Desert in Rajasthan was located with several cultural and geographical challenges.
- The BankoBikano campaign, when it was launched, surprised everyone. The Basic premise of the programme was pride for the family, pride for the village and ultimately for the district. This thought and vision using local language and customs caught on in the social fabric of rural Bikaner and the programme became almost self-propelling.
- Behaviour change is the primary focus and fundamental tool for achievement of ODF outcomes.
- The ministry is doing it by its focused Information Education and Communication (IEC) programme. It promotes gender sensitive information, behaviour change guidelines and various mass educations activates, The Ministry issued gene guidelines in 2017 and Menstrual Management Guidelines on 2015
- Swachhata Pakhwada:
Swachhata Pakhwada started in April 2016 with the objective of brining a fortnight of intense focus on the issues and practices of Swachhata by engaging Central Ministries and Departments in their jurisdiction. An annual calendar is pre-circulated among the Ministries to help them plan for the Pakhwada activities.
- Namami Gange:
Namami Gange Programme is an initiative of Ministry of Water Resources (MOWR) comprising of making villages on the bank of River Ganga ODF and interventions dealing with solid and liquid waste management are being implemented by MDWS
- Swachhata Action Plan (SAP)
SAP, a first of its kind inter-ministerial programme for Swachhata, is a concrete realization of Prime Minister’ vision that Swachhata is everyone’s business. All Union Ministries/Departments have started to work for its realization in a significant manner with appropriate budget provision. A separate budget head has been created for this by the Ministry of Finance
- Swachh Iconic Places (SIP)
The Ministry of Drinking Water and Sanitation has taken up a multi-stakeholder initiative focusing on cleaning up 100 places across India that are “iconic” due to their heritage, religious and/or cultural significance.
- Swachh Sankalp se Swachh Siddhi Competition
To achieve a New India 2022 under Sankalp se Siddhi, a mass resolve to make all dirt and filth quit India. In pursuit of this vision, MoDWS organised country wide Film, Essay and Painting Competition between August 17, and September 8, 2017 as another major step towards making Swachhta a people’s movement.
Citizen’s Charter in India
There exists information asymmetry between the government department and the applicant or the consumer. Add to this the lack of a grievance redress mechanism and the consumer may have no other option but to turn to a middleman to get the work done invariably at a higher cost. Citizen’s Charters were introduced in India in the 1990s as an attempt to address this very lacuna in the system. Though the last two decades have seen the introduction of the Right to Information Act and the Right to Public Services Act that make information sharing a legal requisite, the importance of Citizen’s Charters cannot be undermined.
Citizen’s Charter Initiative:
The United Kingdom pioneered the Citizen’s Charter initiative as a measure to refocus public services towards the need and expectations of their users. This Initiative by the UK created a pathway for many other countries to emulate, albeit with different names “Public Services Users’ Charter’ in Belgium, ‘Service Users’ in France, and ‘The Quality Observatory’ in Spain all in 1992; ‘Client Charter’ in Malaysia, and ‘The Quality Charter in Public Services’ in Portugal, both. In the UK, the same programme was modified and re-introduced again as ‘Services First’ by the Labour Government in 1998, Most critical features, namely, improving quality of Services, standards conformity, and the grievance redress process remained consistent across all the Charters.
Citizen’s Charter in India:
In India, the concept of Citizen’s Charters was first introduced in 1994 when consumer rights activists drafted a charter for health service providers at a meeting of the Central Consumers Protection Council in Delhi. The Department of Administrative Reforms and Public Grievances
Citizen’s Charter can be defined in the following manner: ‘Citizen’s Charter is a document which represents a systematic effort to focus on the commitment of the Organisation towards its Citizens in respects of Standard of Services, Information, Choice and Consultation Non-discrimination and Accessibility, Grievance Redress, Courtesy and Value for Money. This also includes expectations of the Organisation from the Citizen for fulfilling, the commitment of the Organisation.
DARPG outlined the following six components for inclusion in charters drafted by public agencies:
- Vision and mission statements
- Details of business transacted by the organization
- Details of clients
- Details of services provided to each client group
- Details of grievance redress mechanisms and how to access them
- Expectations from clients
- There needs to be a two-pronged approach to ensure that every department of the government has a Citizen’s Charter – firstly, a revision of existing Citizen’s Charters to ensure that they meet with all the 10 critical parameters, and secondly, a systematic Citizen’s Charter that is practical and whose commitments rae achievable as endorsed by those staff members who are the cutting edge of citizen interface.
- An impetus from within that includes a strong government within the department to motivate staff to be part of ‘Mission’ to set standards for themselves.
- Rethink factors for success that will help set realistic standards and commitments based on current constraints and capabilities.
- Take external assistance by including experts (either individuals or Civil Society Organisations) who have proven track record of consultation based document formulation.
- Put accountability mechanisms in place especially with regard to grievance redress to ensure that officials handling cases are able to carry out their duties responsibly.
- Commit to a regular feedback loop that will help the departments to continuously improve themselves.
Addressing Grievances in Health Care
Unfortunately, there is not one singular agency policy or organisation that is comprehensively available to the public or the patient to take their grievance and complaints to and find fast solutions. In addition, the process and procedure for filling and following up the complaints and grievance is also not very simple or is taken up with necessary speed and support.
- National Health Policy 2017 does clearly mention in section 14.2 about the regulation of clinical establishments. It observes that a few states have adopted the Clinical Establishment Act 2010. Advocacy with the other States would be made for adoption of the Act. Grading of clinical establishments and active promotion and adoption of standard treatment guidelines would be one starting point.
- Protection of patient rights in clinical establishments (Such as right to information, access o medical records and reports, informed consent, second opinion, confidentially and privacy) as key process standards would be an important step.
- The policy recommends the setting up of a separate, empowered medical tribunal for speedy resolution, to address disputes/complaints regarding standards of care, prices of services, negligence and unfair practices.
- Standard Regulatory Framework for laboratories and imaging centres specialized emerging services such as assisted reproductive techniques, surrogacy, stem cell banking organ and tissue transplantation and Nano Medicine will be created as required.
Clinical Establishment Act
The Clinical Establishment Act (CEA) 2010 is a Central law for registration and regulation of all clinical establishments in the county (public or private).It prescribes the minimum standards of facilities and services provided by them, and the fees that may be charged from the patients. Non-compliance with the standards can lead to cancellation of the regulation license granted under the Act and imposition of penalties provided in the Act. The closest that the CEA comes is by requiring certain categories of hospitals to have a patient citizen charter in place; however even this charter does not require the creation of a grievance redressal mechanism. This demonstrates that the only central regulatory framework on clinical establishments in the country makes no provision for the enforcement of individual patient rights.
Consumer Protection Act and Health care:
The consumer can also lodge a complaint under the Consumer Protection Act (CPA) 1986 as amended recently. But the applicability of CPA to Public Health Establishments (PHEs) has been debatable due to differences in the interpretation of the term “consumer” and “service” by various courts in India.
The MoHFW has in place a “hospital manual” which lays down provision for the smooth functioning of public hospitals in the areas of management, administration, various departments and wards, and includes a citizen’s charter. The manual envisages a grievance redressal mechanism for every public hospital, and the appendix lays down the citizen’s charter for central government hospitals. The mechanism requires a person to be designated as a grievance redressal officer in each hospital, compliant boxes to be installed and the complaints therein to be registered and regularly responded to follow up action to be taken a committee headed by chief of the hospital to monitor the complaints and the follow up action taken and a nodal officer be appointed to monitor the implementation of the citizen’s charter
“Mera Aaspatal” app launched in 2017 is Ministry of Health’s initiative to capture patient feedback for the services received at the hospital through user friendly multiple channels such as Short Message Service (SMS), Outbound Dialling (OBD), mobile application and web portal. My Hospital app helps the government to take appropriate decisions for handing the quality of healthcare delivery across public facilities which will improve the patient’s experience.
National Accreditation Board for Hospitals and health care:
The National Accreditation Board for Hospitals and health care providers (NABH) is another mechanism under Quality Council of India that addresses grievances and appeals. National Accreditation Board for Hospitals and Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programmes for healthcare organisations. The board is structured to cater to the much desired needs of the consumers and to set benchmarks for progress of the health industry. The board, while being supported by all stakeholders including industry, consumers, and the government, has full functional autonomy in its operation. The Board has a prescribed format for handling of complaints and grievances but is largely within the ambit of the hospitals and health care providers registered or accredited with them.
Indian Medical Association (IMA) is the only representative national voluntary organisation of Doctors of Modern Scientific System of Medicine, which looks after the interest of doctors as well as the well-being of the community at large. National Consumer helpline can also be approached and a complaint can be lodged for medical negligence. The absence of an effective enforcement mechanism across all public and private health establishments is rather unfortunate. The setting up of a regulatory authority as promised in the National Health Policy 2017 will go a long way in this direction.
- Smart Freight Operation Optimisation & Real Time Information (SFOORTI) Application
In a major digital initiative to help plan the traffic flows and optimize freight operations, Ministry of Railways have launched Smart Freight Operation Optimisation & Real Time Information (SFOORTI) App for Freight Managers which provides feature for monitoring and managing freight business using Geographic Information System (GIS) Views and Dashboard.
- MPLAD Scheme Approved Beyond 12th Plan
The Cabinet Committee on Economic Affairs chaired by the Prime Minister has given its approval to continuation of Members of Parliament Local Area Development Scheme (MPLADS) till the term of the 14th Finance Commission i.e., 31.03.2020.
The MPLADS funds are released to the nodal District Authorities on receipt of requisite documents and per provision of Guideline on MPLADS. The entire population across the country stands to benefit through creation of durable assets of locally felt need, namely drinking water, education, public health, sanitation and roads etc., under MPLAD Scheme. The MPLAD Scheme is an on-going Central Sector Scheme which was launched in 1993-94. Since the inception of the Scheme till August, 2017, a total number of 18.82.180 works for Rs 44,929.17 crore have been sanctioned from MPLADS fund.
Innovative Financing for Health System
Improving health care and increasing the number of people who are healthy is the development goal of any country. In India, additional funds for health would be reprioritization which may mean curtailment of funds in other social sectors which are already constrained for resources. Innovative ways of health care financing to create more money for health and enhancing capacity and efficiency to get more health for money are the options to support developing economies to deal with unfinished agenda of millennium Development goals (MDG) and to create a roadmap for Sustainable Development Goals (SDG)
In India health is not solely in the hands of Ministry of Health and Family Welfare and parallel systems in States and local Government but also on counter sectors. They have cross building effect on health.
To generate more resources for health there is need to consider review of taxes and subsidies which play a preventive role in controlling, communicable and non-communicable disease. For example, commodities that, harm health needs to be declared sin and heavily taxed and taxes to be earmarked for preventive and promotive health care whereas those beneficial need to be subsidised in India, as per 2017-18 budget document, 10 per cent of government spending is earmarked for subsides for food, fertilizers and petroleum etc, which have direct and indirect health effects.
Raising taxes on harmful commodities may not only improve health but can generate more fiscal space for health. At present, communicable and non-communicable disease cause more than 65 per cent deaths, the fiscal deficit created due to raised taxes would be impacting socio-economic and cultural factors in a low and middle class society.
No doubt taxes generated from tobacco, alcohol and unhealthy food play an important role in economy but epidemiology transition has brought the society at a juncture where 60 per cent deaths in India are due to Non-Communicable Disease and the risk factors attributed are tobacco, harmful use of alcohol, high blood pressure due to high salt intake, unhealthy diets like sugar sweetened beverages and physical inactivity.
Subsidies on commodities such as sugar, diesel, kerosene and coal needs to be reviewed and savings to be diverted to nutritious food and clean renewable energy sources government needs to subsidies LPG heavily instead of diesel, kerosene and coal for cooking and fruits, dairy products and protein sources to be promoted for healthy life style. In a country like India, inflation suppresses small increase; hence inflation needs to be adjusted to avoid tax ineffectiveness.
For the productive utilization of tax resources, part of tax collection could be earmarked to preventive and promotive health care, improvement for air and water quality, nutrition and treatment of diabetes, Cardiovascular Disease, Cancer and Chronic Obstructive Pulmonary Disease (COPD)
Another front of resources mobilisation is review of subsidies which is a burden on growing economies and may provide some fiscal space. Subsides need to be reviewed and reoriented towards improving the nutritional content of subsidised food.
Production and consumption of pulses have stagnated in India while the output of food grains and sugar has increased. Under the National Good Security Act (NESA), 2013 the government is projected to spend $25 billion a year to subsidize food grains, whereas this food subsidy can be used towards subsidies on pulses, fruits, vegetables and milk which will have a far more beneficial impact on nutrition.
Re-allocating fuel subsides towards clean fuels and eliminating subsidies on those items which have direct harmful effect on health is necessary to improve health and save scarce resources.
How does removal of subsidies affect the Economy?
Removal of agricultural subsidies would adversely affect farmers and small scale manufactures including those who make bidis and other tobacco products. Farmers of tobacco and sugarcane do well as these crops are cash crops in India but they should be assisted to switch over to such crops that are not harmful to human health and just a substitute of their livelihood by allocating part of earmarked revenue collected through taxes for the orientation of these farmers for smooth transition from thee cash crops to other crops without putting them into financial hardship Policy makers need to reorienting tax revenue and subsidies and explain provision on how the losers from these changes would be compensated to ensure that their livelihoods are not compromised.