Author: CD Staff

Context

• According to the latest National Health Accounts Report, India’s total health expenditure went down from 3.9 per cent of the Gross Domestic Product (GDP) in 2013-14 to 3.2 per cent in 2018-19.
• The fact is alarming as it points toward the reducing health expenditure of the government at a time when the Health sector in the country is already under pressure from multiple issues such as poor infrastructure and the burden of the pandemic.
• In this context, in this edition of the burning issue, we will talk about India’s healthcare sector, issues that ail it and possible solutions to these issues.

About the National Health Accounts Report

• India’s National Health Accounts (NHA) estimates report for FY 2018-19 is the sixth in the series of NHA reports prepared by the National Health Systems Resource Centre (NHSRC).
• The report is based on the globally accepted framework of System of Health Accounts, 2011, which enables cross-comparability of estimates across time along with international comparisons.
• The NHA report presents two estimates for the expenditure incurred within the health sector during a financial year: Current Health Expenditure (CHE) and total Health Expenditure (THE).
• CHE includes the recurring expenses corresponding to the final consumption of health goods and services within a financial year. THE, on the other hand, reflects both current and capital expenditure incurred in the health sector within a financial year.

About the Healthcare Sector in India

• The Healthcare industry in India comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment.

• The hospital industry in India accounts for 80% of the total healthcare market. The hospital industry is expected to reach $132 bn by 2023 from $61.8 bn in 2017; growing at a CAGR of 16-17%.
• In 2020, India’s Medical Tourism market was estimated to be worth $5-6 Bn and is expected to grow to $13 Bn by 2026.
• The primary care industry is currently valued at $13 bn. The share of the organized sector is practically negligible in this case.
• ‘Public Health’ subject comes under the state list under the 7^th schedule of the constitution.

Some Data about Healthcare Expenditure in India

• According to the latest National Health Accounts Report, the current health expenditure(CHE) for the year was Rs 5,40,246 crore or 90.58 percent, while the rest was capital expenditures. Of the government health expenditure, the Union government’s share was 34.3 percent.
• Out-of-pocket expenditure on healthcare by households has declined by 16 percentage points, from 64.2 per cent to 48.2 per cent in the same period. It was even higher in 2004-2005, at 69.4 per cent. While this is a welcome improvement, the figure remains significantly higher than the global average.
• The economic burden of healthcare in India is largely borne by households that contribute Rs 3,24,717 crore to the current healthcare expenditure.
• For 2018-19, the health expenditure for India was estimated to be Rs 4, 470 per capita.
• Among the different types of healthcare providers, the major share of CHE is incurred at private hospitals (28.7 percent), followed by pharmacies (22.6 percent), and government hospitals (17.3 percent).

Challenges in the Healthcare sector in India

(A) Outdated Medical education in India

• Limited government seats: The number of seats available for medical education in India is far less than the number of aspirants who leave school with the dream of becoming doctors.
• Lack of skills: Though the institutes are managing to hire professors and lecturers, there is a lack of technical skills. Finding faculties in clinical and non-clinical disciplines is difficult and there are very few faculty development programs for upskilling the existing lot.
• Lack of digital infrastructure: The gap in digital learning infrastructure is currently the biggest challenge the sector is facing. There is an urgent need to adopt technology and have resources available to facilitate e-learning.
• Lack of research and innovation: there haven’t been much ground-breaking research in the medical field. The education system needs to focus more on increasing the quality of research. Additionally, since the industry-academia partnership is not available, hence innovation also takes a back seat.
• No. of doctors-Deficiency: The doctor-patient ratio of 1:1655 in India as against WHO norm of 1:1000 clearly shows the deficit of MBBS.
• Inadequate capacity of the health system: to cater to the healthcare demands of a large population as evident from multiple months waiting for an operation even at large healthcare centers like AIIMS.

(B) Suffering from several Paradoxes

• Healthcare is a fundamental right, but it is not fundamentally right in India: The expenditure on healthcare is one of the lowest in the world. Though our economy has grown robustly post-liberalization, investment in healthcare has consistently hovered around 1% of the GDP. In the 2020-21 Budget, it was 1.02% of overall expenditure.
• The sector attracts investments, but delivery remains contentious: India’s healthcare sector has attracted a steady stream of investments. Lack of penetration, inflated billing, opaqueness in diagnosis, and poor quality of service has ensured that most Indians get treated below the standards prescribed by the WHO.
• Among the cheapest in the world, yet unaffordable for most locally: Healthcare in India is cheap. Yet India has one of the world’s highest rates of out-of-pocket spending in healthcare. Millions in India cannot afford these procedures in their own country.
• Less health infrastructure, but medical tourism booms: There is a dearth of medical schools and clinicians. Most hospitals in India are overburdened, understaffed, and ill-equipped. However, all this has not prevented the private healthcare sector to establish sophisticated medical tourism facilities on the plank of ‘world-class service at low cost’.

(C) Rising Burden of Non-Communicable Diseases

• According to the study report ‘India State-Level Disease Burden Initiative’ in 2017 by the Indian Council of Medical Research (ICMR), it is estimated that the proportion of deaths due to Non-Communicable Diseases (NCDs) in India has increased from 37.9% in 1990 to 61.8% in 2016.

(D) Inadequate Mother and Child Healthcare

• Maternal mortality causes 56,000 deaths every year in India, accounting for 20 percent of maternal deaths around the world.
• The inadequate healthcare system and lack of healthcare facilities in most regions have elevated the number of maternal mortality cases in India. 

(E) Receding government from the health sector

• Currently, government hospitals are having only a 30% share of the total number of hospital beds available in India.
• Also, 70% of new beds added in hospitals are coming from private hospitals rather than government hospitals. This disproportionately impacts poor people more.
• India’s rich and middle classes have opted out of public health completely, leaving the poor with unconscionably meager services.

How pandemic has further exposed the Healthcare sector in India?

 (1) Poor Infrastructure

• In the 2019 Global Health Security Index, which measures pandemic preparedness for countries based on their ability to handle the crisis, India ranked 57, lower than the US at 1, the UK at 2, Brazil at 22, and Italy at 31.
• As per the OECD data available for 2017, India reportedly has only 0.53 beds available per 1,000 people as against 0.87 in Bangladesh, 2.11 in Chile, 1.38 in Mexico, 4.34 in China, and 8.05 in Russia.

(2) Fewer doctors per thousand

• The WHO mandates that the doctor-to-population ratio should be 1:1,000, while India had a 1:1,404 ratio as of February 2020.
• In rural areas, this doctor-patient ratio is as low as 1:10,926 doctors as per National Health Profile 2019.

(3) Denial of healthcare by Private hospitals

• Despite private hospitals accounting for 62 percent of the total hospital beds as well as ICU beds and almost 56 percent of the ventilators, they are handling only around 10 percent of the workload.
• Private hospitals are reportedly denying treatment to the poor. Cases of overcharging patients are also being reported in private hospitals.

 (4) Negligence for mental healthcare

• Mental health problems were already a major contributor to the burden of illness in India which usually gets unnoticed.
• The widespread anxiety due to the lockdown has frustrated the laborers, farmers, and various vulnerable sections to a great extent due to the fear of impoverishment and loss of livelihoods.

Ayushman Bharat- A Game Changer Scheme

• Ayushman Bharat Scheme was launched in 2018, as a step toward Universal Health Coverage (UHC) and would provide quality health services to eligible patients and protect them from financial hardship.
• It aims to provide 110 million “poor, deprived rural families” with an annual family health insurance cover of up to Rs 5 lakh in Secondary and tertiary healthcare.

Outcomes of the scheme

Positive outcomes

• More than 20.8 lakh people from marginalized sections received health treatment worth Rs. 5000 crores in the initial 200 days of the scheme.
• The portability of the scheme helped several migrant workers access health benefits in the state of migration during COVID times irrespective of their home states.

Negative outcomes

• One of the primary objectives of this scheme is to decrease the out-of-pocket (OOP) expenditure on health in India. Multiple research studies suggest that insurance schemes for the poor in India have failed to provide the much-needed relief, with OOP figures higher for those using insurance schemes, compared to those who do not. Predominant reasons are shoddy implementation, lack of infrastructure and corruption.
• As per the latest data available, over 12.5 crore Ayushman cards have been issued and about 1.23 crore people have availed the benefit of this scheme (merely 2 percent of the 50 crore target beneficiaries).
• In addition, Ayushman beneficiaries are denied benefits they were previously entitled to under other schemes—a pregnant woman below-poverty line beneficiary of AB-PMJAY scheme, going for institutional delivery no longer receives the assistance of Rs 1,500 under Janani Surakhsa Yojana.

Some achievements in the Healthcare sector

• Out-of-pocket expenditure on healthcare by households has declined by 16 percentage points, from 64.2 per cent to 48.2 per cent in the same period. It was even higher in 2004-2005, at 69.4 per cent. The decreasing share of OOPE signals the declining incidence of financial hardships faced by households while accessing healthcare in India.
• The increasing share of social security expenditure on health from 6 per cent in 2013-14 to 9.6 per cent of THE in 2018-19, indicates the increasing reach of social security measures in the country. This kind of payment mechanism enables risk protection thus preventing households from incurring catastrophic health expenditure.
• More than half of the government’s current expenditure (55 per cent) has been on strengthening primary healthcare centers. This not only ensures quality services at the grassroots level but also reduces the chances of ailments requiring secondary or tertiary health care services.
• Increasing health insurances– Health insurance contributes 20% to the non-life insurance business, making it the 2^nd largest portfolio. The gross direct premium income underwritten by health insurance grew 17.16% year on year to reach $6.87 bn in FY20

Models to improve the healthcare system in India

(A) Concept of Family Health Teams: 

• Instead of passive design of NHM, we need Family Health Teams (FHT) like in Brazil, accountable for the health and wellbeing of a dedicated population, say 2,000 families.

 (B) Move beyond doctor-led systems:

• India needs to move beyond the doctor-led system. Instead of wasting gynecologists in CHCs midwives (nurses with a BSc degree and two years of training in midwifery) can provide equally good services except surgical, and can be positioned in all CHCs and PHCs.

(C) National Health Service:

• It is based on the UK’s health model. It is similar to creating an All India Service on the lines IAS and IPS for the healthcare services in India. It would help bring uniformity in structure and services related to healthcare in India.

Other Possible solutions

 (1) Promote Universal health coverage

• As part of the SDGs, all countries have pledged to deliver universal health coverage (UHC) by 2030.
• This includes India. But, sadly, nearly 50 percent of the world’s population lacks essential health services.

 (2) Increasing healthcare professionals in numbers

• Considering the rise in the population, new diseases and infections, India is in dire need of more medical staff and amenities.
• If India wants to achieve a 1:1,000 ratio, it will need an additional 2.07 million doctors by 2030. For this, the government needs to increase its spending on the health sector.

 (3) Revamping medical education

• There is a needs to rapidly build medical institutions and increase the number of doctors.
• It needs to aid attempts at constructing new medical institutes, hospitals, Primary health centers and New AIIMS.

 (4) Helping the downtrodden

• Rather than dumping them on government hospitals only, the private hospitals should be held accountable to take on their treatment.
• They can make up for the loss by cross-subsidizing treatments of patients with premium insurance policies.

(5) Enhancing future pandemic preparedness

• This can be done by strengthening the disease surveillance system, Primary health centers, and the Pharmaceutical industry for rapid production of essential medicines and testing kits.

 (6) Optimum use of technology

• The COVID-19 crisis has elevated the importance of digital tools and e-health.
• There is a growing use of mobile apps, online consultations, e-pharmacies, and other tools such as NetMeds, Dhani App and telemedicine.

 (7) Looping-in private players

• For too long, India has allowed the private health sector to grow, with little regulation.
• The lack of alignment between the public and private sectors has been exposed to COVID-19 testing and treatment in India.
• The time is ripe to loop in private players and promote the industrialization of the health sector.

(8) Review of the existing system: 

• Bringing such a transformative health system will require a comprehensive review of the existing training institutions, standardizing curricula and the qualifying criteria.
• Improving Federal cooperation in the health sector as health is a state subject.

Conclusion

• India’s healthcare system is too small for such a large population. There seems to be a long battle ahead. The public healthcare system cannot be improved overnight. 
• The country needs all hands on deck-both public and private sectors- working together and delivering the best healthcare services for all citizens.
• Ultimately, the onus of governance always rests with the government, which needs to set standards, invest resources, ensure quality, and strategically purchase services from the private sector, as needed.

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Context

• Parts of Bengaluru, India’s IT and startup capital faced unprecedented floods last week. This is not the first instance of urban flooding in India.
• In fact, urban flooding is becoming increasingly common in many parts of the country with this monsoon season itself seeing many such instances in the states of Rajasthan, Gujarat, and Madhya Pradesh.
• In this context, this edition of the burning issue will look at the rising problem of urban flooding in India, its causes and consequences, and finally few solutions to it.

Some major Urban Flooding incidents

• There has been an increasing trend of urban flood disasters in India over the past several years whereby major cities in India have been severely affected.
• The most notable amongst them are Hyderabad in 2000, Ahmedabad in 2001, Delhi in 2002 and 2003, Chennai in 2004, Mumbai in 2005, Surat in 2006, Kolkata in 2007, Jamshedpur in 2008, Delhi in 2009 and Guwahati and Delhi in 2010. The most recent devastating ones were Srinagar in 2014 and Chennai in 2015

What is urban flooding?

• Urban flooding is the inundation of property in a built environment, particularly in more densely populated urban areas, caused by heavy rainfall on increased amounts of impervious surfaces and overwhelming the capacity of drainage systems.

• Urban floods stem from a combination of various meteorological and hydrological extremes, such as extreme precipitation and flow in short spans of time.
• Thus, flooding in urban areas is caused by intense and/or prolonged rainfall, which overwhelms the capacity of the drainage system.

Features of Urban Floods

• Faster Flow times: Consequently, flooding occurs very quickly due to faster flow times, sometimes in a matter of minutes.
• Catchment destruction: Urban flooding is significantly different from rural flooding as urbanization leads to developed catchments which are the most vulnerable areas.

Causes of Urban Flooding

Natural factors:

• Meteorological Factors: Heavy rainfall, cyclonic storms and thunderstorms cause water to flow quickly through paved urban areas and impound in low-lying areas.
• Hydrological Factors: Overbank flow channel networks, the occurrence of high tides impeding the drainage in coastal cities.
• Climate Change: Climate change due to various anthropogenic events has led to extreme weather events.

Anthropological factors:

• Unplanned Urbanization: Unplanned Urbanization is the key cause of urban flooding. A major concern is the blocking of natural drainage pathways through construction activity and encroachment on catchment areas, riverbeds and lakebeds.
• Destruction of lakes: A major issue in Indian cities. Lakes can store excess water and regulate the flow of water. However, pollution of natural urban water bodies and converting them for development purposes has increased the risk of floods.
• Unauthorized colonies and excess construction: Reduced infiltration due to paving of surfaces which decreases ground absorption and increases the speed and amount of surface flow
• Poor Solid Waste Management System: Improper waste management system and clogging of storm-water drains because of silting, accumulation of non-biodegradable wastes and construction debris.
• Drainage System: Old and ill-maintained drainage system is another factor making cities in India vulnerable to flooding.
• Irresponsible steps: Lack of attention to the natural hydrological system and lack of flood control measures.

• Human determinism: The fact is that our cities have been built with little to no regard for the natural topography and severely lack holistic action.
• Weaker laws: We have in place the provisions of rainwater harvesting, sustainable urban drainage systems, etc, in regulatory mechanisms like the EIA notification 2006 but still these are on paper majorly.
• Weaker Urban bodies capacity: Public bodies’ focus is largely on de-silting of stormwater drains before monsoon and expansion of the over-burdened infrastructure, but at a crawling pace. 

Lacunae in Urban Planning

• No mapping of water bodies: The preliminary work of mapping and documentation of the surface water bodies even though mentioned by NDMA under the National Database for Mapping Attributes has not been undertaken.
• Failed early-warning system: During the floods of Uttarakhand in 2013, there were questions about the role of NDMA, where it failed to implement the early warning systems to inform people about the floods and landslides.
• Response rather than mitigation: The importance of preparedness for disaster situations like urban floods was realized by the government agencies only after the devastations during Chennai Floods in 2015 and Kerala Floods in 2018.
• Responsiveness of Local bodies: Sufficient training, equipment, and facilities for immediate response and tackling the disaster situation efficiently are not being carried out by the local governments. More onus of mitigation lies with NDMA/SDMA.
• Misutilization of Funds: NDRF/SDRF constituted by the government to deal with the disasters, were used for expenses that were not sanctioned for disaster management. There were cases of financial indiscipline in state management of funds.

Consequences of Urban Floods

• On the economy: Damage to infrastructure, roads and settlements, industrial production, basic supplies, post-disaster rehabilitation difficulties etc.
• On human population and wildlife: Trauma, loss of life, injuries and disease outbreak, contamination of water etc.

• On the environment: Loss of habitat, tree and forest cover, biodiversity loss and large-scale greenery recovery failure.
• On transport and communication: Increased traffic congestion, disruption in rail services, disruption in communication- on the telephone, internet cables causing massive public inconvenience.
• Diseases: the stagnation of flood water causes pollution of drinking water and accumulation of waste in dustbins and on the open road, thus acting as a host of several pathogens and resulting in the spread of diseases like Dengue, Malaria etc.

• Tangible losses: The losses that can be measured physically and can be assigned an economic value. These losses can be direct or indirect. Direct – Structural damage to buildings, property damage and damage to infrastructurewhereas Indirect – Economic losses, Traffic disruption, and emergency costs.

• Intangible losses: Intangible losses include loss of life, secondary health effects, and infections or damages to the environment which are difficult to assess in monetary terms since they are not traded such as Casualties, health effects, ecological losses, the Post-flood recovery process, mental damage to the people.

Solutions to Urban Flooding

• Improved flood warning systems: effective flood warning systems can help take timely action during natural calamities and can save lives. Pre-planning can significantly reduce the effects of floods, giving people time to migrate to safer locations and stock up on essentials.
• Building flood-resilient housing systems: concrete floors can be very useful during floods. Houses should be waterproofed and electric sockets should be placed at higher levels up the walls to reduce the chances of shocks.
• Constructing buildings above flood levels: buildings should be constructed a meter above the ground to prevent flood damage and evacuation during floods.
• Resilience to Climate change: drastic climate changes have increased the frequency of natural disasters in many parts of the world. Governments should bring about environment-friendly policy level changes and eliminate the ones hazardous to the environment to tackle the problem of global warming.
• Create wetlands and encourage reforestation: creating more and more wetlands can help soak up excessive moisture since wetlands act as sponges. Wooded areas can also slow down heavy water flow, minimizing the effects of floods. Reforesting upstream regions can significantly reduce the effects of flood damage.
• Installing flood barriers: these are flood gates designed to prevent the area behind the barrier from flooding. They can also be kept around buildings to keep floodwaters outside the boundary created.

Some international Models of Urban flood control

(A) To enhance Preventive measures

• It can learn a lesson or two from cities in Japan, Malaysia and Europe. These cities have well-prepared mapped flood zones.
• By combining field surveys, historical records, satellite imagery and infrastructure assessment, they have identified vulnerable areas.
• Such maps and data are shared with citizens, which help them understand the status of their neighborhoods and decide where to move or buy new homes.

(B) To enhance Mitigation

• Kuala Lumpur and Tokyo have built extensive water discharge tunnels to divert and store floodwater. This reduces the volume of water that washes the city.
• Tokyo has one of the largest underground tunnels, running to a length of 6.5 km, and the tank can hold 6,70,000 cubic metres of diverted water, which is later pumped into safe watercourses using turbines.

(C) To enhance Response measures

• As cities increasingly face natural hazards and terrorist attacks, they are investing in setting operation centers for early warning and rescue work.
• For example, Rio de Janeiro has spent $14 million and created a real-time monitoring center of infrastructure and traffic flows.
• The recent experience clearly shows the need for early warning and dissemination of reliable information about floods and rescue.

(D) The Dutch Model of Flood Management

• ‘Live with Water, Built with Nature’ sees cities as ‘waterscape’ and not ‘landscape’ as most of our cities are built along water bodies like river banks or coastal areas. The model proposes nature-based solutions for flood management in cities.

(E) Yongning River Park model

• Of China where artificial wetlands are created in and around cities to allow periodic flooding in these parks and act as a buffer for cities and thus preventing flooding.

Way forward

• Building Resilience: The rapid transformation in rainfall characteristics and flooding patterns demands building the resilience of people and urban infrastructure.
• Reconsider projects: Construction projects that impede the movement of water and sediment across the floodplain must be reconsidered.
• Use of technology: At the same time, climate-imposed exigencies demand new paradigms of early-warning and response systems and securing livelihoods and economies.

• Climate variability assessment: As the incidence of climate variability and extreme weather events increases, it is inevitable that we look at the issue from a broad-based perspective.
• Innovation: Water-sensitive urban design and planning techniques — especially in the context of implementation — are of utmost importance. Ex. Sponge Cities.
• Environmental determinism: Planning must take into consideration the topography, types of surfaces (pervious or impervious), and natural drainage and leave very less impact on the environment.
• Vulnerability Analysis: Vulnerability analyses and risk assessments should form part and parcel of city master plans.
• Extending IN-FLOWS flood control systems which have been installed in Chennai and Mumbai to other major cities also.

Conclusion

• A June 2020 Ministry of Earth Sciences climate change assessment report noted how the increased frequencies of heavy rainfall had enhanced flood risk all over India, particularly in urban areas. This requires an urgent fix. 
• Thus, Flooding in India is also all set to increase in magnitude and intensity. The need of the hour is to adopt the Sendai framework’s Disaster risk resilience approach in Urban flood management in India to better cope with urban floods and reduce their impact as much as possible.

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Context

• Bangladesh PM Sheikh Hasina has arrived in India for a four-day visit to boost bilateral ties.
• India has marched past Britain to emerge as the fifth-largest economy and similarly, with Sheikh Hasina at the helm for over 13 years, her country has come of age. 
• In this context, this edition of the burning issue will analyse the growing India-Bangladesh bilateral partnership, its achievements and irritants and finally conclude with a more can be achieved through this partnership.

History of the India-Bangladesh Relationship

• The two neighbours, India and Bangladesh, are organically linked — with their common heritage and shared history, common memories of tragic loss, and the separation of families on a massive scale following the Partition of India in 1947.
• Also, Rabindranath Tagore created the national anthems of both Bangladesh and India in 1905 and 1911 respectively.
• However, the bilateral relations between the two nations formally started after the Bangladesh liberation war,1971 which had played a key role along with the Mukti Bahini, thus helping East Pakistan (as called then) to separate from Pakistan and emerge as an independent nation. Bangladesh liberation day, 16^th December is celebrated as “Vijay Diwas” in India.
• India was the first country to recognize Bangladesh as a separate and independent state and established diplomatic relations with the country immediately after its independence in December 1971.

India-Bangladesh ties: An organic transformation

• India’s links with Bangladesh are civilization, cultural, social and economic.
• There is much that unites the two countries – a shared history and common heritage, linguistic and cultural ties, and passion for music, literature and the arts.
• It is also worth recalling that India shares its longest border of 4,096.7 kilometres with Bangladesh, which is also the fifth-longest border in the contemporary world.
• With the onset of economic liberalization in South Asia, they forged greater bilateral engagement and trade.

Significance of Bangladesh for India

• Strategic– From the perspective of India’s Northeast, Bangladesh is India’s most strategic neighbour. The only connection between India’s mainland and the northeast was the Chicken’s Neck – a narrow strip of land that has always been a huge security concern.
• Connectivity to East Asia– India’s dream of ‘Act East Policy’ can only be materialized with the helping hands of Dhaka. Perhaps on top of the list is connectivity between India’s mainland and the crucial northeast, which is part of India’s “Look East” Policy.
• Internal Security– The other big security concern for India is that Bangladesh should not turn into the frontline of radical terror in the southeast. Bangladesh could turn into a launchpad for religious radical terror activities in India if relations are not maintained well.
• Countering China– India’s relationship with Bangladesh is also linked to its relationship with China. India did not want Bangladesh to become a pearl in China’s “String of Pearls” strategy to hem in India by using its neighbours.
• Trade- Bangladesh is currently India’s biggest trade partner in the South Asian region.

Achievements of the relationship

(1) Border settlements

• In September 2011, the two countries signed a major accord on border demarcation to end the 4-decade old disputes over boundaries. This came to be known as the Tin Bigha corridor. India also granted 24-hour access to Bangladeshi citizens in the Tin Bigha Corridor.
• On 7 May 2015 the Indian Parliament, in the presence of Bangladeshi diplomats, unanimously passed the Land Boundary Agreement (LBA) as its 100th Constitutional amendment, thereby resolving all 68-year-old border disputes since the end of the British Raj.

(2) Power cooperation

• India’s Reliance power agreed to invest US$3 billion to set up a 3,000 MW LNG-based power plant (which is the single largest foreign investment ever made in Bangladesh). Adani power will also be setting up a 1600 MW coal-fired power plant at a cost of US$1.5 billion.
• In 2018, the leaders of both countries inaugurated the 130 km long Bangladesh-India Friendship pipeline to supply 4 lakh tonnes of diesel to Bangladesh.
• India is also looking to export electricity from its northeastern region with the potential to generate some 58,971 MW to its eastern States through Bangladesh. Bangladesh hopes to have access to Nepal and Bhutan’s power through India. Bangladesh has formally requested a ‘power corridor’ to access the Bhutanese and Nepalese markets. 
• Bangladesh currently imports 1160 MW of power from India.

(3) Connectivity

• The Modi government along with the Sheikh Hasina regime restarted that with Bandhan in 2017. The Bandhan Express was the second train to be flagged off after the introduction of Maitree Express between Kolkata and Dhaka Cantonment in April 2008.
• In September 2018, the Bangladesh cabinet approved the draft of a proposed agreement with India to allow it to use the Chittagong and Mongla sea ports for transporting goods to and from its land-locked northeastern states.
• Bangladesh-Bhutan-India-Nepal (BBIN) initiative Motor Vehicles Agreement has also been underway to promote connectivity in the region.
• In August 2021, the two sides started a regular movement of freight trains between the newly-restored link between Haldibari in India and Chilahati in Bangladesh.

(4) Cooperation on Rivers

• India and Bangladesh have 54 rivers in common and a bilateral Joint Rivers Commission (JRC) has been working since June 1972 to maximize cooperation in sharing the waters of these rivers.

(5) Defence and Security

• The militaries of the two countries will conduct joint exercises and training, Exercise Sampriti and Navy (Exercise Milan). India will help Bangladesh set up manufacturing and service centres for defence platforms that both countries possess with the aim of achieving self-sufficiency in defence manufacturing in Bangladesh, and will also provide the Bangladesh military with expert training, and technical and logistic support.
• India also extended its first ever defence-related line of credit to a neighbouring country, by providing Bangladesh with $500 million to purchase defence equipment.
• Closer cooperation to fight against extremist radical groups, terrorist organisations, smuggling of arms, drugs and fake currency and also organized crime as a shared priority.
• India and Bangladesh are also engaged in regional cooperation through multilateral forums such as SAARC (South Asian Association for Regional Cooperation), BIMSTEC (Bay of Bengal Multi-Sectoral Technical and Economic Cooperation) and IORARC (Indian Ocean Rim Association for Regional Cooperation)
• For the first time, a contingent of the Bangladesh Armed Forces, comprising 122 members from its tri–services, participated in the Indian Republic Day parade.

(6) Economic development

• India has extended a line of credit of US$ 800 million to Bangladesh for a range of projects, including railway infrastructure, supply of Broad-Gauge microprocessor-based locomotives and passenger coaches, procurement of buses, and dredging projects.
• The bilateral trade between India and Bangladesh stood at $10.8 billion in 2020-21, as against $9.5 billion in 2019-20. Major exports from India to Bangladesh include cotton, cereals, fuel, vehicle parts and machinery and mechanical appliances.

(7) People’s connectivity

• Scholarships and training programmes under ITEC, TCS of Colombo Plan, ICCR, AYUSH, Commonwealth, SAARC and IOR-ARC scholarships/ fellowship schemes are being offered to Bangladesh nationals.
• Both countries jointly celebrated year-long celebrations of the 150th birth Anniversary of Rabindranath Tagore and the 90th Anniversary of the publication of the poem ‘Bidrohi’ by Kazi Nazrul Islam in 2011-12.
• Also, people from Bangladesh form the biggest foreign tourists arrival in India and also the biggest benefiter of cheap Medical tourism in India.

Issues hurting the relationship

(1) Illegal migration

• This has always been a primary problem for India since the partition of Bengal.
• In view of this, recently, the Supreme Court asked the Centre to complete the fencing of the India-Bangladesh border soon to check illegal immigration from Bangladesh into Assam.
• Continuous border killing of Bangladeshi people by Indian border guards, aiding illegal immigrants, helping in armed dacoity, fake money transfer and illegal drug trades by both Indian and Bangladeshi people are the major problems between Bangladesh and India.

(2) Increasing Chinese footprint

• In 2016 when Chinese President Xi Jinping visited Bangladesh, the smaller country agreed to join the OBOR.
• Bangladesh is increasingly tilting towards China due to the Asian giant’s massive trade, infrastructural and defence investments in these countries.
• In spite of its Neighbourhood First Policy, India has been losing its influence in the region to China.

(3) NRC conundrum

• The National Register of Citizens (NRC) has left out 1.9 million Assamese from the list with a group labelled as “illegal immigrants from Bangladesh” living in Assam post-1971.
• India plans to seek their repatriation to Bangladesh.
• Bangladesh remains firm in its stance that no migrants travelled to Assam illegally during the 1971 war of independence and that the controversial NRC risks hurting relations.

(4) Rohingya Issue

• The Rohingya issue and India’s remarks in 2017 on the issue have been upsetting for Bangladesh which has been facing the challenge of providing shelter to more than a million refugees fleeing persecution.

(5) River disputes

• India and Bangladesh have failed to conclude a framework agreement to optimise the use of waters from six rivers including the Manu, Muhuri, Khowai, Gumti, Dharla and Dudhkumar, which has been discussed for several months.
• No progress was reported on the long-pending Teesta water-sharing agreement either after the recent visit.

(5) Rising radicalization

• Bangladesh is witnessing rising radicalization as evident from multiple attacks on religious places of Hindu minorities in the nation and also from the massive violence during PM Modi’s visit to Bangladesh last year.

(6) Killings at the border

• The shooting of smugglers by BSF personnel at the Indo-Bangladesh Border is often seen by Bangladesh nationals as the killing of innocent Bangladeshis and ‘Big Brother’ attitude of India. Recently, a BSF jawan was also killed by smugglers on the border.

Outcomes from Recent PM Sheikh Hasina’s visit to India (September 2022)

• Bangladesh Prime Minister Sheikh Hasina’s ongoing state visit to India and meeting with Prime Minister Narendra Modi have resulted in positive outcomes and seven agreements.
• These include the conclusion of the first water-sharing agreement in 26 years. The water sharing agreement on the Kushiyara, which was preceded by the first Joint River Commission meeting in 12 years, is a particularly hopeful sign of resolving water management, and a very contentious issue, of 54 transboundary rivers.
• While there has been a smaller agreement on the withdrawal of 1.82 cusecs from the Feni in the interim period, the Kushiyara agreement is the first time the Centre has been able to bring on board Assam and other north-eastern States, for the agreement since the 1996 Ganga water treaty.
• India and Bangladesh have decided to start negotiations this year on a bilateral Comprehensive Economic Partnership Agreement—a free trade agreement in goods, services, investments and other related areas—aiming to implement the pact by the time Bangladesh graduates out of its LDC status in 2026.
• Much of her focus was also on attracting investment by Indian industry, which now constitutes a small fraction of Bangladesh’s FDI inflows. Ms. Hasina made particular mention of two dedicated Special Economic Zones for Indian companies, coming up at Mongla and Mirsarai.
• An MoU on scientific cooperation between the Council of Scientific and Industrial Research (CSIR), India and the Bangladesh Council of Scientific Industrial Research (BCSIR) has been signed.

About Kushiyara- Kushiyara River is one of the transboundary rivers between India and Bangladesh. The Barak of India originates from the northern hills of Assam. The river enters Bangladesh and separates into two arms. The northwest arm is the Surma and the southwestern arm is the Kushiyara.

Way forward

• The future will present itself with an abundance of opportunities to help the two countries to reach a new plane of bilateral relations higher than ever before.
• Both nations should play their diplomatic cards with more maturity and pragmatism, keeping the regional aspirations and nuances of both countries in mind.
• A judicious aggregation of regional expectations on both sides of the border will help in achieving their mutual national objectives.
• To make the recent gains irreversible, both countries need to continue working on the three Cs — cooperation, collaboration, and consolidation.

Conclusion

• After reaching a mutual understanding on issues related to maritime delimitation, land border arrangement, enclaves, short sea shipping as well as inland waterways, both countries are at a positive juncture in their diplomatic relations as called by PM Modi “Sonali Adhyaay” (Golden Chapter).
• While cross-border sensitivities in South Asia often run high over such political rhetoric, it is necessary that New Delhi and Dhaka remain focused on their future cooperation, built on their past partnership, and what is referred to as the “Spirit of 1971”.

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Context: Radicalization in India

• Recently, India witnessed a series of extremist acts by some radicalized youth from different cities like Udaipur which later got extended to the “sar tan se juda” sloganeering and related controversy.
• Last year also, The NIA made multiple arrests in a suspected ISI module that was playing role in the radicalization of Indian youth and performing extremist acts in India.
• The above incidences highlight the issue of radicalization of Indian youth which could pose a serious challenge to India’s internal security. Thus, in this edition of the Burning issue, we will study radicalization in India, its causes, consequences and some way forward.

What is Radicalization?

• Radicalization is the process by which an individual or a group comes to adopt increasingly radical views in opposition to a political, social, or religious status quo. It is when someone starts to believe or support extreme views and then participates in extremist groups or acts.
• It can be motivated by a range of factors, including ideologies, religious beliefs, political beliefs and prejudices against particular groups of people.

Type of Radicalization

Right-Wing Extremism

• It is mostly associated with supremacist ideas promoting the supremacy of the social identity of one class or religion over the other. The fascist, racist, and ultranationalist are types of it.

Left-Wing Extremism

• They believe in the violent overthrow of the politically established governments and aim to control the state. This type includes Maoists, anarchists (one who believes in absence of the state) and Marxist–Leninists who believe in Marx’s revolutionary theory. Example- India’s Naxal violence in Chattishgarh, Jharkhand.

Politico-Religious Extremism

• This form of radicalization generally involves a political interpretation of religion and may defend their identity and customs through violent means that they perceive to be under attack.
• It is the broader aspect of communal extremism where religion is used to politically mobilize people and in the process may turn to violent acts leading to religious extremism.

Single-Issue Extremism

• This type of radicalization uses a single issue to mobilize the masses. These can be issues of hatred against outsiders (xenophobia), feminist rights, and environmental issues. The recent post-Agniveer Scheme launch caused radicalization of youth for the job and following violence can be put under this category.

Causes of radicalization in India

• Political– Lack of civil rights or marginalization of a section of society from the political power may lead to the generation of radical ideas or dissent leading to communal mobilization by certain political groups.
• Economic– Lack or deprivation of equal economic opportunity can be a cause of radicalization. Generally, poverty and unemployment are considered a cause of it. For example, violent Pro-Reservation protests by different communities at different times.
• Cultural– It is generally seen with the communities who feel some threat to their cultural norms and practices due to the presence of outside people in their areas and attack these minorities out of fear of losing their culture.
• Social identification– People identify themselves with different groups such as caste, religion, and ethnicity and when some threat occurs to these identifications, it causes them to rise in violence.   
• Internet radicalization- uses the internet as a medium to propagate extremist views, thus provoking individuals, mainly youth, to rise against so-called injustice thus radicalizing them. Recently, the Union government asked several social media platforms to block accounts and youtube channels promoting hatred against the nation.
• Individual factors– This includes a person’s natural tendency of violent behavior, aggressive attitude and causing harm to others. It may also include a feeling of revenge, a desire to cause harm to the wrongdoer etc also.
• Faulty government policies- such as a land acquisition by the government without due compensation could lead to the generation of feelings of injustice and anger against the state, which often lead to moving towards radicalization.

Consequences of radicalization

• Ruptures the social fabric– as it promotes hatred among communities in the society and thus generation of enmity.
• Causes trust deficit– among different sections of society in the country’s social and political system.
• Breeding ground– for extremist or terrorist forces to train and recruit individuals for their motives.
• Hamper’s economic investments– in a nation as frequent radical acts generate negative sentiments in investors about the future stability of the country and thus  reduce investment.
• Threat to national security- as above all consequences finally reaches extreme levels leading to internal security challenges for the police and intelligence agencies. As Acharya Chanakya has said that “Internal threats are much more dangerous than threats outside”

Current state of radicalization in India

• India currently witnessing radicalization in form of Naxalism in central India, Ethnic insurgency in North East India and the recent new types being mob lynching (eg. Cow vigilantism) and even lone wolf attacks (Udaipur and Amravati killing).
• A number of individuals, though minuscule in number, from India, have joined terrorist organizations such ISIS, Al-Queda etc.
• Increasing threat of “Virtual Radicalisation” as evident from The Indian government recently blocking more than 100 YouTube channels as they were spreading fake information and communal hatred in India.
• There is a growing threat of hate speech, and the demonization of certain communities as anti-nationals, which further promotes radicalization and extremism.

Steps taken to counter radicalization

• Approval of study– The Ministry of Home Affairs has ordered a study on ‘the status of radicalization in India’ which will be conducted under G.S. Bajpai. It will try to legally define ‘radicalization’ and suggest amendments to the UAPA Act,1967.

• Enactment of laws- Various laws such as the UAPA act, 1967; NIA act, 2008 have to be strengthened to give more power to security agencies to tackle radicalism.
• Institutions created– Counter-Terrorism and Counter Radicalization (CTCR) divisions of the Ministry of Home Affairs are the key wings of the Government of India to coordinate with various law-enforcement agencies in the country.
• Cyberworld and technology mechanisms– IB launched Operation Chukravyuh in late 2014 to counter the challenges posed by online radicalization.
• Several deradicalization programs– Certain deradicalization and anti-radicalization programs are coordinated by the Union Government such as Civic Action Programs implemented by the Seema Shastra Bal (SSB) along the Indo-Nepal and Indo-Bhutan Borders.
• State-level de-radicalization programs– such as that of the Maharashtra Anti-Terrorism Squad (ATS) which has been quite successful in their attempts of deradicalizing numerous individuals.
• Other programs- Coverage of the government’s various welfare schemes without discrimination, special schemes for communities and areas, promotion of composite culture and coexistence among various communities and constitutional safeguards for minorities, are some of the steps the government has been taking to keep people away from radicalization

Way Forward

• Launching de-radicalization programs– which focus on states with higher intensity of radicalization and also Development of counseling and rehabilitation centers for radicalized youths under police custody.
• Adopting the holistic approach– of deradicalization, counter-radicalization and anti-radicalization at all necessary levels.
• Promoting research in the field of radicalization– concerning the different regions of India for a deeper understanding of the issue and developing a better solution.
• Ensuring adequate funds– for these programs, capability development of intelligence forces and creation of modern infrastructure to tackle radicalization, especially the virtual one.
• Capacity development of state police- as they are the first line of defense. State police forces need to work in good cooperation with central security agencies to better counter the growing radicalization.
• Increase involvement of family and religious leaders– in not only the process of rehabilitation of radicalized youths but also in preventing youth to move towards radicalized ideologies.
• Increasing awareness– in society about these threats through school and college education or through social media accounts of security agencies to prevent people from falling into trap of extremists.
• Need to de-glamourize terrorism- and also a coordinated South Asian effort in countering radicalization can go a long way for the region as all countries of the region is facing the heat of radicalization.

Conclusion

• Radicalization is an ongoing and dynamic process that needs a multifaceted approach that involves various policies and measures. Structural factors, in addition to psychological and ideological factors, go a long way in the explanation of radicalization.
• Various counter-radicalization steps such as the correct diagnosis, building a counter-narrative, having the right communication strategy, education, having a counter-radicalization law, effective oversight and accountability, regulating the media, academia and public intellectuals and learning from other countries can be deliberated upon.
• We all must work together in the ongoing “Amrit Kaal” to create a radicalization and extremism-free India by 2047, the 100^th year of Indian Independence.

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