The poor public health infrastructure in India hits the poor hard. The article examines the factors responsible for poor public health infrastructure and suggests the measures to deal with it.
Poor state of health infrastructure
World Bank data reveal the poor state of India’s health infrastructure.
It reveals that India had 85.7 physicians per 1,00,000 people in 2017.
In contrast, it is 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan.
India had 53 beds per 1,00,000 people.
It is 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan.
India had172.7 nurses and midwives per 1,00,000 people in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan.
What are the factors responsible for poor health infrastructure?
Stagnant expenditure: Analysis by the Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that health expenditure has been stagnant for years.
Lack of expertise with states: Despite health being a state subject, the main bodies with technical expertise are under central control.
The States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
Inter-State variation: States also differ a great deal in terms of the fiscal space to deal with the novel coronavirus pandemic because of the wide variation in per capita health expenditure.
Kerala and Delhi have been close to top in years from 2011 to 2019-20.
Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in the same years.
Out-of-pocket expenditure and its impact on the poor
Due to low levels of public health provision, the World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
Some of the poorest States, Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha, have a high ratio of OOP expenditures in total health expenditure.
Impact on the poor: High ratio of OOP means that the poor in the poorest States, the most vulnerable sections, are the worst victims of a health emergency.
Way forward
1) Coordinated national plan
The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
The Centre already tightly controls major decisions, including additional resources raised specifically for pandemic relief, e.g. the PM CARES Fund.
The need for a coordinated strategy on essential supplies of oxygen and vaccines is acute.
The Centre can bargain for a good price from vaccine manufacturers in its capacity as a single large buyer like the European Union did for its member states.
Centre will also benefit from the economies of scale in transportation of vaccines into the country.
Once the vaccines arrive in India, these could be distributed across States equitably in a needs-based and transparent manner.
Another benefit of central coordination is that distribution of constrained resources like medical supplies, financial resources can internalise the existing disparities in health infrastructure across States.
2) Form Pandemic Preparedness Unit
There is a need for the creation of a “Pandemic Preparedness Unit” (PPU) by the central government.
PPU would streamline disease surveillance and reporting systems; coordinate public health management and policy responses across all levels of government.
It will also formulate policies to mitigate economic and social costs, and communicate effectively about the health crisis.
Consider the question “India has among the highest out-of-pocket expenditure in the world, which is the result of poor public health infrastructure. Examine the factors responsible for poor public health infrastructure and suggest the ways to deal with it.”
Conclusion
As and when we emerge on the other side of the pandemic, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States.
The Finance Ministry has granted ‘Infrastructure’ status for exhibition and convention centres, a move that is expected to ease bank financing for such projects.
Exhibition-cum-Convention Centre
‘Exhibition-cum-Convention Centre is included in the Harmonized Master List of Infrastructure sub-sectors by insertion of a new item in the category of Social and Commercial Infrastructure.
The benefits available as ‘infrastructure’ projects would only be available for projects with a minimum built-up floor area of 1,00,000 square metres of exclusive exhibition space or convention space or both combined.
This includes primary facilities such as exhibition centres, convention halls, auditoriums, plenary halls, business centres, meeting halls etc.
As of now, the major projects underway in the sector are backed by the government – the International Exhibition-cum-Convention Centres at Dwarka as well as Pragati Maidan in the capital.
What is the Master List?
The Harmonized Master list approved by the cabinet committee on infrastructure has five main sectors and 29 infra subsectors.
The five sectors include transport, energy, water sanitation, communication and social and commercial infrastructure.
The infra tag allows certain benefits including access to easier borrowings overseas, the ability to raise funds through tax-free bonds, tax concessions, and access to dedicated lenders such as IIFCL, and the debt funds.
Last August, the government had added affordable rental housing projects to the list of sectors recognised as infrastructure.
Benefits of the move
The infrastructure tag no longer involves significant tax breaks but would help such projects get easier financing from banks, said experts.
India doesn’t have large convention centres or single halls with capacities to hold 7,000 to 10,000 people, unlike countries like Thailand that is a major global MICE-destination.
Becoming a MICE (Meetings, Incentives, Conferences and Exhibitions) destination can generate significant revenue with several global companies active in India but it will take time to become a preferred destination.
The US government has decided to waive sanctions on the company behind Russia’s Nord Stream 2 pipeline to Europe.
Nord Stream 2 Pipeline
It is a system of offshore natural gas pipelines running under the Baltic Sea from Russia to Germany.
It includes two active pipelines running from Vyborg to Lubmin near Greifswald forming the original Nord Stream, and two further pipelines under construction running from Ust-Luga to Lubmin termed Nord Stream 2.
In Lubmin the lines connect to the OPAL line to Olbernhau on the Czech border and to the NEL line to Rehden near Bremen.
The first line Nord Stream-1 was laid and inaugurated in 2011 and the second line in 2012.
At 1,222 km in length, Nord Stream is the longest sub-sea pipeline in the world, surpassing the Langeled pipeline.
US sanctions
Nord Stream projects have been opposed by the United States as well as by several Central and Eastern European countries because of concerns that the pipelines would increase Russia’s influence in the region.
The US resistance to Nord Stream 2 is also influenced by the country’s increased production of natural gas, which gives the US economic incentive to resist the Russian supply of gas to the EU, in favour of US shale gas.
In a major boost to exports of Geographical Indication (GI) certified products, a consignment of Dahanu Gholvad Sapota from the Palghar district of Maharashtra was shipped to the United Kingdom.
Gholvad Sapota
GI certification of Ghovad Sapota is held by Maharashtra Rajya Chikoo Utpadak Sangh and the fruit is known for its sweet and unique taste.
It is believed that the unique taste is derived from the calcium-rich soil of Gholvad village.
Currently, in the Palgahr district, around 5000 hectares of land is under sapota or plantation.
Sapota is grown in many states- Karnataka, Gujarat, Maharashtra, Tamil Nadu, West Bengal and Andhra Pradesh.
Karnataka is known to be the highest grower of the fruit, followed by Maharashtra.
Do you know?
Earlier this month, a consignment of 2.5 Metric Tonne of GI certified Banganapalli & Survarnarekha mangoes sourced from farmers in Krishna & Chittor districts of Andhra Pradesh was exported to South Korea.
Back2Basics: Geographical Indication (GI)
The World Intellectual Property Organisation defines a GI as “a sign used on products that have a specific geographical origin and possess qualities or a reputation that are due to that origin”.
GIs are typically used for agricultural products, foodstuffs, handicrafts, industrial products, wines and spirit drinks.
Internationally, GIs are covered as an element of intellectual property rights under the Paris Convention for the Protection of Industrial Property.
They have also covered under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement.
India’s Parliament in September 2020 passed a Social Security Code (SS Code 2020).
The SS Code 2020 merges existing social security laws and attempts to include informal workers within the ambit of social security administration.
The SS Code 2020 amalgamates and rationalises the provisions of eight existing central labour laws.
Of these acts, employees provident fund, employees state insurance (ESI), maternity benefit, gratuity are entirely for organised sector workers.
Employee threshold removed: For employees’ state insurance, the existing employee threshold has been withdrawn.
Now the central government can extend ESI benefits to any organisation irrespective of the number of workers employed.
Key benefits not available to informal workers in Social Security Code 2020
Maternity benefit: Under the SS Code, the provision of maternity benefit has not been made universal.
Maternity benefit is presently applicable for establishments employing 10 workers or more.
The definition of ‘Establishment’ in the proposed code did not include the unorganised sector.
Hence, women engaged in the unorganised sector would remain outside the purview of maternity benefit.
Employees Provident Fund: The SS Code maintains that the Employees’ Provident Fund Scheme will remain applicable, as before, to every establishment in which 20 or more employees are employed.
Thus, for informal sector workers, access to employees’ provident fund remains unfulfilled too in the new code.
Payment of gratuity: Gratuity shall be payable to eligible employees by every shop or establishment in which 10 or more employees are employed, or were employed, on any day of the preceding 12 months.
But although payment of gratuity was expanded in the new Code, it still remains inaccessible for a vast majority of informal workers.
Challenges faced by informal workers in availing social security
Registration barrier: To avail social security, an informal worker must register herself on the specified online portal to be developed by the central government.
Absence of definition: The absence of definite and unambiguous provisions in the present code would further complicate achievement of universal registration.
Lack of awareness: Experience shows that there is an awful lack of awareness among informal workers regarding social security schemes.
Lack of digital literacy: Online registration places a further challenge as most informal workers lack digital literacy and connectivity.
Lack of documents: Informal workers also find it difficult to furnish all documentary papers required as part of the registration process.
Furnishing proof of livelihood and income details in the absence of tangible employer-employee relations is very difficult.
Such requirements deter informal workers from completing the registration and they continue to remain outside the social security ambit.
Way forward
The provision of social security could be used to formalise the workforce to a certain extent. Employers could have been made to own up to the responsibility of providing social security to their workers.
1) Inter-State cooperation
As unorganised workers are spread across the length and breadth of India, inter-State arrangement and cooperation becomes imperative.
The central government should conceptualise a basic structure, which if successful, should be adopted by States after necessary customisation.
2) Universal coverage
The unorganised workforce is all encompassing, minus the minuscule regular workers of organised sectors.
This identity should be primal and all unorganised workers should have basic social security coverage, irrespective of labour market classifications.
The code fails to undertake such inclusion in a meaningful way.
Conclusion
The Social Security Code fails to provide adequate protection to informal workers, who constitute 91% of the workforce. The pandemic and misery brought by it on these informal workers highligths the need for universal social security.
Vitalik Buterin, co-creator of the crypto network Ethereum, has made a 1 billion dollar cryptocurrency donation for India’s relief funds as the country battles the latest deadly COVID-19 wave.
Definition
The 2019 Bill defined cryptocurrency as any information, code, number or token, generated through cryptographic means or otherwise, which has a digital representation of value and has utility in business activity, or acts as a store of value or a unit of account. According to professionals a system must need these six points to be called a cryptocurrency system:
The system does not require a central authority; its state is maintained through distributed consensus.
The system keeps an overview of cryptocurrency units and their ownership.
The system defines whether new cryptocurrency units can be created. If new cryptocurrency units can be created, the system defines the circumstances of their origin and how to determine the ownership of these new units.
Ownership of cryptocurrency units can be proved exclusively cryptographically.
The system allows transactions to be performed in which ownership of the cryptographic units is changed. A transaction statement can only be issued by an entity proving the current ownership of these units.
If two different instructions for changing the ownership of the same cryptographic units are simultaneously entered, the system performs at most one of them.
History/Background
In 1983, the American cryptographer David Chaum conceived an anonymous cryptographic electronic money called ecash. Later, in 1995, he implemented it through Digicash, an early form of cryptographic electronic payments which required user software in order to withdraw notes from a bank and designate specific encrypted keys before it can be sent to a recipient.
In 1998, Wei Dai published a description of “b-money”, characterized as an anonymous, distributed electronic cash system.
Shortly thereafter, Nick Szabo described bit gold. Like bitcoin and other cryptocurrencies that would follow it, bit gold (not to be confused with the later gold-based exchange, BitGold) was described as an electronic currency system which required users to complete a proof of work function with solutions being cryptographically put together and published.
In 2009, the first decentralized cryptocurrency, bitcoin, was created by presumably pseudonymous developer Satoshi Nakamoto. It used SHA-256, a cryptographic hash function, in its proof-of-work
In April 2011, Namecoin was created as an attempt at forming a decentralized DNS, which would make internet censorship very difficult.
In October 2011, Litecoinwas released. It used scrypt as its hash function instead of SHA-256. Another notable cryptocurrency, Peercoin used a proof-of-work/proof-of-stake
On 6 August 2014, the UK announced its Treasuryhad been commissioned a study of cryptocurrencies, and what role, if any, they could play in the UK economy. The study was also to report on whether regulation should be considered.
Types of cryptocurrency
The most common and valued cryptocurrency is Bitcoin.
All the other cryptocurrencies other than Bitcoin are together as a set are known as alternate coins or commonly called “Altcoins”. Most famous alt coins are:-
Litecoin
Cardano
Polkadot
Stellar(XLM)
Binance Coin
By the end of March 2021 the total share of altcoins in the cryptocurrency market was estimated to be at 40% of the total market value.
How it works?
Cryptocurrencies work using a technology called blockchain. Blockchain is a decentralized technology spread across many computers that manages and records transactions. Part of the appeal of this technology is its security.
What is Blockchain Technology?
Simply, blockchain is decentralized, distributed and public digital ledger. Blockchains is a new type of network infrastructure (a way to organize how information and value move around on the internet) that create ‘trust’ in networks by introducing distributed verifiability, auditability, and consensus.
Blockchains create trust by acting as a shared database, distributed across vast peer-to-peer networks that have no single point of failure and no single source of truth, implying that no individual entity can own a blockchain network, and no single entity can modify the data stored on it unilaterally without the consensus of its peers.
New data can be added to a blockchain only through agreement between the various nodes of the network, a mechanism known as distributed consensus. Each node of the network keeps its own copy of blockchain’s data and keeps the other nodes honest – if one node changes its local copy, the other nodes can reject it.
Imagine a blockchain as a ledger—because that’s essentially how most blockchains function. Each block of data represents some new transaction on the ledger, whether that means a contract or a sale or whatever else you’d use a ledger for.
Interestingly, blockchains leverage techniques from a field of mathematics and computer science, known as cryptography, to sign every transaction (e.g. the transfer of assets from one person to another) with a unique digital signature belonging to the user who initiated the transaction.
Advantages
Low transaction Fee: Because miners are simply rewarded cryptocurrency from network itself, there are typically little or no fees for core transactions.
Ownership: With your digital key, access to your currency is yours alone. Unlike money you store at a bank, your use of cryptocurrency cannot be frozen or limited by any entity.
Identity Protection: Paying with credit/debit cards requires submitting sensitive banking information that could be stolen or compromised. Cryptocurrency can be sent directly to a recipient without any information other than total amount you want to send.
Risk-free for sellers: Payments using Cryptocurrency can’t be reversed, which means merchants don’t have to worry about stopped payments. The blockchain makes it difficult for you to be defrauded.
Disadvantages
Privacy Concerns: The privacy of users’ data is at stake. There is concern regarding privacy of users data in using cryptocurrencies as all the transaction information is stored in distributed ledger (called blockchain), which is publicly visible. Thus Hacker can easily observe how the money flows.
High Volatility: The price of Bitcoin suddenly rose to almost $20,000 and then dropped to $6,000. Due to such incidents, it is complicated for the investors to trust the ecosystem.
Destination for black money: The fear among regulators and policymakers is that cryptocurrencies, being an alternative source of value to fiat currency, could be misused to launder black money or finance terrorist activities.
Cybersecurity Concerns: Cryptocurrencies are prone to cybersecurity breaches and hacks. Various attacks are common, even companies and governments are not full proof to them. For example, the Swiss blockchain company, Trade.io, has reported that crypto tokens worth almost $8 million have been stolen from their cold wallet.
Dark activities: The possibility that the new money will nurture illicit activities and markets like drug selling, weapons etc. through Darknet is always high using cryptocurrency anonymously. It also increases the risk of its use in various terrorist activities across the border.
Monetary control and economic behavior: It could dramatically change global monetary policymaking. People will exchange their national currencies for the new digital coin in order to buy and sell the many products that will be priced in it. This will further impact the profit of banks and will put stress on their balance sheet.
Inflation: Governments and policymakers will have reduced ability to control inflation. Usually, when inflation picks up, central banks take steps to control it through various monetary rates. Cryptocurrency will be out of control of the central bank so liquidity control will be an issue.
Cryptocurrency and India
The country, at present, has around 75 lakh cryptocurrency investors who have together pooled over Rs 10,000 crore into Bitcoins and other such digital currencies.
The prices have surged by over 900%, courtesy of the worldwide boom – a single bitcoin that used to cost around Rs 4 lakh in 2020 now costs somewhere around Rs 41 lakh now.
FM Nirmala Sitharaman has said that the Centre will take a “calibrated approach” and leave a window open for experiments with blockchain technology.
Legitimacy of Cryptocurrency in India
Finance minister Arun Jaitley, in his budget speech on 1 February 2018, stated that the government will do everything to discontinue the use of bitcoin and other virtual currencies in India for criminal uses.
He reiterated that India does not recognise them as legal tender and will instead encourage blockchain technology in payment systems. “The government does not recognise cryptocurrency as legal tender or coin and will take all measures to eliminate the use of these cryptoassets in financing illegitimate activities or as part of the payments system,” Jaitley said
In early 2018 India’s central bank, the Reserve Bank of India(RBI) announced a ban on the sale or purchase of cryptocurrency for entities regulated by RBI
In March 2020, the Supreme Court of India passed the verdict, revoking the RBI ban on cryptocurrency trade.
In 2021, the government is exploring the creation of a state-backed digital currency issued by the Reserve Bank of India, while banning private ones like bitcoin.
Cryptocurrency Bill India 2019
Cryptocurrency cannot be used as a legal tender or currency at any place in India.
The bill prohibits everyone to mine, generate, hold, sell, deal in, issue, transfer, dispose of or use cryptocurrency in the territory of India.
The central government is allowed to declare Digital Rupee to be the legal tender with the consent of Reserve Bank of India.
The use of Distributed Ledger Technology (DLT) for creating a network for delivery of any financial or other services or for creating value , without involving any use of cryptocurrency is not prohibited.
Direct or indirect use of cryptocurrency shall be punishable with fine or imprisonment of 1 year which may be extended o 10 years or both.
The court is empowered to transfer any fees recovered to the consolidated fund of India.
The central government on the recommendation of the investigating agency without being bound to it is empowered to grant immunity for any offense under this act.
The bill also provides that no such immunity can be granted by the central government in cases where the proceedings for any such offence have been instituted before the date of receipt of application for grant of such immunity.
The Bill promises to “allow for certain exceptions to promote the underlying technology of cryptocurrency (blockchain) and its uses.”
The way the technology is built, an ownerless, consensus-driven, distributed ledger like a blockchain needs cryptocurrency to grease its wheels.
International Scenario
United states of America
The U.S. has the highest number of cryptocurrency users, the highest number of Bitcoin ATMs and also the highest Bitcoin trading volumes globally.
The US government, in 2013, accepted bitcoin as a decentralized virtual currency that can be used for performing transactions. It was classified as a commodity by CFTC in September 2015.
Bitcoin is also taxable as a property. To sum up, bitcoin is legal in the USA, however, there is no clarification about the legalization of other cryptocurrencies.
Japan
Japan has eliminated the consumption tax on Bitcoin trading on April 1, 2017, when it officially declared Bitcoin as a legal tender. Japan also eliminated the possibility of double taxation on trading of Bitcoins.
Japan is now widely considered a hub for cryptocurrency trading/exchange in Asia.
Canada
Bitcoin is viewed as a commodity by the Canada Revenue Agency (CRA). This means that Bitcoin transactions are viewed as barter transactions, and the income generated is considered as business income. The taxation also depends on whether the individual has a buying-selling business or is only concerned with investing.
Canada considers Bitcoin exchanges to be money service businesses. This brings them under the purview of the anti-money laundering (AML) Bitcoin exchanges need to register with Financial Transactions and Reports Analysis Centre of Canada (FINTRAC)
In addition, some major Canadian banks have banned the use of their credit or debit cards for Bitcoin transactions.
European Union
On Oct. 22, 2015, the European Court of Justice (ECJ) ruled that buying and selling digital currencies is considered a supply of services, and that this is exempt from value-added tax (VAT)in all European Union (EU) member states.
Some individual EU countries have also developed their own Bitcoin stances.
In Finland, the Central Board of Taxes (CBT) has given Bitcoin a VAT exempt status by classifying it as a financial service. Bitcoin is treated as a commodity in Finland and not as a currency.
The National Revenue Agency (NRA) of Bulgaria has also brought Bitcoin under its existing tax laws.
Germany is open to Bitcoin; it is considered legal but taxed differently depending upon whether the authorities are dealing with exchanges, miners, enterprises, or users.
China
Bitcoin is essentially banned in China. All banks and other financial institutions like payment processors are prohibited from transacting or dealing in Bitcoin. Cryptocurrency exchanges are banned.
The government has cracked down on miners.
Way Forward
A worldwide regulatory authority must be established to control the volatility, security and inflation of the cryptocurrency market.
While the number of merchants who accept cryptocurrencies has steadily increased, they are still very much in the minority. For cryptocurrencies to become more widely used, they have to first gain widespread acceptance among consumers.
The more popular they become, the more regulation and government scrutiny they will likely to attract, which erodes the fundamental premise for their existence. And therefore the central authority must be made so in keeping mind that the fundamental of the cryptocurrency existence must not be mended.
For cryptocurrencies to become part of the mainstream financial system must :
Be made mathematically complex (for frauds and hackers) but graphically easy for the users to make them understand better.
Be Decentralized but with adequate consumer safeguards and protection.
Preserve user anonymity without being a conduit for tax evasion, money laundering and other nefarious activities.
Punjab CM has recently declared Malerkotla the 23rd district of the State.
How are new districts carved?
The power to create new districts or alter or abolish existing districts rests with the State governments.
This can either be done through an executive order or by passing a law in the State Assembly.
Many States prefer the executive route by simply issuing a notification in the official gazette.
How does it help?
States argue that smaller districts lead to better administration and governance.
For example, in 2016, the Assam government issued a notification to upgrade the Majuli sub-division to the Majuli district for “administrative expediency”.
Are there are any exceptions?
The State government has been vested with unfettered powers under Section 5 of the Punjab Land Revenue Act, 1887 to create new districts.
This power is generally held temporarily in abeyance only during active census operations or during the delimitation exercise of Lok Sabha/Vidhan Sabha constituencies.
Answer this PYQ in the comment box:
Q. The Constitution (Seventy-Third Amendment) Act, 1992, which aims at promoting the Panchayati Raj Institutions in the country, provides for which of the following?
Constitution of District Planning Committees.
State Election Commissions to conduct all panchayat elections.
Establishment of State Finance Commissions.
Select the correct answer using the codes given below:
(a) Only 1
(b) 1 and 2 only
(c) 2 and 3 only
(d) 1, 2 and 3
Does the Central government have a role to play here?
The Centre has no role to play in the alteration of districts or creation of new ones. States are free to decide.
The Home Ministry comes into the picture when a State wants to change the name of a district or a railway station.
The State government’s request is sent to other departments and agencies such as the Ministry of Earth Sciences, Intelligence Bureau, Department of Posts, Geographical Survey of India Sciences and the Railway Ministry seeking clearance.
A no-objection certificate may be issued after examining their replies.
What has been the trend?
According to the 2011 Census, there were 593 districts in the country.
The Census results showed that between 2001-2011, as many as 46 districts were created by States.
Though the 2021 Census is yet to happen, Know India, a website run by the Government of India, says currently there are 718 districts in the country.
The surge in number is also due to the bifurcation of Andhra Pradesh into A.P and Telangana in 2014. Telangana at present has 33 districts and A.P has 13 districts.
The article highlights the issue of shortage of healthcare workers in India even as it exports its healthcare workers to other countries.
India as an exporter of healthcare workers
For several decades, India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council countries, Europe and other English-speaking countries.
As per OECD data, around 69,000 Indian trained doctors worked in the UK, US, Canada and Australia in 2017.
In these four countries, 56,000 Indian-trained nurses were working in the same year.
There is also large-scale migration of health workers to the GCC countries but there is a lack of credible data on the stock of such workers in these nations.
There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.
Shortage of nurses and doctors
The migration of healthcare workers is part of the reason for the shortage in nurses and doctors.
If we look at the figures for countries where we export our healthcare workers, we see just how big the difference is between the sending and the receiving countries.
As per government reports, India has 1.7 nurses per 1,000population and a doctor to patient ratio of 1:1,404.
This is well below the WHO norm of 3 nurses per 1,000 population and a doctor to patient ratio of 1:1,100.
But, this does not convey the entire problem.
The distribution of doctors and nurses is heavily skewed against some regions.
Moreover, there is high concentration in some urban pockets.
Factors driving migration
There are strong pull factors associated with the migration of healthcare workers, in terms of higher pay and better opportunities in the destination countries.
However, there are strong push factors that often drive these workers to migrate abroad.
The low wages in private sector outfits along with reduced opportunities in the public sector plays a big role in them seeking employment opportunities outside the country.
The lack of government investment in healthcare and delayed appointments to public health institutions act as a catalyst for such migration.
Measures to check brain drain and issues with it
Over the years, the government has taken measures to check the brain drain of healthcare workers with little or no success.
In 2014, it stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US.
The NORI certificate is a US government requirement for doctors who migrate to America on a J1 visa and seek to extend their stay beyond three years.
The non-issuance of the NORI would ensure that the doctors will have to return to India at the end of the three-year period.
The government has included nurses in the Emigration Check Required (ECR) category.
This move was taken to bring about transparency in nursing recruitment and reduce the exploitation of nurses in the destination countries.
The government’s policies to check brain drain are restrictive in nature and do not give us a real long-term solution to the problem.
Way forward
We require systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to workers and building an overall environment to motivate them to stay in the country.
The government should focus on framing policies that promote circular migration and return migration — policies that incentivise healthcare workers to return home after the completion of their training or studies.
It could also work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.
The 2020 Human Development Report shows that India has five hospital beds per 10,000 people — one of the lowest in the world.
Increased investment in healthcare, especially in the public sector, is thus the need of the hour.
This would, in turn, increase employment opportunities for health workers.
Consider the question “What are the factors driving the migration of healthcare workers from India? Suggest the measure to stem their migration.”
Conclusion
India needs systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to health workers and building an overall environment that could prove to be beneficial for them and motivate them to stay in the country.
The State of Working India (SWI) 2021 has documented the impact of one year of Covid-19 in India, on jobs, incomes, inequality, and poverty.
Highlights of the SWI 2021
The SWI 2021 showed that the pandemic had forced people out of their formal jobs into casual work, and led to a severe decline in incomes.
There is a sudden increase in poverty over the past year.
Maharashtra, Kerala, Tamil Nadu, Uttar Pradesh, and Delhi, contributed disproportionately to job losses.
Unsurprisingly, these are also the states that suffered the maximum Covid caseload.
Labour Participation Rate (LPR) is the ratio of the labour force to the population greater than 15 years of age. It is defined as the section of working population in the age group of 16-64 in the economy currently employed or seeking employment.
Worsened with COVID
It pointed to an ailment of the Indian economy that has not only been a longstanding one but also one that has gotten worse over the past few years even without the help of Covid.
Agriculture, mines, manufacturing, real estate and construction, financial services, non-financial services, and public administrative services sectors account for 99% of total employment in India.
The number of people employed in the manufacturing sector of the economy has come down from 51 million to 27 million — that is, almost halving in the space of just four years!
For instance, the number of people employed in agriculture is going up.
Equally disheartening is that employment in non-financial services (such as providing education and entertainment industry etc.) has fallen sharply.
Why are these trends worrisome?
It is important to understand that traditionally Indian policymakers have been of the view that the manufacturing sector is our best hope to soak up the surplus-labour otherwise employed in agriculture.
Manufacturing is well suited because it can make use of the millions of poorly educated Indian youth, unlike the services sector, which often requires better education and skill levels.
For the longest time, India has struggled to get its manufacturing industries to create a growing bank of jobs.
But, and this is what the CMIE data shows, what is happening in the past 4-5 years is that far from soaking up excess labour from other sectors of the economy, manufacturing is actually letting go of workers.
Return to Agriculture
India has seen a hike in the number of people “employed” in agriculture over the past year.
This is nothing but disguised unemployment.
Essentially, labourers and workers are returning to their rural homes in the absence of jobs either in manufacturing or services.
Why is Indian manufacturing failing to create jobs?
On the face of it, every past government has come out with a policy to boost manufacturing jobs. But still, the situation is getting worse.
There are different ways to look at this question.
One is to look at why manufacturing has struggled to create as many jobs in the past
The second is to look at the specific reasons why manufacturing has been bleeding jobs, instead of creating them, since 2016-17.
Let’s tackle the historical question first.
If one looks at any of the sectors in the economy — agriculture, industry, services — starting a manufacturing unit requires the highest amount of fixed investment upfront (relative to the output that may be generated later).
In other words, it is a big commitment on the part of an entrepreneur to put up a huge amount of money without necessarily knowing how it will all pan out.
What has traditionally made this truly risky is the highly extractive nature of governments.
In simpler terms, far too often governments have been corrupt, with officials and politicians extracting bribes.
Less focus on manufacturing goods
As regards the demand for manufacturing goods, experts point out that Indians have always consumed relatively less of manufacturing goods and relatively more of food and services.
There are two possible reasons for this.
One, most Indians are quite poor and hence most of the income is spent on food.
Two, repairs and maintenance are a very high part of our consumption choice.
In other words, when Indians buy a manufactured product — say a refrigerator — they tend to use it for much longer than in developed countries.
Core of the problem
The trouble lies with policymakers repeatedly neglecting the labour-intensive industries.
Since the second five year plan, the P C Mahalanobis strategy was to gain self-reliance by investing in capital intensive industries so that India does not have to import machines etc. from other countries.
The hope was that the demand from Indian consumers will make the domestic industry viable.
But Indian domestic demand was quite anaemic due to poverty levels.
Other policy lacunas
As against the capital intensive industries, which were involved in making heavy machines, the labour-intensive ones (such as leather, handicrafts, textiles etc.) were reserved for the small-scale industry framework.
But while the labour-intensive manufacturing firms could not match the capital-intensive firms in terms of GDP value or growth of output, they did have a distinct advantage of creating more jobs.
But, by treating them as small-scale industries, policies held back their growth.
Moreover, India did not push for integrating its labour-intensive manufacturing in the global supply chains by aggressively following exports.
Instead, the idea was to substitute imports in the name of self-reliance.
What has happened since 2016-17?
Things have become worse over the past five odd years despite the Indian government unveiling its ambitious Make in India (MII) initiative and the latest Production-Linked Incentive (PLI) scheme.
For one India is repeating the same mistakes with MII and PLI schemes.
They are again aimed more at capital intensive manufacturing, not labour intensive ones.
Moreover, India is reverting to the protectionist approach, aimed at self-reliance, yet again in recent years.
Further, much like in the past, this time, too, the domestic demand is weak for aggressively boosting labour-intensive industries aimed at capturing the export markets.
Conclusion
The growing rift in the fortunes of informal and formal manufacturing could be the reason why India is seeing such a massive decline in manufacturing jobs.
The government has tried its level best to push for greater formalization but it has often been accused of not understanding the nature and functioning of India’s informal economy.
Way forward
For the same level of employment, formality is good.
But if there is a trade-off between formality and employment generation, choosing formality may not be so beneficial. And this trade-off appears to be quite sharp in India.
Indian manufacturing is still at best hope for creating new jobs and soaking up excess unskilled labour through better infrastructure and easier regulatory support — to create millions of new jobs.
The use of convalescent plasma has been dropped from the recommended treatment guidelines for COVID-19, according to an advisory from the Indian Council of Medical Research (ICMR).
Q.What is convalescent plasma therapy and what are the issues involved in its adoption?
Convalescent Plasma Therapy
The therapy seeks to make use of the antibodies developed in the recovered patient against the coronavirus.
The whole blood or plasma from such people is taken, and the plasma is then injected into critically ill patients so that the antibodies are transferred and boost their fight against the virus.
A COVID-19 patient usually develops primary immunity against the virus in 10-14 days.
Therefore, if the plasma is injected at an early stage, it can possibly help fight the virus and prevent severe illness.
How often has it been used in the past?
This therapy is no new wonder. It has been used several times.
The US used plasma of recovered patients to treat patients of Spanish flu (1918-1920).
In 2014, the WHO released guidelines to treat Ebola patients with convalescent whole blood and plasma.
In 2015, plasma was used for treating MERS patients.
How is it done?
The process to infuse plasma in a patient can be completed quickly.
It only requires standard blood collection practices and extraction of plasma.
If whole blood is donated (350-450 ml), a blood fractionation process is used to separate the plasma.
Otherwise, a special machine called aphaeresis machine can be used to extract the plasma directly from the donor.
While blood is indeed extracted from the donor, the aphaeresis machine separates and extracts the plasma using a plasma kit, and the remaining blood components are returned into the donor’s body.
