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GS Paper: GS2

  • Implementing Universal Health Coverage

    Why in the news?

    On the eve of World Health Day (7th April), many countries aim to implement UHC (Universal Health Coverage) in the same way as India introduced its National Health Policy, in 2017. However, there exist challenges in India too for implementing it.

    Background:

    • On December 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
    • In India, the high-level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).

    BACK2BASICS:

    About National Health Policy, 2017:

    It aims to achieve Universal Health Coverage and deliver quality healthcare services to all at an affordable cost. It focuses on improving health status through preventive, promotive, curative, palliative, and rehabilitative services with an emphasis on quality.

     

    What are the challenges in the Implementation of UHC in India? 

    • Federal Issue: Health is a state subject in India, but UHC policy is envisaged at the national level. This can lead to challenges in coordination between the central government and state governments.
      • While the Directive Principles of State Policy provide a basis for the right to health, the absence of a specific constitutional guarantee may create challenges in ensuring consistent and enforceable healthcare rights.
    • Migrant Population and Urban Slums:  Due to issues such as overcrowding, poor sanitation, and limited infrastructure, a significant portion of the population living in urban slums face issues with the availability and accessibility of Primary Health Services is hard to provide.
    • Lack of Finance: Implementing UHC requires significant financial resources. Reducing out-of-pocket expenditure and strengthening primary healthcare services necessitate substantial investments, which may strain government budgets and require innovative financing mechanisms to ensure sustainability.
    • Lack of Healthcare Infrastructure and Human Resources:  India faces shortages in both infrastructure and human resources, particularly in rural and underserved areas, which hinders efforts to improve healthcare accessibility and quality.
    • The vicious cycle of poverty: The vicious cycle of poverty and poor health perpetuates inequality in various spheres of life which eventually leads to the accessibility of health services.

    Suggestive Measures:

    • Addressing Urban Migrants’ Health Needs: Establishing mobile healthcare units or clinics that can reach migrant communities in urban and peri-urban areas, providing essential primary healthcare services.
    • Reducing Out-of-Pocket Expenditure: Simplifying the reimbursement process by digitizing healthcare payment systems and integrating them with government identification or mobile banking platforms to facilitate easy reimbursement for medical expenses.
    • Creating Inclusive Health Systems: Introducing multilingual and culturally sensitive health information materials and services to bridge language barriers and ensure accessibility for diverse urban populations.
    • Implementing Community-Based Primary Healthcare: Establishing community health centers or clinics in urban and peri-urban areas staffed by trained community health workers who can provide basic healthcare services and referrals.

    Conclusion: Building Constitutional backing, enhancing coordination, and federal with fiscal consensus with adequate infrastructure in addressing urban health needs can improve the reach of the Universal Health Program in India.

    Mains PYQ

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    PYQ Relevance:

    Mains: 
    Q) Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015) 
    Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC CSE 2022) 

    Prelims:
    With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker?  (UPSC CSE 2012) 
    1) Accompanying women to the health facility for antenatal care checkups
    2) Using pregnancy test kits for early detection of pregnancy
    3) Providing information on nutrition and immunization
    4) Conducting the delivery of babySelect the correct answer using the codes given below:
    (a) 1, 2 and 3 only
    (b) 2 and 4 only
    (c) 1 and 3 only
    (d) 1, 2, 3 and 4

    Note4Students: 

    Prelims: National Health Policy; Ayushman Bharat;

    Mains: Health Issues in India; Universal Health Coverage;

    Mentor comments: Indian Health Policies since Independence have neglected diverse perspectives critical for public health systems at the local level. This diversity impacts the nature of policies made, “because we are looking only from a certain lens”. Recently, with the passage of World Health Day 2024, WHO promoted the idea that ‘Health Equity’ is a source of optimism for millions of people, going beyond social justice or legislative change. Now the issue is with the theme of World Health Day ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject (Seventh Schedule) and the ‘Universal Health Coverage’ policy is envisaged at the National level, there is a need for discourses on implementation. 

    Let’s learn. 

    —

    Why in the News?

    The World Health Organization (WHO) has declared health to be a fundamental human right. 

    • India’s ‘Health Equity’ issues require a comprehensive approach that goes beyond improvements in healthcare facilities.
    About World Health Day 2024:

    World Health Day (April 7) unites every country around ‘Health Equity’, an essential topic at the heart of global health and justice. 

    Theme for 2024: “My Health, My Right”.Although over 140 nations recognize health as a Constitutional right, the WHO Council on the ‘Economics of Health for All’ reported that more than half the world’s population needs complete access to essential health services. 

    There is an alarming gap in Indian health-care access, which was highlighted especially during the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. 

    What is meant by Health Equity?

    ‘Health Equity’ ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. 

    WHO’s idea behind Health Equity – Ensuring Everyone’s Right to Health:

    • Aim: To eliminate unfair and preventable health disparities among different social and economic categories.
    • Significance:
      • Builds Equality: True health equity addresses the root causes of health inequities, such as poverty, discrimination, and limited access to resources.
      • Universal Coverage: Pandemics, climate change, and sociopolitical unrest exacerbate health inequities, particularly in diverse countries like India.
    What does the Indian Statistics say?

    1) 2011 Census: 

    Infectious diseases, such as tuberculosis, are 1.5 times more common in slums due to overcrowding and poor sanitation as compared to non-slum areas, according to the Indian Council of Medical Research. Disparities across caste and gender are profound. 

    2)National Family Health Survey (NFHS)-5 (2019-21) 

    Minorities: SCs and STs experience higher child mortality and lower immunization rates. 59% of women in the lowest wealth quintile suffer from anemia, demonstrating the intersection of caste, gender, and economic status in health outcomes.Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The economic effect of NCDs could surpass $6 trillion by 2030.

    3)Public Health Foundation of India:
    Shortage of Doctors: The WHO data indicates that there are only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of Health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas. 
    • Limitations in India:
      • Diversity: The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India.
      • Comprehensive Planning: Achieving health equity requires a comprehensive approach beyond legislative reform, addressing socioeconomic determinants of health.
      • Collaboration and Coordination: Realizing health potential demands collective effort by governments, communities, and individuals to remove barriers.
      • Accessibility: Health equity includes targeting marginalized and vulnerable groups, climate change disproportionately impacting low-income and vulnerable people, and conflicts disrupting healthcare provision.

    Initiatives Taken by Government:

    • Ayushman Bharat Initiative: This initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
    • National Health Mission (NHM): It includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), thus reducing the healthcare gap between rural and urban India. It expands its access by strengthening infrastructure and providing essential services to vulnerable populations.

    Way Forward:

    • Requires a Comprehensive Approach: To move India towards Universal Health Coverage and a more equitable future, the government, civil society, healthcare providers, and communities need to work together.
    • Tap Organizations Together: Organizations (Non-Governmental organizations and Civic Societies) with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programs. 
    • Successful collaborations: Need for open communication, respect for one another, and common goals because this can strongly emphasize empowering communities, sharing knowledge, and building capacity. For Example, WHO, the Global Fund and Gavi support health initiatives.
    • Building R&D: Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.
  • [6 April 2024] The Hindu Op-ed: Parliaments past, a mirror to changing dynamics

    [6 April 2024] The Hindu Op-ed: Parliaments past, a mirror to changing dynamics

    PYQ Relevance:

    Mains: 

    Q. The role of individual MPs (Members of Parliament) has diminished over the years and as a result healthy constructive debates on policy issues are not usually witnessed. How far can this be attributed to the anti-defection law, which was legislated but with a different intention? (UPSC CSE 2013)
    Q. To what extent, in your view, the Parliament can ensure accountability of the executive in India? (UPSC CSE 2021)

    Prelims:

    We adopted parliamentary democracy based on the British model, but how does our model differ from that model?​ (UPSC CSE 2021)

    1. As regards legislation, the British Parliament is supreme or sovereign but in India, the power of the Parliament to legislate is limited.
    ​2. In India, matters related to the constitutionality of the Amendment of an Act of Parliament are referred to the Constitution Bench by the Supreme Court.​

    Select the correct answer using the code given below.​

    (a) 1 only ​(b) 2 only​(c) Both 1 and 2 ​(d) Neither 1 nor 2

    Note4Students: 

    Mains: Parliamentary Democracy; 

    Mentors Comment: We Indians have been through ‘thick and thin’ as our Democracy has evolved. Since the 16th and 17th Loksabha, all have been doubts relating to the accountability of people’s Representation in Parliament due to the reduced Debates and discussions in Parliamentary sessions. Now, as we move towards the general election of 2024, the question arises: will history repeat itself? Or, will a new precedent be set? This prompts us, as citizens of India, to reflect on the performance of our Parliament as we wait to usher in the 18th Lok Sabha.

    Let’s learn. 

    —

    Why in the News?

    The present conduct of business in both Houses of Parliament points out the need for a revitalization of legislative engagement in a more constructive manner.

    • The 17th Lok Sabha (2019-2024) concluded its proceedings marking the culmination of a journey with unexpected twists and turns.

    How did Ministries fare during the 17th Loksabha?

    • Decline in Executive Accountability: The PMO found itself flooded with 1,146 questions from Rajya Sabha Members of Parliament, of which only 28 were answered. Similarly, the House of the People also witnessed a sharp decline, from 5,000 during the 15th and 16th Lok Sabhas to a mere 1,700 in the 17th Lok Sabha.
      • Ministry of Finance tasked with steering the nation’s fiscal destiny, has witnessed a gradual erosion of parliamentary interest, declining to the fourth and fifth position in the Parliament.
    • Decline in Legislative Process: The annual average of Bills passed declined from 65 in the 1952-1990 period to 48 in 1991-2023. The number of Bills sent to committees for scrutiny also dwindled consistently, with the 17th Lok Sabha sending only 16% of Bills for scrutiny, the lowest in the past four Lok Sabhas.
    • A decline in Debates and Discussions: Before 1990, each Lok Sabha typically convened for over 550 days on average, spanning 3,500 hours. The 17th Lok Sabha had the least number of sittings, only 274 days on average.
      • The Ministry of Home Affairs, which was the Ministry with the second most number of questions directed towards it till the 15th Lok Sabha, has now faded. This shift raises questions about the nation’s priorities.
    • Decline in the use of various parliamentary tools:
      • Calling Attention Motion: It is a vital tool allowing MPs to draw attention to issues and elicit responses from ministers was extensively used between 1957 and 1990, with an average of 300 notices allowed per Lok Sabha. Post-1990, only 40 notices have been allowed per Lok Sabha. The 17th Lok Sabha allowed only one such discussion.
      • For example, the Winter Session, 2023 of the Rajya Sabha missed a crucial discussion on the sensitive and key issue of ‘Suicides among students due to competitive exams’.
    • The Adjournment Motion: It is employed to address urgent issues with a subsequent vote, and serves as an expression of disagreement with the government’s policies. Pre-1990, the Lok Sabha permitted discussion and voting on four such motions on average. Post-1990, this number decreased to three. The 16th and 17th Lok Sabha allowed no adjournment motions.
    • Ministries such as Health and Family Welfare, Home Affairs, Defence, Agriculture and Farmers’ Welfare, and Finance, made up 36.6% of all disallowed questions in Rajya Sabha. In contrast, in the Lok Sabha, they made up 37.8% of the disallowed questions, underscoring systemic challenges.

     Way Forward:

    • Need for 15-point Reform: As recommended by the Vice President, it is required to make the Charter function effectively and efficiently by ensuring that the members of the committee are nominated based on domain knowledge and for a longer assured term.
    • Need to work on Democratic Principles: To maximize the Parliament’s ability to hold the executive accountable, it is crucial to promote a conducive environment for constructive debate, scrutiny, and oversight.

    https://www.thehindu.com/opinion/lead/parliaments-past-a-mirror-to-changing-dynamics/article68033393.ece

    https://www.thehindu.com/data/the-many-lows-of-the-17th-lok-sabha-data/article67852889.ece

  • How an Ethanol Factory has turned this Vijayawada village from idyllic charm to Industrial nightmare 

    Why in the news? 

    • Recently Gandepalli village in news because of devastating impact of an ethanol factory (Sentini BioProducts Pvt. Ltd) since 2008
    • Residents are struggling with foul air and water, poisoned crop fields, and depleting water tables

    Negative impact on village 

    Sentini BioProducts Pvt. Ltd. is a company involved in the production of ethanol and animal feed supplements. It specializes in manufacturing extra-neutral alcohol (ENA), a type of ethanol.

    • Under the red category: Ethanol production plants and distilleries, including Sentini BioProducts, fall under the ‘red category’ as per Central government norms, indicating high pollution levels (score of 60 or more)
    • Wastewater Discharge: The factory is mandated to have a Zero Liquid Discharge system in place. However, residents report untreated wastewater discharge into the nearby irrigation canal.
    •  Air Pollution: Residents complain of a choking stench and polluted air emanating from the factory, indicating potential air pollution issues.
    •  Crop Damage: Extensive crop damage is reported by villagers, indicating potential contamination of agricultural lands by pollutants from the factory. Over more than 10 years, farmers in the area have experienced a decline in crop quality and yield, particularly in paddy cultivation.
    •  Negative Impact on quality of Life: Pollution from the factory negatively impacts the quality of life for local residents, posing health risks and environmental hazards.

    Regulatory Failures in this situation:

    • Unable to address the problem: Despite multiple complaints from villagers and show-cause notices issued to the factory since 2013, regulatory authorities, including the Andhra Pradesh Pollution Control Board (APPCB), have been ineffective in addressing the pollution issues.
    • Regulatory lapse revealed by Lokayukta: The Lokayukta inquiry revealed lapses by regulatory bodies, including the APPCB and the Joint Director of Agriculture of Krishna district, in investigating and addressing the environmental damage caused by the factory’s operations.
    • Delay in action: The delay in taking appropriate action and the failure to enforce environmental regulations have allowed the factory to continue its polluting activities unabated.

    Suggestive measures to address the situation:

    •  Need Comprehensive Investigation: Conduct a thorough investigation into the environmental impact of Sentini BioProducts Pvt. Ltd. on Gandepalli village. This investigation should include assessments of air and water quality, soil contamination, and the extent of crop damage caused by the factory’s operations.
    • Enforcement of Environmental Standards: Ensure strict compliance with environmental standards and regulations by the factory.
    • Community Engagement: Foster meaningful dialogue and engagement between the factory management, regulatory authorities, and the local community. Provide opportunities for residents to voice their concerns, share their experiences, and participate in decision-making processes related to environmental management and pollution control measures.
    • Remediation and Compensation: Implement measures to remediate the environmental damage caused by the factory, including restoration of polluted water bodies, soil remediation, and compensation for affected farmers.

     Conclusion 

    The devastating impact of Sentini BioProducts Pvt. Ltd. on Gandepalli village, including pollution, crop damage, and regulatory failures, necessitates urgent comprehensive investigation, strict enforcement of environmental standards, community engagement, and remediation efforts to restore environmental health and livelihoods.

  • [5 April 2024] The Hindu Op-ed: Revisit these sections of the Bharatiya Nyaya Sanhita

    [5 April 2024] The Hindu Op-ed: Revisit these sections of the Bharatiya Nyaya Sanhita

    PYQ Relevance:
    Mains: 
    Q) What is meant by the term ‘constitutional morality’? How does one uphold constitutional morality? (UPSC IAS/2019) 
    Q) What was held in the Coelho case? In this context, can you say that judicial review is of key importance amongst the basic features of the Constitution? (UPSC IAS/2016)

    Note4Students: 

    Prelims:  Governance; Bharatiya Nyaya Sanhita (BNS), 2023;

    Mains:  Governance;  Issues related to the section in Bharatiya Nyaya Sanhita (BNS); 

    Mentor comments: In December 2023, the Indian Parliament enacted three new criminal codes. The Indian Penal Code (IPC), 1860 is the principal law on criminal offenses in India. The stated aim of the new three legislations is to ‘decolonize’ criminal laws of the British era. Currently, ‘Organised crime’ and ‘acts of terrorism’ are not covered under IPC.  Acts of terrorism are covered under the Unlawful Activities (Prevention) Act, 1967 (UAPA).  Organized crime is covered by state laws such as the Maharashtra Control of Organised Crime Act, 1999 (MCOCA), and similar laws are enacted by various states. Hence, there was a demand for a single platform for this code. However, the designed law too has its challenges which need to be revisited considering the diversity of society and its demands.

    Let’s learn. 

    —

    Why in the news? 

    The three new criminal laws that were passed by Parliament in 2023 will come into effect from July 1, 2024, according to a notification by the Ministry of Home Affairs (MHA).

    About the Bharatiya Nyaya Sanhita (BNS), 2023:
    The Bharatiya Nyaya Sanhita, Bharatiya Nagrik Suraksha Sanhita and the Bharatiya Sakshya Adhiniyam that will replace the Indian Penal Code, 1860; Code of Criminal Procedure, 1898; and the Indian Evidence Act, 1872, respectively, received President Droupadi Murmu’s assent on December 25, 2023.

    The Laws that need to be revisited:

    1. The issue with Section 106 (Hit-and-Run):
    • The Section 106 provision is part of the BNS, which is set to replace the colonial-era Indian Penal Code, 1860.
      • Section 106(1) provides for a punishment of up to 5 years for causing death by any rash or negligent act not amounting to culpable homicide.
      • Section 106 (2) stipulates a penalty of up to 10 years in jail and a fine for fleeing an accident spot and failing to report the incident to a police officer or a magistrate.
    • This section has become a focal point of discontent, especially among the driving community. Even though the driver reports immediately after the accident, they will be charged under Section 106(1) instead of Section 106(2). 
    1. The issue with Section 112 (petty organized crime):
    • It talks about a group or gang, either singly or jointly, commits any act of theft, snatching, cheating, unauthorized selling of tickets, unauthorized betting or gambling, selling of public examination question papers, or any other similar criminal acts is said to commit a petty organized crime”.
    • The “unauthorized selling of tickets” and “selling of public examination question papers” are not linked with any special Act. However, the phrase ‘any other similar criminal acts’ of the section is more indefinite and open-ended.
    1. Section 104 (No discretion):
    • Section 303 of the Indian Penal Code (IPC) mandated the death sentence for a person who murders while undergoing imprisonment for life. This provision was struck down by the Supreme Court in Mithu vs State of Punjab (1983) as it violated Articles 14 and 21 of the Constitution of India. 
    • Section 303 of the IPC has been reinstated as Section 104 of the BNS without rectifying the unconstitutional defect. 
    1. Section 303 of the BNS (Reassessment of Theft Offenses):
    • No reason behind it is considered Non-cognizable: The provision stipulates that for theft cases where the value of the stolen property is less than ₹5,000 and it’s the first conviction, community service is mandated upon the return or restoration of the property. This offense is categorized as non-cognizable.
    • Three Legal issues may arise: 
      • Firstly, if property offenses, of whatever value, are not registered, property offenders will be out of the police radar for surveillance. 
      • Secondly, legal issues may also arise about the return of such property if recovered with some other stolen or looted property.
      • Thirdly, if the stolen property of a value less than ₹5,000 is not returned or restored by the convict as provided for, the only option available to the court will be to award imprisonment which may extend up to 3 years. 

    Way Forward:

    • Need for Comprehensive Coverage: We can initiate consultations with all stakeholders to address concerns and gather diverse perspectives.
    • Need for clear Protocols: Establish a clear and standardized protocol for emergency response, emphasizing the importance of prompt reporting without exposing drivers to potential violence. The law should also clarify the reporting procedure and the evidence required for the drivers to prove their innocence or mitigating factors.
    • Need to maintain Balance: The law should be categorized in different scales based on liabilities and eventually, the punishment should be commensurate with the offense.
    • Need for more research: The study and incorporation of successful models and globally best practices with effective legislation is necessary in the Indian context.

    https://www.thehindu.com/opinion/lead/revisit-these-sections-of-the-bharatiya-nyaya-sanhita/article68029299.ece#:~:text=Section%20106(2)%20of%20the,has%20been%20put%20on%20hol

  • At 75, NATO sees reasons to rejoice, facts suggest otherwise

    Why in the News? 

    NATO grandly commemorates its 75th anniversary on April 4, 2024.

    Present Concerns about NATO:

    • Changed Objective: NATO was established to defend its member states from aggression but has engaged in offensive military actions.
    • Cause of Military conflicts worldwide: Over the last seven decades, NATO has initiated or participated in more than 200 military conflicts worldwide, including major ones. Examples of NATO’s military interventions include the bombing of Yugoslavia, invasion of Iraq, disruption of statehood in Libya, military interference in Syria, and combating terrorism in Afghanistan.
    • Role in the creation of ISIS: Critics argue that instead of bringing peace and stability, NATO’s actions have led to damage, casualties, destruction, and alienation. There is a perception that the US, NATO’s leader, played a role in the creation of ISIS.
    • Provoking Russia-Ukraine War: Its expansion since 1991, despite assurances to the contrary, and its actions in Ukraine are seen as provocative moves against Russia. Russia has shown restraint in response to NATO’s actions, but NATO’s behavior remains unchanged.
    • Maintaining Western Hegemony: In stark contrast to its professed peaceful ideals, NATO engages in warfare or issues threats of attack against any state that rejects the established liberal “rules-based order.” for example invasion of Iraq and execution of Saddam Hussein
    • Increase presence in  Indo-Pacific: The US has been actively establishing smaller multilateral arrangements, like AUKUS, the US-Japan-South Korea trio, and the Tokyo-Seoul-Canberra-Wellington quartet, to involve them in practical collaboration with NATO.

    BACK2BASICS

    What is NATO?

    NATO, founded in 1949, is an intergovernmental military alliance initially aimed at collective defense against potential aggression, notably from the Soviet Union during the Cold War. However, its role has expanded over time to address various security challenges beyond its original purpose.

    Membership:

    • Starting Members: In starting only 12 founding members of NATO were Belgium, Canada, Denmark, France, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, the United Kingdom, and the United States.
    • Expansion: NATO has expanded since its founding, with new member countries joining in multiple rounds. The alliance currently consists of 32 member countries.

    Objectives:

    • Core mission: NATO’s core mission is collective defense, as articulated in Article 5 of the North Atlantic Treaty. This article specifies that an attack on any member nation will be regarded as an attack on all, triggering a collective response from the members.
    • Role in crisis management: Besides its core function of collective defense, NATO also participates in crisis management activities. These include conflict prevention, peacekeeping, and stabilization efforts in diverse regions globally.

     

    Conclusion: NATO, founded in 1949 for collective defense, faces criticisms for engaging in offensive actions, causing global conflicts, and perceived roles in creating ISIS and provoking tensions with Russia. It has expanded and diversified its roles beyond its original purpose.

    Mains Question for practice 

    Q Examine the key concerns raised about NATO’s actions and their implications for global security. 

  • [pib] Ayushman Bharat Health Accounts (ABHA)

    Why in the news?

    This newscard is an excerpt from an explainer published in the PIB.

    Ayushman Bharat Health Accounts (ABHA)

    • ABHA, an integral part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), serves as a link for all health records of an individual.
    • It is a sub-component of the Ayushman Bharat Digital Mission launched in September 2021.
    • It is a 14-digit id employed to uniquely identify individuals, verify their identity, and connect their health records (with their consent) across various systems and stakeholders.

    Features of ABHA

    • Cashless Transactions: ABHA enables cashless transactions for eligible beneficiaries, reducing the financial burden during medical emergencies.
    • Electronic Health Records (EHR): It integrates electronic health records, facilitating storage, and retrieval of patient information for streamlined healthcare delivery.
    • Portability: ABHA accounts are portable across various healthcare providers under the Ayushman Bharat scheme, ensuring seamless access to services.
    • Real-time Monitoring: Incorporating real-time monitoring mechanisms to track fund utilization, ABHA ensures efficient allocation and prevents misuse.

    Various Components

    • Beneficiary Identification: ABHA involves the identification and registration of eligible beneficiaries under the Ayushman Bharat scheme, assigning a unique health identification number (UHID).
    • Funds Management: It manages the allocation and disbursement of funds for healthcare services, ensuring prompt and secure transfers.
    • Claim Settlement: ABHA processes and settles claims submitted by healthcare providers, verifying authenticity, and disbursing payments.
    • Audit and Oversight: Incorporating audit mechanisms to monitor fund utilization, ABHA ensures compliance with regulations and maintains system integrity.

    Back2Basics: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

    Details
    Umbrella Scheme
    1. Ayushman Bharat
    2. Incepted in National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC)
    Launch Year 2018
    Components
    1. Health and Wellness Centres (HWCs)
    2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
    Pradhan Mantri Jan Arogya Yojana (PM-JAY)
    • Offers a sum insured of Rs. 5 lakh per family for secondary and tertiary care
    • Provides cashless and paperless access to services at any empanelled hospital across India
    • Portable scheme, allowing beneficiaries to avail treatment at any PM-JAY empanelled hospital
    Coverage
    • 3 days pre-hospitalisation and 15 days post-hospitalisation
    • Includes diagnostic care and expenses on medicines
    • No restriction on family size, age, or gender
    • Covers all pre-existing conditions from day one
    Beneficiaries Identified through Socio-Economic Caste Census (SECC) data
    Funding
    • Shared funding: 60:40 for states and UTs with legislature, 90:10 in Northeast states and J&K,
    • Himachal Pradesh, and Uttarakhand, 100% central funding for UTs without legislature
    Nodal Agency National Health Authority (NHA)

    • Autonomous entity under the Society Registration Act, 1860
    • Responsible for effective implementation of PM-JAY in alliance with state governments

    State Health Agency (SHA)

    • Apex body of the State Government responsible for the implementation of AB PM-JAY in the State

     

    PYQ:

    2021:

    “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

     

    Practice MCQ:

    Consider the following statements about the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):

    1.    3 days pre-hospitalisation and 15 days post-hospitalisation.

    2.    Includes diagnostic care and expenses on medicines.

    3.    No restriction on family size, age, or gender.

    4.    Beneficiaries are identified from national family health survey.

    How many of the above discussed features is/are correct?

    (a) One

    (b) Two

    (c) Three

    (d) Four

  • Living wills implementation lags in India

    Why in the news? 

    In early March this year, 30 people in Thrissur in Kerala executed living wills.

    Context:

    • The Supreme Court’s 2018 order on Passive Euthanasia, wherein it recognized the ‘Right to die with dignity’ as a fundamental right and an aspect of Article 21 (right to life) of the Constitution.
    • However, the people wanting to get a “living will” registered were facing problems due to cumbersome guidelines, prompting a reconsideration by the apex court.
    • A Constitution Bench, led by Chief Justice of India Dipak Misra, in three concurring opinions, upheld that the fundamental right to life and dignity includes the ‘Right to Refuse Treatment and Die with dignity’.

    What is a Living Will? 

    A Living Will is a healthcare directive, in which people can state their wishes for their end-of-life care, in case they are not in a position to make that decision.

    The Court’s procedure:

    • Pre-2023: Initially, the process of creating living wills was deemed overly complex by the Court, with elaborate bureaucratic procedures in place to prevent abuse by unscrupulous individuals seeking to exploit the patient’s assets.
    • Post-2023: Recognizing the impracticality of requiring judicial magistrate countersignatures on living wills, the Court streamlined the process in January 2023. Now, living will require signatures in the presence of witnesses, attestation by a notary or gazetted officer, and submission to a designated government officer acting as a custodian.

    Challenges in Implementation :

    • Decision-Making Process: Even if a living will is created, its implementation is not automatic. Decisions on withholding or withdrawing treatment require certification by primary and secondary medical boards, posing logistical challenges, especially in hospitals without designated boards.
    • Ambiguities and Discomfort: Ambiguities in guidelines, discomfort with end-of-life care topics, and unclear legal definitions contribute to the hesitancy among officials to implement the Court’s directives without clear instructions from higher authorities.
    • Legal Ambiguity: Indian law lacks a clear definition of ‘next of kin’, leading to potential disputes among family members about medical decisions for terminally ill patients.
    • Barriers to End-of-Life Decisions: A survey of intensive care doctors reveals a general belief that end-of-life decisions are fraught with legal implications, serving as a significant barrier to making such decisions in the ICU.
    • Regional Disparities in India:
    • Haryana: While some states like Haryana have issued directions to follow the judgment, they have not provided essential guidance or protocols for implementation.
    • Odisha: In contrast, Odisha has taken a more thorough approach by forming a committee of experts to develop detailed draft orders for implementing the judgment, setting a potential example for other states.

    Conclusion: The central government could help bridge the gap in expertise by developing and publishing model orders and protocols to provide states with confidence and guidance in effectively implementing the judgment.

    Mains question for practice 

    Q Discuss the challenges surrounding the implementation of living wills in India, as established by the Supreme Court’s landmark judgment in 2018.

     

     

     

  • [3 April 2024] The Hindu Op-ed: The Gaza war needs a smart exit strategy

    [3 April 2024] The Hindu Op-ed: The Gaza war needs a smart exit strategy

    PYQ Relevance:
    Mains: 
    Q) Too little cash, too much politics, leaves UNESCO fighting for life.’ Discuss the statement in the light of US withdrawal and its accusation of the cultural body as being ‘anti-Israel bias’. (UPSC CSE 2019) 
    Q) How will the I2U2 (India, Israel, UAE, and USA) grouping transform India’s position in global politics? (UPSC CSE 2022)

    Note4Students: 

    Prelims: UNSC;

    Mains: UNSC; Recent Global challenges;

    Mentor comments: “History always repeats itself”. We all know that it is always easy to start a war but very difficult to decide when and how to call it off. If we see our Global past, the U.S. war in Afghanistan is a classical example. It was launched in October 2001 with the aim of ‘finishing off Al-Qaeda’, later it became a war that dragged on till the U.S. finally made a messy exit in August 2021. Secondly, think about the U.S. war in Iraq in 2003 is another example of a military offensive without a clearly defined exit strategy. The same history applies to the present context of the Middle East (Gaza Issue). Although the UNSC passed the Resolution, still the stand of major powers like the US remains questionable and it eventually leads the situation ‘back to square one’ in the context of Israel.

    Let’s learn. 

    —

    Why in the News?

    The Gaza Issue has become a more unwinnable conflict even after the UNSC resolution in March 2024.

    The Story behind the war concerning Israel and Hamas:

    • Israel had two major aims:
      • To Flatten Gaza: By eliminating Hamas, and getting back all its hostages. With the war well into its sixth month, it is important to review each of these aims. In short, Israel has flattened Gaza, in such a way that Gaza will be virtually uninhabitable (created a Buffer Zone) for years.
      • Destruction of Hamas: Israel has succeeded in eliminating only 30% of an estimated 30,000 Hamas fighters. Except for the exchange of a few hostages during a brief ‘humanitarian pause’ last November, Israel has not been able to rescue its hostages.
    • Hamas had two objectives:
      • Reminding Palestinian cause: To remind the world that while talks of normalization and reconciliation between Israel and the Arab world could go on; the cause for a Palestinian state could not be lost sight of.
      • Creating Support base: To expose to the world, and especially its support base, the false sense of the invincibility of the Israeli military and its intelligence services. For Hamas, it was not about winning the war militarily but making its voice heard.

    Major Challenges that are arising throughout the immediate region:

    • Neighboring countries in the region, Egypt and Qatar have been separately negotiating for an early ceasefire. Still, Israel had launched an attack on Gaza for the second time, again resulting in heavy civilian casualties.
    • Meanwhile, Hezbollah has also intensified its missile strikes, inflicting damage to key military assets and loss of lives.
    • Houthi rebels in the southern part continue to disrupt and block Israeli, U.S., and British ships in the Red Sea, causing heavy economic losses for Israel and its allies. 
    The passing of UNSC Resolution:

    On March 25, 2024, the United Nations Security Council (UNSC) adopted a resolution demanding an immediate ceasefire in Gaza calling for the immediate and unconditional release of all hostages.

    Previously, all four resolutions in the UNSC had failed due to veto, thrice exercised by the US. Although the US has historically protected Israel from censure, this time it abstained from voting. The resolution this time drew mixed reactions.

    Israel was the first to react, as it canceled the visit of its ministerial delegation to the US. Under Israeli pressure, the U.S. came out with a statement that the UN Resolution is ‘non-binding’ and that Israel can continue what it is doing in Gaza, making a mockery of the whole process in the UNSC.

    Hamas, on the other hand, initially welcomed the ceasefire resolution, but later, reiterated its position on a permanent ceasefire accompanied by a complete withdrawal of Israeli forces from Gaza. This turned the whole situation into a ‘back to square one’.

    Is the UNSC resolution binding?
    UNGA resolutions are like recommendations, while UNSC resolutions are normally seen as somewhat more prescriptive. However, there is a difference between UNSC votes under Chapter 6 and Chapter 7 of the UN Charter, with the latter considered as binding.

    How can it be enforced?
    If the UNSC wants to enforce its decision, it can decide to authorize travel bans, sanctions, or the sending of troops.

    What are the Impacts on Israel?

    • Military Impact: The Israeli Army has suffered losses and injuries to its personnel. Militarily, Gaza has been defeated, but Hamas, as an organization, is unlikely to be eliminated.
    • Economic Impact: Its economy is shrinking rapidly, with some estimates showing a decline of almost 20%.
    • Political Impact: Currently, it is becoming difficult for Mr. Netanyahu to hold on to his position, domestically and internationally. The U.S., Israel’s staunchest ally, has, in the past few weeks, made it clear that Israel has to restrain itself and cannot bank upon blanket support for any Israeli action in Gaza.

    What is the most viable option then for Israel?

    • Adapting to Ceasefire: To prevent a recurrence of ‘another 07th October’, there is an urgent need for an early ceasefire and withdrawal of forces from the Gaza Strip.
    • Two-state solution: Stakeholder countries will have to go back to the drawing board and search for a time-bound and acceptable solution. 

    Conclusion: Israel and Palestine are bound by geography and destiny and the solution for a peaceful future will have to include major compromises and climb-downs from previously stated positions. 

    https://www.thehindu.com/opinion/lead/the-gaza-war-needs-a-smart-exit-strategy/article68020974.ece

  • Why Supreme Court bar unregulated soil extraction for linear projects?

    Why in the News?

    Recently, the SC revoked the notification given by the Environment Ministry to exempt the extraction of ordinary earth for linear projects, such as road and railway construction.

    • It was challenged before the National Green Tribunal (NGT), which asked the Ministry to review it within three months. However, the Ministry did not take any action, leading the matter to reach the SC.

    What are the linear projects? 

    Linear projects refer to Construction or Development Projects. It includes the construction of linear structures like utility lines, pipelines, railroad tracks, highways, stormwater channels, and stream restoration activities.

    What was the 2020 exemption?

    • September 2006: The Environment Ministry issued a notification under the Environment (Protection) Act, 1986, on activities that would require prior Environmental Clearance.
    • January 2016: A second notification was issued, exempting certain categories of projects from this requirement.
    • March 2020: It added “Extraction or sourcing or borrowing of ordinary earth for the linear projects such as roads, pipelines, etc” to the list of exempted activities.
      • The general purpose of the 2020 notification was to conform to the amendments made to the Mines and Minerals (Development and Regulation) Act, 1957, in March 2020, allowing new lessees to continue mining for two years with the statutory clearances and licenses issued to their predecessors.

    Nexus between the Judiciary and the Union Government (Ground for Challenges)

      • Judicial stand: The SC invalidated the broad and random exception, highlighting that the announcement was rushed during the COVID-19 lockdown without seeking feedback or objections through prior notification.
    • The exemption granted without incorporating safeguards was deemed arbitrary and violative of Article 14 of the Constitution.
    • The court emphasized that the absence of safeguards defeats the purpose of the Environment Protection Act (EP Act).
    • An argument by the center: The Center contended that the exemption was essential “to benefit the general public” and would support “the kumhars (potters), farmers, gram panchayats, banjaras, roads of Gujarat,” and all non-mining activities recognized by the states.
      • However, the Apex court stated that the Centre had failed to provide reasons for concluding that the notification was issued in the public interest.

    Similar Judicial Scrutiny in the Past:

    • January 2018: The NGT quashed an exemption offered by the Ministry’s 2016 notification from the requirement of prior EC for building and construction activities having built-up areas of more than 20,000 sq m. According to the Tribunal, there was nothing to suggest an improvement in the quality of the environment to justify the exemption.
    • July 2015: Underlining that the EP Act mandates prior approval, the NGT struck down two Office Memorandums issued by the Ministry in December 2012 and June 2013 for granting ex-post facto EC to projects under the 2006 notification.
    • July 2021: Another notification of the Ministry that sought to perpetuate an amnesty window opened for just six months in March 2017 to clear projects under the “violation category” and issued ex-post facto approval to more than 100 projects, until the SC stayed it in January this year.
    • March 2024: The Kerala HC quashed a 2014 notification that exempted educational institutions and industrial sheds with built-up areas of more than 20,000 sq m from obtaining EC.

     

    Conclusion: The Supreme Court invalidated the Environment Ministry’s exemption for earth extraction in linear projects due to a lack of justification and safeguards, emphasizing compliance with Environmental Clearance to minimize environmental harm, safeguarding the Environment Protection Act’s purpose.

    Mains PYQ

    Q How does the draft EnvironmentImpact Assessment(EIA)Notification, 2020 differ from the existing EIA Notification, 2006? (UPSC IAS/2020)