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GS Paper: GS2

  • The many challenges for WTO

    The next Director-General of the organization will have to navigate through a slew of thorny issues in WTO.

    WTO to lead by a woman for the first time

    • For the first time in its 25-year history, the World Trade Organization (WTO) will be led by a woman.
    • The D-G’s job will require perseverance and outstanding negotiating skills for balancing the diverse and varied interests of the 164 member countries, and especially, for reconciling competing for multilateral and national visions, for the organization to work efficiently.
    • The next D-G will have to grapple with the global economic fallout of the COVID-19 pandemic and work towards carrying out reforms of the multilateral trading system for reviving the world economy.
    • On all these issues, her non-partisan role will be watched carefully.

    Practice Question: In the wake of the global economic fallout of the COVID-19 pandemic, discuss the challenges ahead of WTO.

    Tussle between developed and developing countries

    • The current impasse in the WTO negotiations has led member countries to believe in the necessity of carrying out urgent reforms, which is likely to throw up some difficult choices for developing countries like India.
    • At the core of the divide within the WTO is the Doha Development Agenda, which the developed countries sought to move in favour of a new agenda that includes, amongst others, e-commerce, investment facilitation, MSMEs and gender.
    • Salvaging the ‘development’-centric agenda is critical for a large number of developing countries as they essentially see trade as a catalyst of development.
    • Restoring the WTO dispute settlement mechanism, especially the revival of its Appellate body, is also crucial for the organization’s efficient functioning.

    Definition of ‘Developing Country’ – a contentious issue

    • The push for a change in the definition of “developing country” under the principle of special and differential treatment (S&DT), aimed at upgrading certain developing countries, will deeply affect the status of emerging economies such as India, China, South Africa, Turkey, Egypt, etc.
    • The assumption that some countries have benefited immensely from the WTO rules since its formation in 1995 is flawed, at least in the case of India. And even if there may be no consensus of views on measuring ‘development’, India will remain a developing country no matter which parameter is used.
    • The way out for India could be to negotiate a longer phase-out period or an acceptable formula based on development indices, etc.

    Fisheries subsidies negotiations

    • Among the current negotiations at the WTO, the fisheries subsidies negotiations command the highest attention.
    • India can lead the way in finding a landing zone by urging others to settle for the lowest common denominator while seeking permanent protection for traditional and artisanal farmers who are at the subsistence level of survival.
    • The danger lies in seeking larger carve-outs, which could result in developed countries ploughing precious fisheries resources in international waters.

    Lessons from COVID-19

    • The COVID-19 crisis has revealed the urgent and enduring need for international cooperation and collaboration, as no country can fight the pandemic alone.
    • The D-G can help mitigate the effects of the pandemic by giving clear directions on ensuring that supply chains remain free and open, recommending a standard harmonized system with classification for vaccines, and by the removal of import/export restrictions.
    • Voluntary sharing and pooling of Intellectual Property Rights (IPR) is required for any global effort to tackle the pandemic, but with the fear of vaccine nationalism looming large, several countries are seeking to secure the future supply of leading COVID-19 vaccines.
    • India’sreiteration that its vaccine production and delivery capacity will help the whole of humanity will require the D-G to play a responsible role in removing barriers to intellectual property and securing a legal framework within the WTO TRIPS Agreement.
    • This can be done by lending salience to the effective interpretation of Articles 8 and 31 of the Agreement, that allow compulsory licensing and agreement of a patent without the authorization of its owner under certain conditions.

    Way Forward

    • The consensus-based decision-making in the WTO, which makes dissension by even one member stop the process in its track, gives developing countries some heft and influence at par with developed countries.
    • The D-G would need to tread cautiously on this front, as some will allude to the successful implementation of the Trade Facilitation Agreement in 2017 that allowed member countries to make commitments in a phased manner in accordance with their domestic preparedness.
    • Most imminently, the next D-G will need to build trust among its members that the WTO needs greater engagement by all countries, to stitch fair rules in the larger interest of all nations and thwart unfair trade practices of a few.

  • How Parliament meets

    The centre has said that there will be no winter session of Parliament this time due to the COVID despite the ‘success’ in curbing the pandemic. This year, the Parliament has met for only 33 days!

    Q. The undue delays and inactions by the constitutional functionaries threaten to widen the constitutional faultlines among the Executives. Critically comment.

    Sessions of Parliament

    • The power to convene a session of Parliament rests with the government. But it is the President who summons Parliament.
    • The decision is taken by the Cabinet Committee on Parliamentary Affairs, which currently comprises nine ministers, including those for Defence, Home, Finance, and Law.
    • The decision of the Committee is formalized by the President, in whose name MPs are summoned to meet for a session.
    • A general scheme of sittings was recommended in 1955 by the General Purpose Committee of Lok Sabha.
    • It was accepted by the government of PM Jawaharlal Nehru but was not implemented.

    No fixed calendar

    • India does not have a fixed parliamentary calendar.
    • By convention, Parliament meets for three sessions in a year.
    • The longest, the Budget Session, starts towards the end of January and concludes by the end of April or first week of May.
    • The session has a recess so that Parliamentary Committees can discuss the budgetary proposals.
    • The second session is the three-week Monsoon Session, which usually begins in July and finishes in August.
    • The parliamentary year ends with a three-week-long Winter Session, which is held from November to December.

    What the Constitution says

    • The summoning of Parliament is specified in Article 85 of the Constitution. Like many other articles, it is based on a provision of The Government of India Act, 1935.
    • This provision specified that the central legislature had to be summoned to meet at least once a year and that not more than 12 months could elapse between two sessions.
    • Dr B R Ambedkar stated that the purpose of this provision was to summon the legislature only to collect revenue and that the once-a-year meeting was designed to avoid scrutiny of the government by the legislature.
    • His drafting of the provision reduced the gap between sessions to six months and specified that Parliament should meet at least twice a year.

    Convening a Session: The debate

    • During the debate, members of the Constituent Assembly highlighted three issues: (i) the number of sessions in a year, (ii) the number of days of sitting and, (iii) who should have the power to convene Parliament.
    • Prof K T Shah from Bihar was of the opinion that Parliament should sit throughout the year, with breaks in between.
    • Others wanted Parliament to sit for longer durations and gave examples of the British and American legislatures which during that time were meeting for more than a hundred days in a year.
    • Prof Shah also wanted the presiding officers of the two Houses to be empowered to convene Parliament in certain circumstances. These suggestions were not accepted by Dr Ambedkar.

    Moved, delayed, stretched

    • Over the years, governments have shuffled around the dates of sessions to accommodate political and legislative exigencies.
    • Sessions have also been cut short or delayed to allow the government to issue Ordinances.

    Fewer House sittings

    • Over the years, there has been a decline in the sittings days of Parliament.
    • During the first two decades of Parliament, Lok Sabha met for an average of a little more than 120 days a year.
    • This has come down to approximately 70 days in the last decade.

    Why sittings are reducing day by day?

    • One institutional reason given for this is the reduction in the workload of Parliament by its Standing Committees, which, since the 1990s, have anchored debates outside the House.
    • However, several Committees have recommended that Parliament should meet for at least 120 days in a year.

  • [pib] PM Special Scholarship Scheme (PMSSS)

    The Prime Minister’s Special Scholarship Scheme (PMSSS) instalment has been released to support J&K and Ladakh students.

    Tap to read more about: Reorganization of J&K

    About PMSSS

    • The PMSSS aims to build the capacities of the youths of J&K and Ladakh by educating, enabling and empowering them to compete in the normal course.
    • Under the Scheme, the youths of J&K and Ladakh are supported by way of scholarship in two parts namely the academic fee & maintenance allowance.
    • The academic fee is paid to the institution where the student is provided admission after on-line counselling process conducted by the AICTE (All India Council for Technical Education).
    • The academic fee covers tuition fee and other components as per the ceiling fixed for various professional, medical and other under-graduate courses.
    • In order to meet the expenditure towards hostel accommodation, mess expenses, books & stationery etc., a fixed amount of Rs.1.00 Lakh is provided to the beneficiary and is paid in instalments of Rs. 10,000/- pm directly into students account.

  • PM -WANI : As Game changer

    The PM-WANI project seems to fit within the framework of an evolving decentralized concept to bridge the e-divide.

    Practice Question:

    With the PM-WANI, the state is expanding the reach of digital transformation to those who have been excluded till now. It is a game-changer because it has the potential to move Digital India to Digital Bharat. Discuss.

    PM WANI – the ‘game-changer’

    • The term ‘game-changer’ can be seen as an accurate reflection of the capability of an initiative to change the status quo for Prime Minister’s Wi-Fi Access Network Interface, or PM WANI.
    • It provides for “Public Wi-Fi Networks by Public Data Office Aggregators (PDOAs) to provide public Wi-Fi service spread across the length and breadth of the country to accelerate the proliferation of Broadband Internet services through Public Wi-Fi network in the country”.

    What the data shows

    • The initiative can help to bridge the increasing digital divide in India. Recently, the NITI Aayog CEO had said that India can create $1 trillion of economic value using digital technology by 2025.
    • As per the latest Telecom Regulatory Authority of India (TRAI) data, about 54% of India’s population has access to the Internet.
    • The 75th round of the National Statistical Organization survey shows that only 20% of the population has the ability to use the Internet.
    • The India Internet 2019 report shows that rural India has half the Internet penetration as urban, and twice as many users who access the Internet less than once a week.

    Digital poverty

    • Umang App (Unified Mobile Application for New-age Governance) allows access to 2,084 services, across 194 government departments, across themes such as education, health, finance, social security, etc.
    • The ability to access and utilize the app enhances an individual’s capabilities to benefit from services that they are entitled to.
    • With each move towards digitization, we are threatening to leave behind a large part of our population to suffer in digital poverty.
    • What the government is trying to achieve with PM-WANI is anyone living in their house, a paan shop owner or a tea seller can all provide public Wi-Fi hot posts, and anyone within range can access it.
    • This will also help to reduce the pressure on the mobile Internet in India. Going back to the India Internet report, it shows that 99% of all users in India access the Internet on mobile, and about 88% are connected on the 4G network.
    • This leads to a situation where everyone is connected to a limited network, which is getting overloaded and resulting in bad speed and quality of Internet access.

    Key links

    • There are three important actors here.
    1. First is the Public Data Office (PDO). The PDO can be anyone, and it is clear that along with Internet infrastructure, the government also sees this as a way to generate revenue for individuals and small shopkeepers. It is important to note that PDOs will not require registration of any kind, thus easing the regulatory burden on them.
    2. Second is the PDOA, who is basically the aggregator who will buy bandwidth from the Internet service provider (ISPs) and telecom companies and sell it to PDOs, while also accounting for data used by all PDOs.
    3. The third is the app provider, who will create an app through which users can access and discover the Wi-Fi access points.
    • Two pillars have been given as a baseline for public Wi-Fi.
    1. Interoperability – where the user will be required to login only once and stay connected across access points.
    2. Multiple payment options – allowing the user to pay both online and offline.
    • The products should start from low denominations, starting with ₹2. It is suggested in the report that the requirement of authentication through stored e-know your customer (KYC) is encouraged, which inevitably means a linking with Aadhaar.

    Aiding rural connectivity

    • The PM-WANI has the potential to change the fortunes of Bharat Net as well. Bharat Net envisions broadband connectivity in all villages in India.
    • The project has missed multiple deadlines, and even where the infrastructure has been created, usage data is not enough to incentivize ISPs to use Bharat Net infra to provide services.
    • One of the reasons for the lack of demand is the deficit in digital literacy in India and the lack of last-mile availability of the Internet.
    • The term digital literacy must be seen as an evolving decentralized concept, which depends on how people interact with technology in other aspects of their life and is influenced by local social and cultural factors.
    • The PM-WANI seems to fit within this framework, simply because it seeks to make accessing the Internet as easy as having tea at a chai shop. This is not a substitute for the abysmal digital literacy efforts of the government, but will definitely help.

    Security, privacy issues

    • There are some concerns, mainly with respect to security and privacy. A large-scale study conducted at public Wi-Fi spots in 15 airports across the United States, Germany, Australia, and India discovered that two thirds of users leak private information whilst accessing the Internet.
    • Further, the TRAI report recommends that ‘community interest’ data be stored locally, raising questions about data protection in a scenario where the country currently does not have a data protection law in place.
    • These are, however, problems of regulation, state capacity and awareness and do not directly affect the framework for this scheme.

  • Law and disorder

    Several inadequacies in the justice delivery system lie hidden as disproportionate attention is given to the Supreme Court.

    Public expects the judiciary to be ideal

    • The citizens of the country expect the Supreme Court and its constituents to be ideal, and the challenge of the Supreme Court is to come to terms with that reality.
    • However, it is not the Supreme Court alone that matters in the justice delivery system. There are other inadequacies of the system that don’t get as much public attention.

    Practice Question: Explain the various inadequacies in the justice delivery system in India which lie hidden. What steps need to be taken to address them?

    Spending on judiciary

    • The issue of spending on judiciary, most often, is equated with increasing the salaries of judges and providing better court infrastructure. Such perceptions are unfortunate.
    • India has one of the most comprehensive legal aid programmes in the world, the Legal Services Authority Act of 1987.
    • Under this law, all women, irrespective of their financial status, are entitled to free legal aid. Scheduled Castes and Scheduled Tribes and children too are entitled to free legal aid.
    • In reality, this law is a dead letter. There has been little effort on the part of successive governments to provide a task force of carefully selected, well-trained and reasonably paid advocates to provide these services.
    • In comparison, the system of legal aid in the U.K. identifies and funds several independent solicitor offices to provide such services. India is yet to put in place anything similar to this.

    Poor judge-population ratio

    • The judge-population ratio provides one of the most important yardsticks to measure the health of the legal system. The U.S. has about 100 judges per million population. Canada has about 75 and the U.K. has about 50.
    • India, on the other hand, has only 19 judges per million population. Of these, at any given point, at least one-fourth is always vacant.
    • Lower courts where the common man first comes into contact (or at least should) with the justice delivery system is also unnoticed and hardly any attention is focused on their gaping inadequacy.
    • These inadequacies are far more important to the common man than the issues relating to the apex court that are frequently highlighted in the public space.
    • In All India Judges Association v. Union of India (2001), the Supreme Court had directed the Government of India to increase the judge-population ratio to at least 50 per million population within five years from the date of the judgment. This has not been implemented.

    Access to justice

    • Though ‘access to justice’ has not been specifically spelt out as a fundamental right in the Constitution, it has always been treated as such by Indian courts.
    • In Anita Kushwaha v. Pushpa Sadan (2016), the Supreme Court held unambiguously that if “life” implies not only live in the physical sense but a bundle of rights that make life worth living, there is no justice or other basis for holding that denial of “access to justice” will not affect the quality of human life.
    • It was for the first time that the Supreme Court had attempted a near-exhaustive definition of what “access to justice” actually means.
    • Further, the court pointed out four important components of access to justice.
    1. The need for adjudicatory mechanisms.
    2. The mechanism must be conveniently accessible in terms of distance.
    3. The process of adjudication must be speedy.
    4. The process of adjudication must be affordable to the disputants.
    • It is of course a paradox that this judgment, which emphasizes the concept of speedy justice, was passed in 2016 in a batch of transfer petitions that were filed between 2008 and 2014.

    Way forward

    • The state in all its glorious manifestations — the executive, judiciary and the legislature — there is a need to draw out a national policy and road map for clearing backlogs and making these concepts real.
    • A disproportionate amount of attention that is given to the functioning of the Supreme Court, it is equally important to have a clear focus on these and similar issues.

  • US imposes CAATSA sanctions on Turkey

    The US has imposed sanctions on NATO-ally Turkey for its purchase of Russia’s S-400 missile defence system.

    Q.What is CAATSA law? Discuss how it will impact India’s ties with Russia.

    Turkey defies the US

    • Turkey decided to move ahead with the procurement and testing of the S-400, despite the availability of alternative, NATO-interoperable systems to meet its defence requirements.
    • This decision resulted in Turkey’s suspension and pending removal from the global F-35 Joint Strike Fighter partnership.

    What is CAATSA?

    • CAATSA stands for Countering America’s Adversaries through Sanctions Act (CAATSA).
    • It is a US federal law that imposed sanctions on Iran, North Korea, and Russia.
    • The bill provides sanctions for activities concerning:

    (1) cybersecurity, (2) crude oil projects, (3) financial institutions, (4) corruption, (5) human rights abuses, (6) evasion of sanctions, (7) transactions with Russian defence or intelligence sectors, (8) export pipelines, (9) privatization of state-owned assets by government officials, and (10) arms transfers to Syria.

    Why is India concerned?

    • This sanction is of particular interest to New Delhi, which is also in the process of buying the S-400 from Moscow.
    • This action has sent a clear signal that the US will fully implement CAATSA sanctions and will not tolerate significant transactions with Russia’s defence and intelligence sectors.

    What does the sanction mean?

    These sanctions comprise:

    1. a ban on granting specific US export licences and authorizations for any goods or technology,
    2. a ban on loans or credits by US financial institutions totalling more than $10 million in any 12-month period
    3. a ban on US Export-Import Bank assistance for exports
    • Additionally, sanctions will include full blocking sanctions and visa restrictions as well.
    • Last year, the US had removed Turkey from its F-35 jet programme over concerns that sensitive information could be accessed by Russia if Turkey used Russian systems along with US jets.

    India may get an exemption

    • Most of India’s weapons, naval arsenal, missiles, aircraft and aircraft carriers are of Soviet/Russian origin.
    • As per the Stockholm International Peace Research Institute (SIPRI) Arms Transfer Database, during the period 2010-17, Russia was the top arms supplier to India.
    • The Russian share in India’s arms imports during the same period has declined to 68 per cent, from an all-time high of 74 per cent during the 2000s.
    • The combined share of the US and Israel has increased from nine to 19 per cent.
    • Accounting for about 15 per cent, the US is the second-biggest supplier of arms to India during the five year period ending 2017.
    • Hence, US officials have earlier requested for “some relief from CAATSA” for countries like India.

    China factor

    • China being more assertive and Russia finding new partners, this waiver or “carve-out” would mean India has been able to secure its interests.
    • Hence, the US has designated India as a Major Defence Partner, and both countries coming together on Indo-Pacific strategy, the newly formed Quad, are on a stable footing.

    Why is CAATSA bad?

    • CAATSA impacts Indo-US ties and dents the image of the US as a reliable partner.
    • It also makes a point on principles that, as a sovereign country, India cannot be dictated about its strategic interests by a third country.
    • It also shows the need for India to be nimble-footed in its diplomacy when it comes to its key major power relationships – and one cannot be sacrificed at the cost of another.

    Back2Basics: India-US Defence Partnership

    • India is a major market for the US defence industry.
    • In the last decade, it has grown from near zero to USD 15 billion worth of arms deals.
    • Since 2008, major deals include the C-17 Globemaster, C-130J transport planes, P-8 (I) maritime reconnaissance aircraft, M777 light-weight howitzer, Harpoon missiles, and Apache and Chinook helicopters.
    • In percentage terms, the US share of Indian arms imports total 23 per cent in terms of the number of contracts and 54 per cent by value.
    • This value is all set to increase further with the US likely accepting an Indian request for Sea Guardian drones.

     

  • Issues related to Judicial appointment

    The SC Collegium has recommended the transfer of judges of several HC, including the transfer of a Justice of the Andhra Pradesh High Court.

    Must read:

    [Burning Issue] Uproar over AP CM’s letter to CJI

    What is Collegium?

    • Collegium system of the Supreme Court (SC) and the High Courts (HCs) of India is based on the precedence established by the “Three Judges Cases (1982, 1993, 1998) “.
    • It is a legally valid system of appointment and transfer of judges in the SC and all HCs.
    • It is a system of checks and balance, which ensures the independence of the senior judiciary in India.

    The Collegium System: A detailed backgrounder

    • The Collegium of judges is the Indian SC’s invention.
    • It does not figure in the Constitution, which says judges of the SC and HC are appointed by the President and speaks of a process of consultation.
    • In effect, it is a system under which judges are appointed by an institution comprising judges.
    • After some judges were superseded in the appointment of the CJI in the 1970s and attempts made subsequently to effect a mass transfer of High Court judges across the country.
    • Hence there was a perception that the independence of the judiciary was under threat. This resulted in a series of cases over the years.

    The Judges Cases

    • The First Judges Case (1981) ruled that the “consultation” with the CJI in the matter of appointments must be full and effective.
    • However, it rejected the idea that the CJI’s opinion, albeit carrying great weight, should have primacy.
    • The Second Judges Case (1993) introduced the Collegium system, holding that “consultation” really meant “concurrence”.
    • It added that it was not the CJI’s individual opinion, but an institutional opinion formed in consultation with the two senior-most judges in the SC.
    • On a Presidential Reference in its opinion, the SC, in the Third Judges Case (1998) expanded the Collegium to a five-member body, comprising the CJI and four of his senior-most colleagues.

    The procedure followed by the Collegium:

    Appointment of CJI

    • The President of India appoints the CJI and the other SC judges.
    • As far as the CJI is concerned, the outgoing CJI recommends his successor.
    • In practice, it has been strictly by seniority ever since the supersession controversy of the 1970s.
    • The Union Law Minister forwards the recommendation to the PM who, in turn, advises the President.

    Other SC Judges

    • For other judges of the top court, the proposal is initiated by the CJI.
    • The CJI consults the rest of the Collegium members, as well as the senior-most judge of the court hailing from the High Court to which the recommended person belongs.
    • The consultees must record their opinions in writing and it should form part of the file.
    • The Collegium sends the recommendation to the Law Minister, who forwards it to the Prime Minister to advise the President.

    For HC

    • The CJs of HC is appointed as per the policy of having Chief Justices from outside the respective States. The Collegium takes the call on the elevation.
    • High Court judges are recommended by a Collegium comprising the CJI and two senior-most judges.
    • The proposal, however, is initiated by the Chief Justice of the High Court concerned in consultation with two senior-most colleagues.
    • The recommendation is sent to the Chief Minister, who advises the Governor to send the proposal to the Union Law Minister.

    Does the Collegium recommend transfers too?

    • Yes, the Collegium also recommends the transfer of Chief Justices and other judges.
    • Article 222 of the Constitution provides for the transfer of a judge from one High Court to another.
    • When a CJ is transferred, a replacement must also be simultaneously found for the High Court concerned. There can be an acting CJ in a High Court for not more than a month.
    • In matters of transfers, the opinion of the CJI “is determinative”, and the consent of the judge concerned is not required.
    • However, the CJI should take into account the views of the CJ of the High Court concerned and the views of one or more SC judges who are in a position to do so.
    • All transfers must be made in the public interest, that is, “for the betterment of the administration of justice”.

    Loopholes in the Collegium system

    • Many have faulted the system, not only for its being seen as something unforeseen by the Constitution makers but also for the way it functions.
    • Opaqueness and a lack of transparency, and the scope for nepotism are cited often.
    • The attempt made to replace it by a ‘National Judicial Appointments Commission’ was struck down by the court in 2015 on the ground that it posed a threat to the independence of the judiciary.
    • Some do not believe in full disclosure of reasons for transfers, as it may make lawyers in the destination court chary of the transferred judge.
    • Embroilment in public controversies and having relatives practising in the same High Court could be common reasons for transfers.

    Scope for transparency

    • In respect of appointments, there has been an acknowledgement that the “zone of consideration” must be expanded to avoid criticism that many appointees hail from families of retired judges.
    • The status of a proposed new memorandum of procedure, to infuse greater accountability, is also unclear.
    • Even the majority opinions admitted the need for transparency, now the Collegium’s resolutions are now posted online, but reasons are not given.

  • [pib] Vision 2035: Public Health Surveillance in India

    NITI Aayog today released a white paper: Vision 2035: Public Health Surveillance (PHS) in India.

    Q.Discuss the role of Public Health Surveillance in the success of Ayushman Bharat Abhiyan.

    Vision 2035 for PHS

    • It is a continuation of the work on health systems strengthening.
    • It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.
    • Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

    Let’s have a look at the executive summary of the vision document:

    PHS in India

    • Surveillance is an important Public Health function.
    • It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

    Why need PHS?

    • Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance.
    • India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated.
    • India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.
    • These successes are a result of effective community-based, facility-based, and health system-based surveillance.
    • The COVID19 pandemic has further challenged the country. India rapidly ramped up its diagnostic capabilities and aligned its digital technology expertise.
    • This ensured that there was a comprehensive tracking of the pandemic.

    Highlights of the vision document

    • It builds on initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program.
    • It aligns with the citizen-centricity highlighted in the National Health Policy 2017 and the National Digital Health Blueprint.
    • It encourages the use of mobile and digital platforms and point of care devices and diagnostics for amalgamation of data capture and analyses.
    • It highlights the importance of capitalizing on initiatives such as the Clinical Establishments Act to enhance private sector involvement in surveillance.
    • It points out the importance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the ICMR, and others.

    Gap areas in India’s PHS that could be addressed

    • India can create a skilled and strong health workforce dedicated to surveillance activities.
    • Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
    • Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
    • An amalgamation of plant, animal, and environmental surveillance in a One-Health approach.
    • PHS could be integrated within India’s three-tiered health system.
    • Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
    • To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

    Moving ahead

    • Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
    • Identify broad disease categories that will be included under PHS.
    • Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
    • Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
    • Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
    • Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action.
    • Encourage innovations at every step-in surveillance activity.

  • Standards must not be lowered to certify Ayurveda postgraduates surgeons

    This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.

    Practice Question: There is a need to rethink on the recent notification of AYUSH Ministry allowing Ayurveda postgraduates to conduct surgeries keeping the safety of the patient at the centre. Discuss.

    The current clash

    • The clash between the allopathic and AYUSH fraternities is about the AYUSH practitioners’ “right” to conduct surgeries.
    • The Ayurvedic fraternity maintains postgraduates in Shalya and Shalakya (two surgical streams among 14 post-graduate courses) are taught procedures listed in the curriculum.
    • The oldest-known surgical specialist was, in fact, an Ayurvedic surgeon/sage Sushrut (600 BC) who wrote the Sushrut Samhita — a profound exposition on conducting human surgery which continues to receive worldwide acclaim.
    • Surgery was practised by Ayurvedic surgeons long before the advent of western medicine.
    • Allopaths question the logic of Sushrut’s millennia-old pre-eminence bestowing the right to practise modern surgery. Ayurvedic surgeons may not know the hidden risks of every surgical procedure and how to surmount sudden mishaps.
    • The Ministry of AYUSH justifies its notification on the ground that not all vaidyas but only postgraduates qualifying from two surgical streams have been authorized to perform selected surgeries.

    The contentious issue

    • The moot point is about who decides whether Ayurvedic surgeons possess sufficient proficiency to conduct these surgeries safely and by what standard their skills are judged.
    • Surgical proficiency cannot be judged by different standards in one country — particularly when less-educated patients would rather save money than question a surgeon’s qualifications.
    • The statutory regulatory body for AYUSH education is the Central Council of Indian Medicine (CCIM). CCIM has only promoted what private college managements demand, propelled, in turn, by students’ need to earn a stable income as medical professionals.
    • In this misplaced zeal to give better earnings to the Ayurvedic vaidyas, CCIM has sidelined many skills that Ayurveda could have included, which are relevant even today.
    • This has subjugated the curriculum to nurture more and more replicas of doctors of modern medicine.
    • This has killed the knowledge, purity and goodness of classical Ayurveda, which ironically is the Ayurveda in high demand in Europe, Russia and America.

    Nothing can replace practise and training to perform surgery

    • When it comes to surgery, it is not knowledge but rigorous training and continuous practice which makes for perfection. Both require clinical material and most Ayurvedic hospitals do not have a fraction of the surgical patients found in allopathic general hospitals.
    • Allopathic students of surgery learn first by watching and then performing scores of surgeries under supervision.
    • Surgical skills are by no means impossible to learn but they become difficult to master without continuous training and supervision.
    • Due to the paucity of patients, limited scope for training and access to gaining hands-on practice, it is hazardous to allow all Shalya and Shalakya postgraduates to undertake surgical procedures.
    • In the last three decades, specialization has excluded general surgeons from performing what was once considered routine. For example, only an ENT surgeon can perform a tonsillectomy.
    • Therefore, to notify that Ayurvedic postgraduates in surgery can perform omnibus operations runs counter to the norm in India and in other countries.

    Way forward

    • In performing surgery, the only benchmark should be the duration of hands-on training received — counted by surgeries under supervision, and being judged through external evaluation.
    • Every surgeon’s skills and competence must be tested by applying exactly the same standards before she/he can operate.
    • This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.

  • India needs to rethink its nutrition agenda

    Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

    Nutrition-related data released by NFHS-5

    • The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
    • The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

    Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

    Worrying findings

    • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
    • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
    • Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
    • There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
    • Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
    • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
    • Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

    Economic growth vs health indicators

    • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
    • This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
    • The World Health Organization calls stunting “a marker of inequalities in human development”.
    • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
    • Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
    • The situation has become even worse due to the pandemic and lockdown-induced economic distress.
    • Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
    • All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

    Social protection schemes and their impact on nutrition indicators

    • Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
    • However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
    • Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
    • There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

    A piecemeal approach

    • The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
    • Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
    • Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
    • The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

    Conclusion

    • The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
    • An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
    • There have been many indications in our country that business as usual is not sustainable anymore.
    • It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.