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GS Paper: GS2

  • Changing India’s health delivery landscape through NDHM

    The National Digital Health Mission promises to transform the Indian healthcare system with the aid of technology. The article highlights the key aspects of the mission.

    Building integrated digital health infrastructure through NDHM

    • NDHM is based on the principles of health for all, inclusivity, accessibility, affordability, education, empowerment, wellness, portability, privacy and security by design.
    • NDHM will build the backbone necessary to create an integrated digital health infrastructure.
    • With its key building blocks HealthID, DigiDoctor, Health Facility Registry, Personal Health Records, Telemedicine, and e-Pharmacy, the mission will bring together disparate stakeholders and radically strengthen and, thus change India’s healthcare delivery landscape.
    • NDHM is also a purposeful step towards the achievement of the United Nations’ Sustainable Development Goal of Universal Health Coverage.

    Importance of digital intervention in health service

    • Digital interventions significantly enhance the outcomes of every health service delivery programme.
    • Importance of digital intervention is demonstrated in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana scheme.
    • Under PM-JAY, 1.2 crore cashless secondary and tertiary care treatments have been provided using an indigenously developed state-of-the-art IT platform.
    • The Arogya Setu mobile app deploys ICT innovations for contract tracing.

    Principal highlight of NDHM

    1) Voluntary in nature

    • HealthID is entirely voluntary for citizens.
    • Its absence will not mean denial of healthcare to a citizen.
    • They can choose to generate their Health Account or ID using their Aadhaar card or digitally authenticable mobile number and by using their basic address-related details and email ID.
    • The use of Aadhaar, therefore, is not mandatory.

    2) Data sharing based on consent

    • Providing access to and sharing of personal health records is a prerogative of the HealthID holder.
    • The consent of the health data owner is required to access this information or a part of it.The consent can be withdrawn anytime.
    • The personal health record will enable citizens to store and access their health data, provide them with more comprehensive information and empower them with control over their private health records.

    3) Compliance with laws and fundamental rights

    • NDHM has been built within a universe of fundamental rights and legislation such as the Aadhaar Act and the IT Act 2008 as well as the Personal Data Protection Bill 2019.
    • This project is also informed by the entire gamut of Supreme Court judgments and core democratic principles of cooperative federalism.
    • The Mission gets its strategic and technical foundation from the National Digital Health Blueprint, the architectural framework of which keeps the overall vision of NHP 2017 at its core and ensures security and privacy by design.

    4) Reaching out to the unconnected population

    •  NHDM is a digital mission led by technology powered by the internet.
    • So, to reach out to and empower the large number of “unconnected” masses specialised systems are being built and off-line modules that will be designed to reach out to the “unconnected”.

    5) Partnership with all key stakeholders

    • The design of NDHM has been built on the principle of partnership with all key stakeholders — doctors, health service providers, technology solution providers and above all citizens.
    • Without their belief, trust, adoption, and stewardship, this mission will not achieve its desired result.

    Consider the question “Examine the key aspects of the National Digital Heath Mission and how it could help transform the Indian healthcare landscape?”

    Conclusion

    NDHM is a mission whose time has come because health is the first step towards self-reliance and only a healthy nation can become Atma Nirbhar.

  • [pib] Eklavya Model Residential Schools

    An Eklavya Model Residential School (EMRS) teacher was selected for National Award to Teachers 2020.

    Note the specific features of EMRS. Each year in the CSP, there is a question related to tribes/tribal development.

    Eklavya Model Residential Schools

    • EMRS started in the year 1997-98 to impart quality education to ST children in remote areas in order to enable them to avail of opportunities in high and professional education courses and get employment in various sectors.
    • Across the country, as per census 2011 figures, there are 564 such sub-districts out of which there is an EMRS in 102 sub-districts.
    • As per revised 2018 scheme, every block with more than 50% ST population and at least 20,000 tribal persons, will have an EMRS by the year 2022.
    • These schools will be on par with Navodaya Vidyalayas and will have special facilities for preserving local art and culture besides providing training in sports and skill development.

    Features of EMRS

    • Admission to these schools will be through selection/competition with suitable provision for preference to children belonging to Primitive Tribal Groups, first-generation students, etc.
    • Sufficient land would be given by the State Government for the school, playgrounds, hostels, residential quarters, etc., free of cost.
    • The number of seats for boys and girls will be equal.
    • In these schools, education will be entirely free.

  • Leveraging its market to force China to settle border issue

    The article charts out the plan to leverage the potential and the present size of the India markets to settle the boundary dispute with China.

    Boycott of Chinese goods: view and counterview

    • After Galwan incident, there have been calls for the boycott of Chinese goods.
    • Counter views have been expressed that the Indian economy is so dependent on China that the costs would be disproportionately higher for India.
    • Our dependence can be reduced substantially if there is a national will and resolve to do so.

    Need for mutually acceptable boundary agreement

    • China may not be willing to go back substantially from the areas they have occupied.
    • Agreeing on maintaining peace and tranquillity or clarification of the LAC has left space for the Chinese to create border incidents which have now led to casualties.
    • So India needs to get China to seriously negotiate a mutually acceptable boundary agreement.

    India could use its market as leverage

    • Size of Indian market: The size of the Indian market and its potential in the coming years provides India considerable leverage.
    • But to use this leverage, Indians, individual consumers as well as firms, have to accept that there would be a period of adjustment in which they would have to pay higher prices.
    • The Chinese have a competitive advantage and are integral to global supply chains.
    • But whatever they sell is, and can be, made elsewhere in the world.
    • Indian can produce everything imported by China: Most of what we import from China was, is and can be made in India itself.
    • With volumes and economies of scale, the cost of production in India would decline as it did in China.

    Steps need to be taken to use market as leverage

    • Focus on those imports from China which have been increasing: The initial focus should be on items which are still being made in India and where imports from China have been increasing.
    • Depriciate Rupees: If the RBI let the currency depreciate in real terms it would be equivalent to an increase in import duties of about 10 per cent.
    • China-specific safeguard duties and use of non-tariff trade barriers should be used in segments like electrical appliances to let Indian producers expand production and increase market share.
    • Government Finances for expansion: The government should also facilitate the flow of finances for expansion and provide technical support for testing, improving quality and lowering costs of production.
    • Look for other players: In critical areas such as Active Pharmaceutical Ingredients, we need a vigorous approach to procure from elsewhere and have early production in India.
    • The government could provide support for environmental compliance to bring down costs of production.This would create demand for domestic goods and services.
    • There are strategic sectors where we should reduce vulnerability: Like scrutiny of -Chinese FDI, Chinese 5G participation etc.
    • Assured government procurement: In critical areas like solar panel and grid storage batteries private investment for manufacturing in India would be triggered by assured government procurement.

    Consider the question “Size and potential of India market could be leverage by India to settle the issues it has with its neighbour. What India needs to achieve this is a strategy and its implementation. Comment.”

    Conclusion

    A sustained and graded economic response to the recent Chinese conduct on the border is needed. We should signal India’s firm resolve and willingness to bear the cost. China could choose to settle the border amicably and have full access to our market. We could then work together to make this the Asian century.

  • States can have sub-groups among SCs/STs: Supreme Court

    A five-judge Bench of the Supreme Court has held that States can sub-classify Scheduled Castes and Scheduled Tribes in the Central List to provide preferential treatment to the “weakest out of the weak”.

    Try this question for mains;

    Q.Reservation is no more seen by the Supreme Court as an exception to the equality rule; rather, it is a facet of equality. Discuss this in light of the quest for sub-categorisation of Scheduled Castes/Tribes.

    What is the sub-categorisation of SCs?

    • States have argued that among the SCs, there are some that remain grossly under-represented despite reservation in comparison to other SCs.
    • This inequality within the SCs is underlined in several reports, and special quotas have been framed to address it.
    • For example, in AP, Punjab, Tamil Nadu and Bihar, special quotas were introduced for the most vulnerable Dalits.
    • In 2007, Bihar set up the Mahadalit Commission to identify the castes within SCs that were left behind.

    About the Judgement

    • The judgment is based on a reference to the Constitution Bench the question of law involving Section 4(5) of the Punjab Scheduled Caste and Backward Classes (Reservation in Services) Act, 2006.
    • The legal provision allows 50% of the reserved Scheduled Castes seats in the State to be allotted to Balmikis and Mazhabi Sikhs.

    There lies struggle within castes: SC

    • There is a “caste struggle” within the reserved class as a benefit of reservation is being usurped by a few, the court pointed out.
    • The million-dollar question is how to trickle down the benefit to the bottom rung.
    • It is clear that caste, occupation, and poverty are interwoven.
    • The State cannot be deprived of the power to take care of the qualitative and quantitative difference between different classes… to take ameliorative measures, said the judgment.

    Overruling the old judgment

    • With this, the Bench took a contrary view to a 2004 judgment delivered by another Coordinate Bench of five judges in the E.V. Chinnaiah case.
    • The judgment had held that allowing States to unilaterally “make a class within a class of members of the Scheduled Castes” would amount to tinkering with the Presidential list.
    • The judgment is significant as it fully endorses the push to extend the creamy layer concept to the Scheduled Castes and Scheduled Tribes.
    • Citizens cannot be treated to be socially and educationally backwards till perpetuity; those who have come up must be excluded like the creamy layer, the judgment said.

    What is the Presidential list?

    • The Constitution, while providing for special treatment of SCs and STs to achieve equality, does not specify the castes and tribes that are to be called SCs and STs.
    • This power is left to the central executive — the President. As per Article 341, those castes notified by the President are called SCs and STs.
    • A caste notified as SC in one state may not be an SC in another state. These vary from state to state to prevent disputes as to whether a particular caste is accorded reservation or not.
    • According to the annual report of the Ministry of Social Justice and Empowerment, there were 1,263 SCs in the country in 2018-19.
    • No community has been specified as SC in Arunachal Pradesh and Nagaland, and Andaman & Nicobar Islands and Lakshadweep.
    • The Constitution treats all Schedule Castes as a single homogeneous group.

    Arguments against sub-categorisation

    • The argument is that the test or requirement of social and educational backwardness cannot be applied to SCs and STs.
    • The special treatment is given to the SCs due to untouchability with which they suffer.
    • In a 1976 case, State of Kerala v N M Thomas, the Supreme Court laid down that “Scheduled Castes are not castes, they are class.”
    • The petitioner’s argument against allowing states to change the proportion of reservation is also based on the perception that such decisions will be made to appease one vote-bank or the other.
    • A watertight President’s list was envisaged to protect from such potential arbitrary change.

    Way ahead with the Judgement

    • The judgement reasoned that sub-classifications within the Presidential/Central List do not amount to “tinkering” with it.
    • No caste is excluded from the list. The States only give preference to weakest of the lot in a pragmatic manner based on statistical data.
    • Preferential treatment to ensure even distribution of reservation benefits to the more backward is a facet of the right to equality, judgement observed.

    Also read:

    [Burning Issue] SC judgement on Reservation not being a Fundamental Right

  • Turkey’s Maritime Disputes

    Turkish President Erdogan has asserted that his country will take whatever belongs to it in the Mediterranean, as well as Aegean and the Black Sea.

    Try this PYQ:

    Q.Turkey is located between

    (a) The Black Sea and Caspian Sea

    (b) The Black Sea and Mediterranean Sea

    (c) Gulf of Suez and the Mediterranean Sea

    (d) Gulf of Aqaba and the Dead Sea

    Assertion over the Mediterranean

    • Greece and Turkey have been locked in a dispute over control of eastern Mediterranean waters.
    • They are at odds over the rights to potential hydrocarbon resources, based on conflicting claims over the extent of their continental shelves.
    • The Turkish navy will hold the shooting exercises in the eastern Mediterranean off the coast of Iskenderun, northeast of Cyprus.
    • Cyprus was divided in 1974 following a Turkish invasion triggered by a Greek-inspired coup.
    • Turkey recognizes the Turkish-populated north of Cyprus as a separate state, which is not recognised by other countries.

  • National Recruitment Agency: Taking jobs closer to people

    Recruitment reform in the form of National Recruitment Agency will resolve many issues faced by the youth appearing for the multiple government exam.

    Context

    • On average, 2.5-3 crore candidates appear for about 1.25 lakh vacancies in the central government every year.
    • But from next year, the NRA will conduct the CET and based on the score, one can apply for a vacancy with the respective agency.

    NRA: Composition and functioning

    • The NRA will have representatives from the Ministry of Railways, Ministry of Finance/Department of Financial Services, Staff Selection Commission (SSC), Railway Recruitment Boards (RRBs) and Institute of Banking Personnel Selection (IBPS).
    • A multi-agency body, the NRA will conduct a Common Eligibility Test (CET) to screen/shortlist candidates for the Group B and C (non-technical) posts.
    • The NRA shall conduct a separate CET each for the three levels of graduate, higher secondary (12th pass) and the matriculate (10th pass) candidates for those non-technical posts to which recruitment is presently carried out by the SSC, RRBs and IBPS.

    How it will benefit youth

    • It will eliminate multiple tests and save time as well as resources.
    • It will give a big boost to transparency.
    • The multiple recruitment examinations are a burden on the candidates, as also on the respective recruitment agencies, involving avoidable/repetitive expenditure, law and order/security-related issues and venue-related problems.
    • The NRA is a combination of convenience and cost-effectiveness for candidates.
    • Examination centres in every district would greatly enhance access to the candidates located in far-flung areas, with a special focus on creating examination infrastructure in the 117 Aspirational Districts.
    • This will prove a great boon to crores of aspirants residing in hilly, rural and remote areas and most importantly, for female candidates.
    • Taking job opportunities closer to the people is a radical step that would greatly enhance ease of living for the youth.

    Consider the question “Recruitment reform in the form of National Recruitment Agency is a radical step that would greatly enhance ease of living for the youth.”

    Conclusion

    Taking job opportunities closer to the people is a radical step that would greatly enhance ease of living for the youth.

  • BRICS Innovation Base for 5G and AI Technology

    China has made a proposal to create what it has termed a BRICS innovation base to take forward 5G and Artificial Intelligence (AI) cooperation.

    Try this question from CSP 2019:

    Q.With reference to communication technologies, what is/are the difference/differences between LTE (Long-Term Evolution) and VoLTE (Voice over Long-Term Evolution)?

    1. LTE ‘is commonly marketed as 3G and VoLTE is commonly marketed as advanced 3G.
    2. LTE is data-only technology and VoLTE is voice-only technology.

    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

    BRICS Innovation Base

    • China is considering the establishment of a BRICS innovation base in China, in order to strengthen practical cooperation with the BRICS.
    • It has urged fellow nations, including India, to boost cooperation in areas including 5G and AI in partnership with Huawei.
    • The move could pose an awkward question for India, which is the only country in the grouping that is leaning towards excluding Chinese participation in the roll-out of India’s 5G networks.

    Huawei in BRICS

    • In South Africa, Huawei is providing services to three of its telecom operators in the roll-out of their 5G networks.
    • Brazil has allowed participation in trials but yet to take a final call.
    • India is unlikely to allow Chinese participation in 5G, particularly in the wake of recent moves to tighten investment from China and national security concerns.

    Back2Basics: BRICS

    • BRICS is an acronym for the grouping of the world’s leading emerging economies, namely Brazil, Russia, India, China and South Africa.
    • The BRICS Leaders Summit is convened annually. It does not exist in form of organization, but it is an annual summit between the supreme leaders of five nations.
    • On November 30, 2001, Jim O’Neill, a British economist who was then chairman of Goldman Sachs Asset Management, coined the term ‘BRIC’ to describe the four emerging economies of Brazil, Russia, India, and China.
    • The grouping was formalized during the first meeting of BRIC Foreign Ministers on the margins of the UNGA in New York in September 2006.
    • The first BRIC Summit took place in 2009 in the Russian Federation and focused on issues such as reform of the global financial architecture.
    • South Africa was invited to join BRIC in December 2010, after which the group adopted the acronym BRICS.

  • India needs a Fiscal Council

    The newscard highlights the need of bipartisan, independent Fiscal Council to report and analyse FRBM discrepancies by the Government.

    Try this question for mains:
    Q.Fiscal Council is an important institution needed to complement the rule-based fiscal policy. Discuss.

    What is a Fiscal Council?

    • A Fiscal Council is an independent fiscal institution (IFI) with a mandate to promote stable and sustainable public finances.
    • They aim to provide nonpartisan oversight of fiscal performance and/or advice and guidance — from either a positive or normative perspective — on key aspects of fiscal policy.
    • These institutions assist in calibrating sustainable fiscal policy by making an objective and scientific analysis.

    Voices for a Fiscal Council

    • The 13th Finance Commission recommended that a committee be appointed by the Ministry of Finance which should eventually transform itself into a Fiscal Council.
    • The FC expected it to conduct an annual independent public review of FRBM compliance, including a review of the fiscal impact of policy decisions.
    • The FRBM Review Committee too made a similar recommendation underlining the need for an independent review by the Finance Ministry appointing the Council.

    Why need a fiscal council?

    (1)Burgeoning deficits

    • For the current year, even without any additional fiscal stimulus, the deficit is estimated at about 7% of GDP as against 3.5% estimated in the Budget due to a sharp decline in revenues.
    • The consolidated deficit of the Union and States could be as high as 12% of GDP and the overall debt could go up to 85%.
    • Thus it is necessary that the government must return to a credible fiscal consolidation path once the crisis gets over.

    (2)Transparency issues

    • Besides large deficits and debt, there are questions of comprehensiveness, transparency and accountability in the Budgets.
    • The practice of repeated postponement of targets, timely non-settlement of bill payments and off Budget financing to show lower deficits has been common.
    • The report of the CAG of India in 2018 has highlighted various advances done to keep the liabilities hidden.

    Fiscal Council can be a game changer. How?

    • First, an unbiased report to Parliament helps to raise the level of debate and brings in greater transparency and accountability.
    • Secondly, costing of various policies and programmes can help to promote transparency over the political cycle to discourage populist shifts in fiscal policy and improve accountability.
    • Third, scientific estimates of the cost of programmes and assessment of forecasts could help in raising public awareness about their fiscal implications and make people understand the nature of budgetary constraint.
    • Finally, the Council will work as a conscience keeper in monitoring rule-based policies, and in raising awareness and the level of debate within and outside Parliament.

    Issues meddling between

    • The problem is that a Council created by the Finance Ministry and reporting to it can hardly be expected to be independent.

    Diverse role to play ahead

    • According to the IMF, there were 36 countries with IFIs in 2014 and more have been established since.
    • While most of the IFIs are in advanced countries, emerging economies too have also shown growing interest in them.
    • Although their common agenda has been to function as watchdogs, there is considerable diversity in their structure and functions.
    • Over the years, monitoring compliance with fiscal rules and costing policies and programmes have become major tasks of these councils.

    Way forward

    • When the markets fail, governments have to intervene.
    • Whenever governments seem obstructed, it is here that we need systems and institutions to ensure checks and balances.
    • In that respect, a Fiscal Council is an important institution needed to complement the rule-based fiscal policy.

    Conclusion

    • Of course, it is not a ‘silver bullet’; if there is no political will, the institution would be less effective, and if there is political will, there is no need for such an institution.
    • That is also true of the FRBM Act. While we cannot state that the FRBM Act has been an unqualified success, it has also not been an abject failure either.

  • Reversing health sector neglect with a reform agenda

    The article analyses the issues India could face in implementing the universal health coverage.

    Context

    • Both India and the U.S. leads the Covid cases in the world and also lack effective universal health coverage (UHC).

    What explains the lack of UHC in both the countries

    • The lack of UHC is due to multiple long-standing factors and historical reasons that have put a damper on the UHC agenda.
    • This long legacy has two important and inter-related implications when it comes to health-care reform.
    • 1) Certain foundational aspects of these health systems that have been adopted over decades tend to dictate the terms of further evolution and lead to a number of compromises.
    • 2) The long legacy itself comprises a path-dependent trajectory that precludes far-reaching health-care reform.
    • This applies both to AB-PM-JAY and NDHM.

    India’s attempt at UHC: Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana

    • The government has looked poised to employ Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance as the tool for achieving UHC.
    • Taking the health insurance route to UHC driven by private players, rather than strengthening the public provisioning of health care, is reflective of the non-negotiability of private health care in India.
    • Covering the remaining population under the AB-PM-JAY presents massive fiscal and design challenges.
    • Turning it into a contributory scheme based on premium collections would be a costly and daunting undertaking, given the huge informal sector and possible adverse selection problems.
    • Distributing benefits among various beneficiary groups, and a formalisation and consolidation of practices in a likely situation of covering outpatient care, are formidable additional challenges.
    • One possible advantage for India over the U.S. could be a relative ease of integrating fragmented schemes into a unified system. The AB-PM-JAY has this ability.

    Issues with AB-PM-JAY

    1) Universal insurance will not be universal access

    • In India, almost two-third corporate hospital are located in cities.
    • So, such maldistribution of health-care facilities and low budgetary appropriations for insurance could mean that universal insurance does not translate to universal access to services.
    • So far, insurance-based incentives to drive private players into the rural countryside have been largely unsuccessful.

    2) Lack of regulatory robustness

    • AB-PM-JAY is without enough regulatory robustness to handle everything from malpractices to monopolistic tendencies.
    • This could have major cost, equity, and quality implications.

    National Digital Health Mission (NDHM)

    • Integration and improved management of patient and health facility information are sought through NDHM.
    • But in the absence of robust ground-level documentation practices and its prerequisites, it would do little more than helping some private players and adding to administrative complexity and costs.

    Consider the question “What are the challenges India faces in the implementation of universal health coverage? Suggest the measures to achieve it.”

    Conclusion

    Upheavals offer a window for reforms. We cannot afford to be complacent and think that the pandemic will automatically change the Indian health-care landscape. It will require mobilising concerted action from all quarters.

  • Seeking equilibrium with China

    The article analyses the India’s efforts to establish strategic equilibrium with assertive China and how that idea clashes with China’s desire to form an Asian order with itself at the top.

    Strategic equilibrium

    •  External Affairs Minister S Jaishankar articulated that India is seeking strategic equilibrium with an increasingly aggressive China.
    • It is hoped that with China’s growing differences with the U.S. China would pay attention to India’s sensitivities.
    • In achieving equilibrium with China, India has bravely been confronting a face-off in the Himalayas for the past several months.
    • India has been building issue-based alliances with the US and Asian majors like Japan, Korea, Vietnam and Indonesia, and Australia.
    • It has taken initiatives in the direction of economic de-coupling with China in the name of “atmanirbharata”.

    Hierarchical Asian order with China at top

    • China is not interested in equilibrium with any of its Asian neighbours, least of all with India.
    • China’s efforts are clearly to build a hierarchical Asian order, with itself at the top.
    • It is acutely conscious of India’s economic strength, military modernisation and overall capabilities.
    • It knows that India is also far behind on these counts.
    • China is ruthlessly resisting India’s access to global governance bodies, such as the UNSC and NSG.
    • To keep India tied at that level, China is objecting to India’s growing strategic proximity to the US. I
    • It is encircling India strategically and economically through its strategic and economic corridors — BCIM (Bangladesh, China, India and Myanmar), CPEC and the Trans-Himalayan Connectivity Network.
    • It is raising issues like Kashmir at the UN and establishing footprints in the Indian Ocean.

    What should India do

    1. Adjust with China, at least tactically.

    • Such an adjustment could be based on mutual give and take.
    • For India, our first priority could be the resolution of the border dispute.
    • Secondly, since China has offered to mediate between India and Pakistan, it should be asked to prevail over Pakistan to resolve the Kashmir issue.
    • In return for these “takes” India could offer access to Chinese commercial cargos to sea, through the Nathula pass.
    • India could also join China’s BRI on mutually acceptable terms.
    • India may also show its willingness, at least tactically, to join CPEC as both Pakistan and China have asked for, provided, India is allowed to undertake projects in PoK and Balochistan.

    2.India should revisit its Tibet policy, which is a core irritant for China.

    Consider the question “China seeking to establish an Asian order with itself at the top comes in the way of India establishing strategic equilibrium with China. Comment.”

    Conclusion

    It is possible that this “give” and “take” may not be acceptable to China. Even if it does not work out as planned, India would have made a bold diplomatic initiative and a huge tactical move towards thinking through out-of-the-box solutions and displaying that it can undertake risks to pursue its long-term national interests.