August 2018
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[op-ed snap] The public-private gap in health care

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme

Mains level: The inequality between public and the private sector in healthcare and its impact on citizens especially poor


Context

Lack of transparency in transplants

  1. The recent controversy about transparency in the working of the cadaver transplant programme in Tamil Nadu has provided an opportunity to revisit the vexed question of medical rationing in India
  2. It is a hard reality that not all medical interventions are available to every citizen who may need it

NITI Aayog’s vision document

  1. The NITI Aayog’s document, ‘Three Year Action Agenda, 2017-18 to 2019-20’, has a section on health care
  2. One of the recommendations is for the government to prioritise preventive care rather than provide curative care
  3. The document also advises the government to pay attention to stewardship of the health sector in its entirety rather than focussing on provision of health care

Mismatch between policy and actual programs

  1. Every government since Independence has stated egalitarianism as its goal in healthcare
  2. The policies, however, have not matched the statements
  3. Many interventions, especially those which are very expensive, continue to be provided only to those who can pay for them
  4. This is medical rationing of the covert kind
  5. The new Ayushman Bharat health scheme to provide secondary and tertiary care to those who are socio-economically deprived has a cap of ₹5 lakh per family per year
  6. It is quite obvious that many interventions cannot be accessed for this amount, certainly not human organ transplants
  7. In India, out-of-pocket expenses for medical care are about 70% of all medical expenditure

Organ transplant is a complex process

  1. Transplanting a human organ is not a single event, but a life-long process
  2. The actual act of transplantation itself needs expensive infrastructure and trained human resources
  3. For the continuing success of the transplanted organ, expensive medication is needed

Reverse flow of resources

  1. Healthcare in India is obviously not egalitarian
  2. Governments have been giving subsidies to private players, especially to corporate hospitals
  3. The repeated boast that India can offer advanced interventions at a fraction of the costs in the West does not take into account the cost of the subsidies that make this possible
  4.  Since it is all taxpayers’ money, it is a clear case of taking from the poor to give to the rich

Dependence on private sector

  1. Successive governments have been increasingly dependent on the private sector to deliver healthcare
  2. The Ayushman Bharat scheme is a further step in this process
  3. The benefit to patients is questionable but private players will see a large jump in profits
  4. It will further institutionalise medical rationing by explicitly denying certain interventions — a “negative list” presumably of procedures which will not be covered, which is not yet in the public domain

Poor effects of medical rationing

  1.  One is a distrust of the public in government hospitals
  2. The poor expect to get from them what the rich get in private hospitals
  3. With present policies, this is simply not possible
  4. Without a clearly defined mandate, morale among medical personnel in public hospitals is low
  5. The perception that doctors in the private sector are much better than those in the public sector has a severe debilitating effect on the professional image of medical personnel in public hospitals

Way Forward

  1. Every possible medical intervention should be available to every citizen
  2. The only pressure group which can ensure at least equitable medical care is the electorate
  3. Until such time as it demands this from governments, we will continue to witness the tragic drama of two levels of medical care in India
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Banning of Unregulated Deposit Schemes Bill, 2018

Note4students

Mains Paper 2: Polity | Parliament & State Legislatures – structure, functioning, conduct of business, powers & privileges & issues arising out of these

From UPSC perspective, the following things are important:

Prelims level: Chit Funds (Amendment) Bill, 2018, Banning of Unregulated Deposit Schemes Bill, 2018

Mains level: Illicit deposit schemes spreading across the country and measures to curb them


News

Bill to regulate illicit deposit schemes

  1. The Union government has come up with two bills to tackle the menace of non-regulated deposit schemes
  2. The Chit Funds (Amendment) Bill, 2018 was introduced in the Lok Sabha during the second leg of the Budget Session
  3. The second Bill is Banning of Unregulated Deposit Schemes Bill, 2018

Provisions of the bill

  1. The proposed Bill aims to provide a comprehensive legislation to tackle illicit deposit schemes by completely prohibiting such activities
  2. Nine regulators including the RBI, SEBI, the Ministry of Corporate Affairs, and the State governments regulate financial activities
  3. According to the Bill, all deposit-taking schemes are required to be registered with the relevant regulator, failing which the “Deposit Takers” will be considered “unregulated” and hence be banned
  4. The Bill creates three different types of offences, namely, running of Unregulated Deposit Schemes, fraudulent default in Regulated Deposit Schemes, and wrongful inducement in relation to Unregulated Deposit Schemes
  5. A ‘Competent Authority’ will be appointed which has the powers similar to a civil court, including powers to attach properties of the deposit takers
  6. It also empowers police to search and seize any property believed to be connected with an offence under the Bill, with or without a warrant
  7. The Bill enables the creation of an online central database, for collection and sharing of information on deposit-taking activities in the country

Definitions

  1. “Deposit Takers” include all possible entities (including individuals) receiving or soliciting deposits, except specific entities such as those incorporated by legislation
  2. “Deposit” is defined in such a manner that deposit takers are restricted from camouflaging public deposits as receipts, and at the same time not to curb or hinder acceptance of money by an establishment in the ordinary course of its business
Capital Markets: Challenges and Developments

[op-ed snap] Improving state finances by reducing power losses

Note4students

Mains Paper 3:Economy| Infrastructure: Energy, Ports, Roads, Airports, Railways, etc.

From UPSC perspective, the following things are important:

Prelims level: India Consensus Project, Copenhagen Consensus

Mains level:  Structural issues in the power sector


News

Context

  1. Numbers indicate that agricultural users across the country pay only one-fourth the price for the power they consume compared to other users.
  2. India’s total energy losses came to 24% in 2015-16, significantly more than international norms.
  3. This, however, is an improvement on 2003-04 when the losses were 38%. Progress was made because of national- and state-level reforms.

Shortcomings of the state discoms

  1. Inadequate and poor-quality power supply means frequent interruptions, poor voltage levels, and dissatisfied consumers across much of the country.
  2. Other losses includes those due to energy dissipated in conductors, transformers and other equipment, along with pilferage by those who bypass meters, and losses from failure to recover the amount billed to consumers,.

India Consensus project

  1. It is commissioned by Tata Trusts and the Copenhagen Consensus for the India Consensus project to look at state-level solutions for Andhra Pradesh and Rajasthan.
  2. They unite academic research, employing cost-benefit analysis, with sector expert input, broad and inclusive stakeholder engagement, and extensive policy outreach to evaluate and prioritize the smartest interventions.
  3. The researchers looking at power distribution found the agriculture sector, one of the most inefficient electricity users.

Crippled Policy Measures

  1. In the 1960s, the rural electrification programme was introduced to enhance agricultural output using groundwater for irrigation.
  2. Due to un-metered supply and the flat-rate electricity tariff provided for irrigation, the number of pump sets increased substantially and unregulated and free water has contributed to over-exploitation of groundwater resources.
  3. Subsidized power intended to benefit farmers allowed problems such as pilferage and theft, and disguised losses from the utilities, which degraded their finances.

What incurred such heavy loss?

  1. One of the major reasons for the high losses was the adoption of a low tension (LT) distribution network spread over long distances to serve dispersed, small, individual agriculture connections.
  2. This resulted not only in high technical losses, but also in theft facilitated by un-metered supply and the flat tariff.
  3. This has adversely affected farmers by making the supply and quality of power unpredictable and by providing it mainly during the night hours.
  4. This resulted in frequent failure of pump sets, forcing farmers to use inefficient motors, and keep the pump sets constantly on, wasting energy and causing overexploitation of groundwater.
  5. This is a vicious cycle in which farmers, distribution companies and state governments alike face ever-increasing losses.

Solutions over Distribution Losses

The researchers propose two solutions.

(A) The first is to introduce a high-voltage distribution system (HVDS), by upgrading the network and replacing transformers.

  • Andhra Pradesh (AP), which has already made a strong start on conversion of its LT network to HVDS, managing to reduce losses to 12%, has demonstrated that this approach works.
  • The biggest saving would come from the fact that pump sets wouldn’t fail so often.
  • Factoring in carbon savings, it will also benefit energy savings and the reduction in transformer failure.

(B)  The second solution proposed by the researchers—replacing inefficient pump sets with energy efficient ones—further enhances the return on investment.

  • We would need not only the high-voltage distribution system to be set up, but also to replace all existing pumps.
  • Yet, the total benefits would grow even more, allowing each rupee to generate ₹3 of social benefits through lower pump breakage along with energy savings and carbon savings.
  • These interventions will enable reduction in the subsidy by governments for irrigation amounting to at least ₹3,000 crore in AP and about ₹7,000 crore in Rajasthan, which could be redirected to other spending.

Way Forward

  1. This study project highlights the lasting challenges that can result from well-meaning decisions such as the low-tension distribution network.
  2. Two pronged strategy needs to be envisaged to counter losses incurred by discoms which are already under revitalisation.
  3. And on the other hand, losses incurred in agriculture needs to be curbed with the help of above mentioned strategies.

Law Commission to finalise report on ‘Family Law Reform’

Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these scheme

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Arguments in favor of Uniform Civil Code


News

Uniform Civil Code in making

  1. What started off as an exercise to examine the possibility of a common civil code, as was evident in the release of the Law Commission’s ‘Questionnaire on Uniform Civil Code’ in 2016, is soon set to culminate in the submission of a report on ‘Family Law Reform’.
  2. It will suggest ways to codify and reform personal laws of all religions.
  3. With the two-year-long consultation process drawing to a close on July 31, the Law Commission is expected to finalise its report before the end of its term under Justice B S Chauhan in August.

Most consultative process ever

  1. This has been the most widespread consultative process of the Law Commission involving 70,000 responses, 50-odd face-to-face consultations.
  2. These include women’s rights groups, advocates, sexual minorities, religious groups and experts in Muslim personal.

Expected outcomes of the report

  1. The aim is not to identify an identical procedure for all but to correct the gender discriminatory nature of family laws across religions.
  2. This would be done with reference to the precedents already available in the law said the Law Commission.

Other aspects of the Report include:

  • Parenting issue after divorce
  1. For instance, with reference to child custody laws among Shias this, in case of a divorce, allows the father the custody of the son above the age of two years.
  2. The Commission will refer to the Githa Hariharan vs Reserve Bank of India Supreme Court order of 1999 where it ruled that women were as much the natural guardians of their children as men.
  3. Similarly, with adoption being disallowed or restricted under Muslim and Christian personal laws, the Commission will refer to the Shabnam Hashmi vs Union Of India 2014 Supreme Court order that gives prospective parents the right to adopt children irrespective of their religious background.
  • Reconsidering Divorce
  1. With the Supreme Court already declaring instant triple talaq unconstitutional, the Law Commission is also expected to look at how to bring men under the purview of Dissolution of Muslim Marriages Act, 1939, under which currently women have to approach the court of law if they want a divorce.
  2. The three months period in fact means far less agony for the women as opposed to personal laws of Hindu or Christian or even the Special Marriage Act, wherein it takes anywhere from one year to three years.
  3. Even if the man chooses to approach an extra-judicial authority like a Qazi for talaq, he has to qualify the reasons for the divorce.
  4. Likewise, the Hindu personal law doesn’t allow for unilateral filing of no fault divorce, which also needs to be looked at.
  • Reforming Property Rights
  1. In terms of property rights, the Muslim personal law which allows daughters only half the share of sons will be examined as will be the Hindu personal law which, while it allows for an equal share.
  2. For property, there has been a very low claim rate for women, and the Parsi law wherein a girl marrying outside the community is disinherited.
  3. The report is also sought to address these issues.
Uniform Civil Code: Triple Talaq debate, Polygamy issue, etc.

Rajasthan first State to implement biofuel policy

Note4students

Mains Paper 2: Governance | Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the National Policy on Biofuels

Mains level: Read the attached story.


News

With emphasis on increasing production of oilseeds

  1. Rajasthan has become the first State in the country to implement the national policy on biofuels unveiled by the Centre in May this year.
  2. It will lay emphasis on increasing production of oilseeds and establish a Centre for Excellence in Udaipur to promote research in the fields of alternative fuels and energy resources.
  3. A biodiesel plant of the capacity of 8 tonnes a day has already been installed in the State with the financial assistance of the Indian Railways.
  4. The State government would promote marketing of biofuels and generate awareness about them.
  5. The Minister said the State Rural Livelihood Development Council would also encourage women’s self help groups to explore the scope for additional income through the supply of biodiesel.

Back2Basics

National Biofuels Policy, 2018

  1. The Union Cabinet approved a national policy on biofuels that seeks to not only help farmers dispose of their surplus stock in an economic manner but also reduce India’s oil-import dependence.
  2. The policy expands the scope of raw material for ethanol production by allowing the use of sugarcane juice, sugar-containing materials like sugar beet, sweet sorghum, starch-containing materials like corn, cassava, damaged food grains like wheat, broken rice, rotten potatoes that are unfit for human consumption for ethanol production.
  3. The policy also provides for a viability gap funding scheme of ₹5,000 crore in six years for second generation (more advanced) ethanol bio-refineries in addition to tax incentives and a higher purchase price as compared to first-generation biofuels.
  4. Farmers are at a risk of not getting appropriate price for their produce during the surplus production phase.
  5. Taking this into account, the policy allows use of surplus food grains for production of ethanol for blending with petrol with the approval of National Biofuel Coordination Committee.
Biofuel Policy

India gets STA-1 status from U.S.

Image Source

Note4students

Mains Paper 2: IR | Bilateral, regional and global groupings and agreements involving India and/or affecting India’s interests

From UPSC perspective, the following things are important:

Prelims level: STA-1

Mains level:  India-US defence relations.


News

A strategic push for India

  1. US government granted India the status of STA-1 a trading partner equivalent to its closest allies in the NATO. This decision is likely to boost India’s defence trade with the U.S.
  2. The US decision to move India into Tier-1 of the Department of Commerce’s Strategic Trade Authorisation (STA) license is a logical culmination to India’s designation as a Major Defence Partner of the US
  3. It is a reaffirmation of India’s impeccable record as a responsible member of the concerned multilateral export control regimes.
  4. As a result of this move, India will require less number of licences for acquiring U.S. defence exports.
  5. Apart from India, other Asian countries in the STA-1 list are Japan and South Korea.

Way Forward

  1. The move is a sign of trust not only in the relationship but also on India’s capabilities as an economic and a security partner.
  2. This is because it also presupposes that India has the multilateral export control regime in place, which would allow the transfer of more sensitive defense technologies and dual use technologies to India and without the risk of any proliferation.
  3. Currently, 36 countries, mostly all NATO nations, have this status, so it’s a very elevated status from an export control point of view.
Foreign Policy Watch: India-United States

[pib] Setting up of Vegetable Clusters

Note4Students

From UPSC perspective, the following things are important:

Prelims level: MIDH

Mains level: Schemes for promoting Horticulture


News

Mission for Integrated Development Horticulture (MIDH)

  1. MIDH a centrally sponsored scheme is implemented for the holistic development of horticulture sector in the country.
  2. Aim: Promote holistic growth of horticulture sector, including bamboo and coconut through area based regionally differentiated strategies, which includes research, technology promotion, extension, post harvest management, processing and marketing, in consonance with comparative advantage of each State/region and its diverse agro-climatic features.
  3. It covers fruits, vegetables, roots and tuber crops, mushrooms, spices, flowers, aromatic plants, coconut, cashew, cocoa and bamboo through various interventions.
  4. While Government of India (GOI) contributes 85% of total outlay for developmental programmes in all the states except the states in North East and Himalayas, 15% share is contributed by State Governments.
  5. In the case of North Eastern States and Himalayan States, GOI contribution is 100%.

New cluster based approach under MIDH

  1. Under MIDH, cluster-based approach is adopted for production and linking it with available infrastructure, or to be created, for post harvest management, processing, marketing and export.
  2. The cluster preference is given to those areas where natural resource base and water resources have been developed.
  3. Special emphasis is also given for adoption of area based cluster approach towards developing regionally differentiated crops, which are agro-climatically most suitable for the State/region.
  4. However, the details of clusters including vegetables are not maintained at the Central level.
Horticulture, Floriculture, Commercial crops, Bamboo Production – MIDH, NFSM-CC, etc.