February 2019
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Pharma Sector – Drug Pricing, NPPA, FDC, Generics, etc.

[op-ed snap] The correct prescriptionop-ed snap


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

From UPSC perspective, the following things are important:

Prelims level: E-pharmacies

Mains level: The news-card analyses the issues of cartelisation in pharma sector and how e-pharmacies will increase the competition leading to better prices.



Amid a slew of conflicting judicial decisions from different High Courts, the legality of e-pharmacies continues to be questioned by various trade associations such as the All India Organisation of Chemists and Druggists (AIOCD).


  • E-pharmacies, which operate through websites or smartphone apps on the Internet, offer medicines for sale at a discount of at least 20% when compared to traditional pharmacists.
  • The added convenience of home delivery of medicines to one’s doorstep is there.
  • For scheduled drugs, patients can submit photographs of prescriptions while placing orders.
  • The legal status of these e-pharmacies is not clear because the government is yet to notify into law draft rules that it published in 2018.

Opposition to e-pharmacies

  • The fiercest opponents of e-pharmacies are trade associations of existing pharmacists and chemists.
  • They argue that their livelihoods are threatened by venture capital-backed e-pharmacies and that jobs of thousands are on the line.
  • These trade associations also spin imaginary tales of how e-pharmacies will open the door to drug abuse and also the sale of sub-standard or counterfeit drugs, thereby threatening public health.

Need for e-pharmacies to curb cartelisation

  •  The entry of e-pharmacies will have effect on lowering the price of medicine for Indian patients.
  • Associations of pharmacists is one of rampant, unabashed cartelisation that has resulted in an artificial inflation of medicine prices.
  • In a fully functional, competitive market, pharmacists would compete with each other for business.
  • This competition could happen in the form of discounts or improving operational efficiency.
  • This practice of two competitors colluding to fix the sale price and area of operation is called cartelisation and is illegal under India’s Competition Act.
  • Over the last decade, the Competition Commission of India (CCI) has had to deal with several complaints alleging that trade associations of pharmacists are providing platforms for cartelisation.

Barriers in way of e-pharmacies

  • The practice of requiring pharmaceutical companies to apply for a no-objection-certificate (NOC) from the regional trade association before they appoint new stockists in a region to sell a particular drug prohibits competition.
  • By creating such artificial, extra-legal barriers to the free trade of medicines within India, these trade associations create huge distortions in the Indian market.
  • In its recent policy note on “Making markets work for affordable healthcare”, published in October 2018, the CCI noted, “One major factor that contributes to high drug prices in India is the unreasonably high trade margins.”
  • One of the culprits for this phenomenon identified by the CCI was “self-regulation by trade associations [which] also contributes towards high margins as these trade associations control the entire drug distribution system in a manner that mutes competition”.

Solutions Proposed by CCI

  • As stated by the CCI in its policy note, “Electronic trading of medicines via online platforms, with appropriate regulatory safeguards, can bring in transparency and spur price competition among platforms and among retailers, as has been witnessed in other product segments.”

Way Forward

Where the state has failed, it is possible that venture capitalist backed e-pharmacists will succeed in bringing back competition to the retail drug markets in India. There is no reason for India to continue indulging trade associations that have no taste for competition or fair business practices.

Air Pollution

[op-ed snap] The thing about airop-ed snap


Mains Paper 3: Environment | Conservation, environmental pollution and degradation, environmental impact assessment

From UPSC perspective, the following things are important:

Prelims level: air quality standards,Lancet Report, NCAP

Mains level: Worsening air quality and findind alternatives to energy consuming air cleaning methods.



Air pollution is a silent killer in India, especially in the country’s northern belt. Eighteen per cent of the world’s population lives in India, but the country bears 26 per cent of the global disease burden due to air pollution.

Impact of air pollution on public health

  • According to estimates of the India State-Level Disease Burden Initiative — published last year in Lancet Planetary Health — over half the 12.4 lakh deaths in India attributed to air pollution in 2017 were of individuals under the age of 70.
  • The average life expectancy in the country could be 1.7 years higher if air pollution is contained at a level at which human health isn’t harmed.

Policy and civil society responses to air pollution

  • Policy and civil society responses to air pollution have been limited and delayed.
  • in January that the Ministry of Environment, Forest and Climate Change revamped the National Clean Air Programme (NCAP) to make it the country’s first overarching policy framework on air quality.
  • Bloomberg Philanthropies and The Energy and Resources Institute (TERI) came forward to provide technical assistance to the government for implementing the NCAP by an emission inventory database.
  • The two institutes would also cooperate with the government in identifying sources of pollution and tracking emissions in order to help it realise the target of reducing particulate matter by 20-30 per cent in the next five years.

Energy costing Measures to tackle Air Pollution

  • In India too, researchers, entrepreneurs and environmentalists have voiced the need for devices such as sensor-based monitors, air purifiers and smog towers.
  • The use of mass spectrometers  to identify volatile substances that pollute air. But their energy footfall is likely to offset recent gains in energy efficiency.
  • It is a nationwide concern that requires systemic measures, long-term planning, stringent action against those violating emission laws and standards.
  • The country also requires inter-departmental coordination, continuous monitoring, appropriate warning systems and adequate protocols for assessment of air quality.

Problems with air purifiers

  • These devices consume energy, require constant maintenance and constitute a lopsided and expensive answer to the air pollution problem.
  • Studies have shown that many types of air purifiers used in households, offices and commercial set-ups do not actually improve the air quality .
  • ertain types of air purifiers do not remove chemicals or gases. Ionisers have limited utility against harmful particles and activated carbon filters — amongst the most popular air purifying devices — are not effective against particulate matter and allergens.
  • Electrostatic filters are not effective in large rooms and ozone purifiers are known to trigger asthma attacks.

Way Forward

  • It is also high time we recognise that air pollution problem is not merely a technological issue, but a social concern.
  • It is high time we recognise that air pollution will not go away if we continue to see it as a problem of only the affluent sections of society.
  • Besides emphasising on clean energy devices, energy efficiency technologies, dust control mechanisms and clean transport facilities, the government must be alive to the concerns of the people whose livelihoods are affected when polluting industries are banned.
  • Some states of the US, Singapore and China, for instance, have come out with citizen-friendly remedies that emphasise dust management, soil conservation and ecological restoration.
  • Addressing air pollution is a human concern. Regulation and technological solutions should not lose sight of this perspective.

[op-ed snap] Slipping on Democracyop-ed snap


Mains Paper 2: Polity | Comparison of the Indian constitutional scheme with that of other countries

From UPSC perspective, the following things are important:

Prelims level: EIU, Democracy Index

Mains level: State of democracy in India & world.



The Economist Intelligence Unit recently published its 11th report on the “State of Democracy in the World in 2018” titled “Me Too?Democracy Index confirms the paradox of India being the world’s largest electoral wonder, but an increasingly flawed democracy.

About Survey

  • The survey ranks 165 independent countries based on five parameters — namely, electoral process and pluralism, civil liberties, functioning of the government, political participation and political culture.
  • Index classifies countries into four types — Full Democracies, Flawed Democracies, Hybrid Democracies and Authoritarian Regimes.
  • Most of the shift has taken place into flawed democracies, which constitute the largest group with 43 per cent of the world’s population.
  • A third of the world lives under authoritarian governments, the majority being in China.
  • Nordic democracies continue to top the rankings year after year, with high political participation, robust welfare state and progressive workers’ rights and environmental standards.

Findings of The Survey

  • Voter turnout was on the rise in 2018, in expression of disillusionment.
  • The culture of protest is on the rise, with a number of demonstrations around the world for a plethora of causes.
  • The rise of social media has made public outreach quicker and easier, making lawful assembly an increasing trend.
  • Quotas for women candidates have made parliaments more inclusive, pointing to the instrumental importance of positive political discrimination.
  • Japan introduced women’s quota legislation in 2018. In the subcontinent, Nepal already tops South Asia in women’s representation, with 33 per cent of the seats reserved for women in Parliament and a record 40 per cent of women in local bodies.
  • It is time the Indian Parliament also walks the talk on women’s representation.
  • Four out of five attributes of the Democracy Index either showed stagnation or improvement for the whole world, except for “civil liberties”, which continues its decline since 2008, coming down from 6.3 to 5.7.
  • “Functioning of the government” remains at the bottom of the score card, with hardly any improvement from a high of 5.0 since 2008.
  • The score for perception of democracy as a sub-attribute suffered its biggest fall in the index since 2010, indicating that people are losing faith in the capability of democracy to deliver basic goods and utilities.

Situation in The South Asia

  • Among the SAARC countries, India (41) and Sri Lanka (71) are classified as flawed democracies, followed by Bangladesh (88), Bhutan (94) and Nepal (97) which are hybrid regimes, with Pakistan (112) and Afghanistan (143) being authoritarian.
  • This is the worst ranking ever on the index for India. It is a mid-range country among flawed democracies, with a high score of 9.17 in electoral process and pluralism but moderate record not crossing 7.5 on the rest of the parameters.

Factors Affecting Indian ranking

  • What has adversely affected Indian rankings, according to the report last year, is the rise of “conservative religious ideologies”.
  • Vigilantism, violence, narrowing scope for dissent, threat to minorities and marginalised groups has affected our ranking.
  • Journalists are increasingly under attack, with murders taking place in several areas.
  • As a result of limited scope for fair reportage, the Indian media is classified as only “partially free”, a fact also corroborated by the “Freedom in the World Report, 2018”.


This year’s report maintains those concerns, and also warns of incumbents trying to further consolidate power: “In India, the ruling  coalition has struggled to maintain its dominance in state elections. To some extent, this is in fact a reflection of the strength of the country’s democratic institutions, which has yielded upsets for the government, despite various coercive tactics used by the ruling Party to consolidate power.”

Citizenship and Related Issues

Explained: PRC IssueStates in News


Mains Paper 1: Social Issues | Population & associated issues

From UPSC perspective, the following things are important:

Prelims level: PRC, Various tribes mentioned

Mains level: Row over PRC



  • Violence erupted in the state over Arunachal Pradesh government’s proposal to grant permanent resident certificate (PRC) to six non-tribal communities.
  • The state government announced it was considering issuing PRC to six non-Arunachal Scheduled Tribes (APSTs) communities.
  • There is resentment among several community-based groups and organisations who feel the rights and interests of indigenous people will be compromised.

Permanent Resident Certificate

  • Permanent resident certificate is a legal document issued to Indian citizens that serves as evidence of residence and is required to be submitted as residential proof for official purpose.
  • It is a domicile certificate otherwise called as Permanent Residence Certificate (PRC) to the residents of the state who stayed therein over a period.
  • Those citizens who are not currently residing in the state but are sure of permanently staying therein can also apply for it.
  • Besides the permanent residence certificate, the State also offers Temporary Residence Certificate (TRC) for those who reside in the State on a temporary basis.
  • It enables the citizens to avail various policies and claims made in their particular state.

Communities under Proposal

  • The government in the state is considering issuing the certificate to the six non-APSTs communities living in Namsai and Changlang districts and to the Gorkhas living in Vijaynagar.
  • Amongst those communities are Deoris, Sonowal Kacharis, Morans, Adivasis and Mishings.
  • Most of these communities are recognised as Scheduled Tribes in neighbouring Assam.

Who gets PRC in Arunachal Pradesh?

  • Communities listed as Arunachal Pradesh Scheduled Tribes (APST) have been given PRC status.
  • This is because they are considered the original natives of the state.
  • Several other communities have been demanding the status to get domicile-linked benefits.
  • These non-APST communities say that while their names are on land records, they do not get “pattas” (ownership documents).

What is the main bone of contention?

  • The non-APST communities have a sizeable population in neighbouring Assam and enjoy domicile-linked rights in that state.
  • Many of these communities are recognised as STs in Assam, while Morans and Adivasis come under the Other Backward Classes category in Assam.
  • They say that they should have the same rights in Arunachal Pradesh; the APST communities are opposed to this.

Why do APST communities not want other communities to get PRC?

  • APST communities say that giving other communities PRC will dilute the Bengal Eastern Frontier (Regulation) Act 1873, which says that all non-residents and visitors to Arunachal Pradesh must get a permit to travel to the state and stay there.
  • The APST communities say that allowing residency to other communities will lead to many non-tribals entering the state.
RTI – CIC, RTI Backlog, etc.

EVM is ‘information’ under RTI ActPriority 1


Mains Paper 2: Polity | Statutory, regulatory & various quasi-judicial bodies

From UPSC perspective, the following things are important:

Prelims level: CIC, SIC

Mains level: Issues surrounding EVMs


  • An Electronic Voting Machine (EVM) is “information” under the Right to Information Act, the Central Information Commission has ruled.

Defining Information

  • The CIC noted that the definition of information under Section 2(f) of the RTI Act includes “any material in any form, including records, documents, memos, e-mails, opinions, advices, press releases, circulars, orders, logbooks, contracts, reports, papers, samples, models, data material held in any electronic form.

What CIC Ruled?

  • The Chief Information Commissioner ruled that the EVM which is available with the respondent [ECI] in a material form and also as samples is an information under the RTI Act.
  • The Commission was hearing the appeal of an RTI applicant who had asked the Election Commission for an EVM but was denied.
  • The models/samples of EVM are available with the ECI, but the same are only kept for training purpose by the ECI, and not saleable to the general public.

Why such ruling?

  • EVMs have been in the spotlight recently as several Opposition leaders have raised doubts about the credibility of the machines.
  • They have also demanded that the ECI cross-check 50% of results with voter-verifiable paper audit trails (VVPAT) in the upcoming Lok Sabha poll.

Certain Exemptions

  • The information was exempted from disclosure under Section 8(1)(d) of the RTI Act as the software installed in the machines is an intellectual property of a third party.
  • The disclosure would harm the competitive position of the third party concerned.
  • The CIC noted this fresh argument, but did not rule on it.
  • Instead, he directed the ECI to file an appropriate response to the appellant, as it had erroneously denied the information sought, using Section 6(1) of the RTI Act, which does not deal with grounds for exemption.


Central Information Commission (CIC)

  1. The Central Information Commission (CIC) set up under the Right to Information Act is the authorized quasi judicial body, established in 2005.
  2. It acts upon complaints from those individuals who have not been able to submit information requests due to either the officer not having been appointed, or because the respective Officer refused to receive the application for information under the RTI Act.
  3. The Commission includes 1 Chief Information Commissioner (CIC) and not more than 10 Information Commissioners (IC) who are appointed by the President of India.
  4. CIC and members are appointed by the President of India on the recommendation of a committee consisting of—Prime Minister as Chairperson, the Leader of Opposition in the Lok Sabha; a Union Cabinet Minister to be nominated by the Prime Minister.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Ayushman Bharat will not cover cataract ops, dialysis and normal deliveriesGovt. Schemes


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

From UPSC perspective, the following things are important:

Prelims level:  Ayushman Bharat Programme

Mains level: Everything about Ayushman Bharat Programme


  • The National Health Authority (NHA) is planning to remove procedures covered under existing national programmes from the list of packages approved for reimbursement under PMJAY (Ayushman Bharat).
  • Certain procedures like cataract surgeries, dialysis and normal deliveries will not be covered by the flagship health scheme.

Avoiding Duplication

  • Procedures or diseases for which there is already an existing national programme, do not need to be covered under AB packages.
  • Diseases for which there are existing national programmes and for which treatment is reimbursed under PMJAY for specified rates include tuberculosis, chronic kidney disease (dialysis), leprosy, malaria, HIV-AIDS and mental health disorders.
  • For many diseases like malaria, where surgeries are not established protocol for treatment, PMJAY approves a daily hospitalization cost of Rs 2,000.

I. Cataract

  • Cataract surgeries have topped the list of claims submitted under PMJAY.
  • In the first three months of PMJAY until Nov 2018 — 6,900 claims had been submitted for cataract surgeries.
  • However they are done for free under the National Blindness Control Programme (NBCP).

II. Normal Delivery

  • The NHA is planning to leave out normal deliveries from the ambit of PMJAY.
  • There are a host of national programmes for mother and child health, high-risk deliveries will continue to be covered.

III. Dialysis

  • The Pradhan Mantri National Dialysis Programme was rolled out in 2016 under which dialysis is already provided free of cost.

Bringing Implants under AB-NHPM

  • The NHA is also in talks with the National Pharmaceutical Pricing Authority (NPPA) to negotiate special rates for implants or other devices that are used under PMJAY to further bring down costs.
e-Commerce: The New Boom

Draft e-commerce policy: Keeping our data safe and securePriority 1


Mains Paper 3: Economy | Changes in industrial policy & their effects on industrial growth

From UPSC perspective, the following things are important:

Prelims level: Analysis of Draft e-commerce policy

Mains level: The newscard provides various prospects of the draft policy in short and lucid manner


  • The DPIIT has released the draft National e-commerce Policy that sends a clear message that India and its citizens have a sovereign right to their data.

Key Issues addressed

  • Data
  • Infrastructure development
  • E-commerce marketplaces
  • Regulatory issues
  • Stimulating domestic digital economy
  • Export promotion

Indian control over own data

  • Govt to be given access to source code, algorithms of AI systems Impose custom duties on electronic transmissions to reduce revenue loss.
  • Bar sharing of sensitive data of Indian users with third party entities, even with consent.
  • A ‘data authority to look at community data.

Local Presence of Apps and Websites

  • All e-commerce websites, apps available for downloading in India to have a registered business entity here.
  • Non-compliant e-commerce app/website to be denied access here.

Incentives for data localization

  • Location of the computing facilities like data centres, server farms within India.
  • Firms to get 3 years to comply with local data storage requirements.
  • Data storage facilities to get ‘infrastructure status’.

FDI in E-Commerce

  • FDI only in marketplace model (where multiple vendors come together under an IT based platform).
  • No FDI in inventory model (where inventory of goods and services is owned by e-commerce entity and is sold to the consumers directly).

Certain E-Com Trade Rules

  • Curbs on Chinese ecommerce exports.
  • Gifting route, often used by Chinese apps, websites, banned for all parcels except life-saving drugs.
  • Integrating Customs, RBI and India Post to improve tacking of imports through ecommerce.
  • Incentives & e-commerce export promotions.
  • Ecommerce startups may get ‘infant industry’ status raising limit for courier shipments from Rs 25,000 to boost ecommerce export.

Regulation for E-coms

  • No separate regulator for ecommerce sector.
  • E-consumer courts to be developed.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] 4th Global Digital Health Partnership SummitIOCRPIB


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

From UPSC perspective, the followaing things are important:

Prelims level: About the summit

Mains level: Need of HER in India


  • Union Health Ministry has inaugurated the ‘4th Global Digital Health Partnership Summit’ in New Delhi.

4th Global Digital Health Partnership Summit

  • The global intergovernmental meeting on digital health is hosted by the Ministry of Health and Family Welfare in collaboration with WHO and the Global Digital Health Partnership (GDHP).
  • The Conclave discussed the implication of digital health interventions to health services accessibility, quality and affordability and explores ways of leveraging digital health technologies to strengthen the healthcare delivery systems globally.

Electronic Health Record (EHR) in India

  • India has embraced digital health to achieve the targets of UHC.
  • A “National Resource Centre for EHR Standards” has also been set up in order to augment facilitation for adoption of the notified EHR Standards.
  • Indian government has notified health informatics standards and approved Metadata & Data Standards for enabling seamless exchange of information across care providers.
  • It aims to make these systems interoperable and to build electronic health records of citizens.
  • India took the world stage at the 71st World Health Assembly in Geneva, Switzerland by successfully introducing and unanimous adoption of Resolution on Digital Health.

About GDHP

  • The Global Digital Health Partnership (GDHP) is an international collaboration of governments, government agencies and multinational organisations.
  • It is dedicated to improving the health and well-being of their citizens through the best use of evidence-based digital technologies.
  • Governments are making significant investments to harness the power of technology and foster innovation and public-private partnerships that support high quality, sustainable health and care for all.
  • The GDHP facilitates global collaboration and co-operation in the implementation of digital health services.