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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed of the day] Equity’s weak pulse and commodified medicineop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Lack of coverage of the public health system, Role of private sector and regulation.


Context

As the government tries to overhaul the public health system in India, its time to take into account the advent and the role played by the private sector and its implications.

The advent of the private sector

  • Increase in the role of the private sector in the post-Independence era: Post-Independence, the private sector increased its footprint in India.
    • Perpetual sub-optimal investments in public health allowed the private sector to capitalise, flourish, and increasingly gain the confidence of the masses.
    • The private sector went from having about 1,400 enterprises in 1950 to more than 10 lakh in 2010-11.
    • To doctors, this promised greater professional liberty, lesser restrictions, and higher incomes.
    • After liberalisation, the greater focus shifted to the lucrative tertiary-care sector and led to an onslaught of sophisticated private health care in cities.

The dominance of the private sector and malpractices

  • The scale of dominance: Private sector has over 70% of the health-care workforce and 80% of allopathic doctors, has meant that it is scarcely possible for a health-care provider to function in defiance of its norms.
    • Pervasive malpractices: The pervasiveness of malpractices in this market has come to ensure that few could survive without condoning them.
    • Nexus of the private players: Players in this market, in much of their malpractices, have also learnt to function as a harmonious family.
    • Organised form to safeguard interest: The family plays its role in safeguarding its members, acquainting them with its norms and interests, and leveraging the power of its patriarchs to defend its interests in society.
    • Standards of success dictated by the markets: It is little wonder that the market has also come to dictate the avenues of aggrandisement and yardsticks of professional success for health-care professionals.
    • Benchmark of quality changed: Business finesse and social adroitness rather than clinical excellence and empathy become the touchstones of calibre in this market.

Failure of the government

  • Absence of national system: The larger chunk of Indian health care (and health workforce) could not be brought under a “national system” having some form of overarching state control or involvement.
    • If such a system existed it could avail of essential health care without most people having to rely on a vagarious market, except as a luxury.
    • Example of the UK’s NHS: The National Health Service of the United Kingdom, remains the single largest health-care provider.
    • NHS employs nearly the entire health-care workforce.
    • NHS makes essential health care available to all practically free at the point of service.
  • Consequences of the absence of such system: The absence ensures is that the profit-driven private sector, the minor component, caters mainly to the affluent lot as largely a matter of deliberate choice rather than desperate compulsion.
    • Hopes of benefits of free-market belied: The Indian example, much like the United States’, bespeaks the failure of the idea that a free market will compel players to be more efficient.
    • The exploitation of the loops by the private players: Rather than increasing efficiency, the players have found it expedient to scrupulously exploit the prevailing cracks in the system and employ devious methods in order to maximise profits.

Conclusion

  • Health-care providers, just like others, are moulded by their social surroundings. When necessary controls are loosened, the connatural vices are let loose; when the habitat is conducive to values, the right traits develop.
  • A system that starts off with health care as an overt tradable commodity it threatens the development of virtues in the system.
  • On the other hand, a system founded on the concept of equity cultivates a totally different culture of patient care.

 

 

Make in India: Challenges & Prospects

[op-ed snap] Why ‘Make in India’ has failedop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 3- 'Make in India' , its performance, and reasons for not delivering on the set goals.


Context

Five years after its launch its appropriate time to take the stock of the progress made by ‘Make in India’.

Three major objectives of the initiative

  • First- Manufacturing growth rate at 12-14 %: The first objective is to increase the manufacturing sector’s growth rate to 12-14% per annum in order to increase the sector’s share in the economy.
  • Second-100 million jobs: The second objective is to create 100 million additional manufacturing jobs in the economy by 2022.
  • Third-increase manufacturing’s contribution to GDP to 25%: The third objective is to ensure that the manufacturing sector’s contribution to GDP is increased to 25% by 2022 (revised to 2025) from the current 16%.

Assessment of the progress made so far

  • As the policy changes were intended to usher growth in three key variables of the manufacturing sector — investments, output, and employment growth.
  • Progress on the investment front:
    • Slow growth: The last five years witnessed slow growth of investment in the economy.
    • This is more so when we consider capital investments in the manufacturing sector.
    • The decline in gross fixed capital formation: Gross fixed capital formation of the private sector declined to 28.6% of GDP in 2017-18 from 31.3% in 2013-14 (Economic Survey 2018-19).
    • Gross Fixed Capital Formation is the measure of aggregate investment.
    • Increase in private sector’s savings decrease in investment: Household savings have declined, while the private corporate sector’s savings have increased.
    • This is a scenario where the private sector’s savings have increased, but investments have decreased, despite policy measures to provide a good investment climate.
  • Progress on the output growth front:
    • Double-digit growth only in two quarters: The monthly index of industrial production (IIP) pertaining to manufacturing has registered double-digit growth rates only on two occasions during the period April 2012 to November 2019.
    • Below 3% for the most part: The data show that for a majority of the months, it was 3% or below and even negative for some months.
    • The negative growth implies a contraction of the sector.
  • Progress on the employment growth front:
    • No progress: The employment, especially industrial employment, has not grown to keep pace with the rate of new entries into the labour market.

Problems with the policy

  • The initiative had two major lacunae.
  • First- Too much reliance on foreign capital: The bulk of these schemes relied too much on foreign capital for investments and global markets for produce.
    • This created an inbuilt uncertainty, as domestic production had to be planned according to the demand and supply conditions elsewhere.
  • Second-Lack of implementation: The policy implementers need to take into account the implications of implementation deficit in their decisions.
    • The result of such a policy oversight is evident in a large number of stalled projects in India.
    • The spate of policy announcements without having the preparedness to implement them is ‘policy casualness’.
    • ‘Make in India’ has been plagued by a large number of under-prepared initiatives.

Three reasons why ‘Make in India’ failed to perform

  • Too-much ambitious goals: It set out too ambitious growth rates for the manufacturing sector to achieve.
    • Beyond capacity rate for the sector: An annual growth rate of 12-14% is well beyond the capacity of the industrial sector.
    • Overestimation of implementation capacity: To expect to build capabilities for such a quantum jump is perhaps an enormous overestimation of the implementation capacity of the government.
  • Dealing with too many sectors: The initiative brought in too many sectors into its fold.
    • Lack of policy focus: Bringing in too many sectors under its fold led to a loss of policy focus.
    • Lack of understanding of comparative advantages: Further, it was seen as a policy devoid of any understanding of the comparative advantages of the domestic economy.
  • Ill-timed launch
    • Given the uncertainties of the global economy and ever-rising trade protectionism, the initiative was spectacularly ill-timed.

Conclusion

  • In order to revive the ‘Make in India’ there is a need to make necessary changes in the policy and root out the causes associated with the policy implementation.

 

 

 

 

 

 

Food Procurement and Distribution – PDS & NFSA, Shanta Kumar Committee, FCI restructuring, Buffer stock, etc.

[op-ed snap] A farm wish list for the budgetop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 3-Rationalization of subsidies on food in PDS and Fertilizers and need to reform them.


Context

As finance minister presents the budget the FM need to ensure transparency and to fully account for the food subsidy.

The excess buffer stock and need to reform

  • A buffer stock norm and actual stock: A buffer stock norm is at 21.4 million tonnes (mt).
    • Actual stock far exceeds the norm: The actual stocks of grains with the central pool stood at 75.5 mt.
    • Which is 3.5 times what the government needs to hold.
  • The economic cost of the excess stock: At its economic cost, the value of the excess stocks with the government stands at Rs 1.6 lakh crore.
    • Potential for revenue: There is no better place to find revenue for the FM than to liquidate these stocks.
    • Need for the reform in grain management system: Unless the grain management system is reformed, the inefficiency of the grain management system will keep on increasing and the nation will suffer.

Food subsidy reforms

  • Link food prices to procurement price: It is the time to revise the central issue of price and link it to the procurement price-say at half the procurement price.
    • Limit the population coverage: There is a need to limit this highly subsidised food of Rs 3/kg for rice and Rs 2/kg of wheat to say 40 per cent of the population.
    • Move to DBT: The real fundamental reform would be to move towards direct cash transfers for the intended beneficiaries of food subsidy.

Fertiliser subsidy reforms

  • Imbalance in the subsidisation: The real problem of this sector is the imbalance in the policy of fertiliser subsidisation.
    • While urea (N) is subsidised to the extent of 75 per cent of its cost, phosphatic (P) and potassic (K) fertilisers are subsidised only to the tune of about 25 per cent of their cost.
  • Consequences of this imbalance: The result is the highly imbalanced use of N, P and K on farmers’ fields. Which results in
    • Giving a very low fertiliser-to-grain response ratio.
    • Degrading the soil.
    • Degrading underground water.
    • Degrading the environment with excessive nitrogen use.
    • Discouragement to natural farming: The current fertiliser subsidy discourages those who want to pursue natural farming as they don’t get subsidy anywhere near the amount chemical-based fertilisers do.
  • Reforms: There are two ways in which the fertiliser subsidy regime can be reformed.
    • Bring nitrogenous fertiliser under NBS: The solution to the imbalance in use is to bring nitrogenous fertilisers under the Nutrient Based Subsidy (NBS) scheme.
    • Cash transfer based on per hectare basis: The second option is to move towards direct cash transfers for fertilisers on a per hectare basis, with some adjustment for irrigated tracts.
    • 50,000 Crore saving: The above-mentioned reforms could result in the saving of Rs. 50,000 crores to the public exchequer.

Way forward

  • Investing the savings where it matters the most: The savings from the reforms could be invested in-
    • Better water management, especially drip irrigation.
    • Infrastructure for agri-markets.
    • Solar trees: The investments could also be made in setting up the solar trees in the farm to harvest solar power on farmer’s fields with buyback agreements for surplus production.
Foreign Policy Watch: India-Pakistan

India-Pakistan TradePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Cross LoC trade


Tensions between India and Pakistan in 2019 have reduced the already low volumes of trade between the two countries to near zero.

India-Pakistan trade, in the beginning

  • In 1948-49, about 56% of Pakistan’s exports were to India, and 32% of its imports came from India.
  • From 1948-65, India and Pakistan used a number of land routes for bilateral trade; there were eight customs stations in Pakistan’s Punjab province and three customs checkpoints in Sindh.
  • India remained Pakistan’s largest trading partner until 1955-56. Between 1947 and 1965, the countries signed 14 bilateral agreements on trade, covering avoidance of double taxation, air services, and banking, etc.
  • In 1965, nine branches of six Indian banks were operating in Pakistan.

Close to vanishing

  • Following the terrorist attack on the CRPF convoy in Pulwama in February, India withdrew Most Favoured Nation (MFN) status for Pakistan and raised customs duty on Pakistani imports to 200% .
  • In April, India suspended cross-LoC trade to stop the misuse of this route by Pakistan-based elements.
  • Pakistan on its part closed its airspace to India for a prolonged period.
  • The decisions by both countries, while targeted at hurting the neighbour, have severely impacted the livelihoods of individuals and families involved in cross-border trading activities.
Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Pulse Polio ProgrammePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Polio and its vaccine

Mains level : Pulse Polio Programme


The beginning of this year’s Pulse Polio Programme was inaugurated from the Rashtrapati Bhavan itself.  To prevent the virus from coming to India, the government has since March 2014 made the Oral Polio Vaccination (OPV) mandatory for those travelling between India and polio-affected countries.

The Pulse Polio Programme

  • India launched the Pulse Polio immunisation programme in 1995, after a resolution for a global initiative of polio eradication was adopted by the World Health Assembly (WHA) in 1988.
  • Children in the age group of 0-5 years are administered polio drops during national and sub-national immunisation rounds (in high-risk areas) every year.

India is polio-free

  • According to the Ministry of Health, the last polio case in the country was reported from Howrah district of West Bengal in January 2011.
  • The WHO on February 24, 2012, removed India from the list of countries with active endemic wild polio virus transmission.
  • Two years later, the South-East Asia Region of the WHO, of which India is a part, was certified as polio-free.

Back2Basics

What is Polio?

  • The WHO defines polio or poliomyelitis as a highly infectious viral disease, which mainly affects young children.
  • The virus is transmitted by person-to-person, spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis.
  • Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent.
  • There is no cure for polio, it can only be prevented by immunization.
Oil and Gas Sector – HELP, Open Acreage Policy, etc.

Natural Gas Grid (NGG)Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Natural Gas Grid (NGG)

Mains level : Natural gas: Its uses and limitations


A study to facilitate the development of a National Gas Grid is to be undertaken soon by a U.S. entity. The Government has last year envisaged developing the NGG.

National Gas Grid

  • At present about 16,788 Km natural gas pipeline is operational and about 14,239 Km gas pipelines are being developed to increase the availability of natural gas across the country.
  • These pipelines have been authorized by Petroleum and Natural Gas Regulatory Board (PNGRB) and are at various stages of execution viz. Pre-Project activities/laying/testing/commissioning etc.

Aims and Objective

  • To remove regional imbalance within the country with regard to access of natural gas and provide clean and green fuel throughout the country.
  • To connect gas sources to major demand centres and ensure availability of gas to consumers in various sectors.
  • Development of City Gas Distribution Networks in various cities for supply of CNG and PNG.

NGG Technical Assistance Program

  • The India NGG Technical Assistance programme stems from an agreement in September between PNGRB and the US Trade Development Agency (USTDA).
  • The study will aim at developing an economic basis for building India’s Natural Gas Grid (NGG).

Utility of the study

  • It would provide an update on the gas demand analysis, including anchor consumers, industries, city gas distribution (CGD) and emerging demand centres such as CNG and LNG for road transport.
  • The study will take a fresh look at the gas supply analysis too. This includes review of LNG imports, domestic supply, potential transnational gas pipeline imports and virtual pipelines.
  • Share of natural gas in India’s energy basket is 6.2% as against 23.4% globally and is expected to increase.
Innovations in Biotechnology and Medical Sciences

IVF of White RhinosSpecies in News

Note4Students

From UPSC perspective, the following things are important :

Prelims level : In-vitro fertilization, White Rhinos

Mains level : Ethical issues surrounding IVF


Researchers had created another embryo — the third — of the nearly extinct northern white rhino. This is seen as a remarkable success in an ongoing global mission to keep the species from going extinct.

What is IVF?

  • IVF is a type of assisted reproductive technology used for infertility treatment and gestational surrogacy.
  • A fertilised egg may be implanted into a surrogate’s uterus, and the resulting child is genetically unrelated to the surrogate.
  • Some countries have banned or otherwise regulate the availability of IVF treatment, giving rise to fertility tourism.
  • Restrictions on the availability of IVF include costs and age, in order for a woman to carry a healthy pregnancy to term.
  • IVF is generally not used until less invasive or expensive options have failed or been determined unlikely to work.

IVF process

  • In vitro fertilisation (IVF) is a process of fertilization where an egg is combined with sperm outside the body, in vitro (“in glass”).
  • The process involves monitoring and stimulating a female ovulatory process, removing an ovum or ova (egg or eggs) from the female ovaries and letting sperm fertilise them in a liquid in a laboratory.
  • After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the same or another female uterus, with the intention of establishing a successful pregnancy.

Types of Rhinos

  • The northern white is one of the two subspecies of the white (or square-lipped) rhinoceros, which once roamed several African countries south of the Sahara.
  • The other subspecies, the southern white is, by contrast, the most numerous subspecies of rhino, and is found primarily in South Africa.
  • There is also the black (or hook-lipped) rhinoceros in Africa, which too, is fighting for survival, and at least three of whose subspecies are already extinct.
  • The Indian rhinoceros is different from its African cousins, most prominently in that it has only one horn.
  • There is also a Javan rhino, which too, has one horn, and a Sumatran rhino which, like the African rhinos, has two horns.
Civil Aviation Sector – CA Policy 2016, UDAN, Open Skies, etc.

Drone CensusPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Drone Census, Drone Categorization

Mains level : Regulation of drones in India


India’s first drone census has seen only 2,500 Ownership Acknowledgment Numbers (OANs) being issued by the Ministry of Civil Aviation (MoCA) since five days of beginning.

Drone Census

  • The MoCA had issued a notice providing a one-time opportunity for voluntary disclosure of all drones and operators starting from January 14.
  • The DGCA issued the Civil Aviation Requirements (CAR), Section 3 – Air Transport Series X, Part I, Issue I, dated August 27, 2018 regulates use of drones.
  • It provides the process for obtaining Unique Identification Number, Unmanned Aircraft Operator Permit (UAOP) and other operational requirements; there are drones that do not comply with the CAR.
  • If a drone is not enlisted by 5 p.m. on January 31, then it will most definitely be confiscated.
  • After January 31, only authorised retailers will be allowed to sell them after uploading buyers’ Know your Customer (KYC) and sale invoice, similar to the sale of mobile phones and cars.

Why such move?

  • The exercise will give the government a picture of who owns what kind of drone in which part of the country.
  • It will help in making policy decisions that should ideally become the base for understanding the scale of operations.
Wildlife Conservation Efforts

Irrawaddy DolphinsPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Irrawaddy Dolphins

Mains level : Not Much


146 Irrawaddy dolphins were recently sighted in Chilika Lake of Odisha. The lake has highest single lagoon population of the aquatic mammal in the world.

Irrawaddy Dolphins

  • IUCN Status: Endangered
  • Scientific Name: Orcaella brevirostris
  • Habitats: Lakes, Rivers, Estuaries, and Coasts

  • The Irrawaddy dolphin is a euryhaline species of oceanic dolphin found in discontinuous subpopulations near sea coasts and in estuaries and rivers in parts of the Bay of Bengal and Southeast Asia.
  • They are also found in coastal areas in South and Southeast Asia, and in three rivers: the Ayeyarwady (Myanmar), the Mahakam (Indonesian Borneo) and the Mekong.
  • The total population of these aquatic mammals in the world is estimated to be less than 7,500.
  • Of these, more than 6,000 Irrawaddy dolphins have been reported from Bangladesh, while the dolphin distribution in Chilika is considered to be the highest single lagoon population.
Indian Missile Program Updates

K-4 MissilePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : K-4 Missile, Circular Error Probability

Mains level : India's missile nuclear arsenal


India successfully test-fired the 3,500-km range submarine-launched ballistic missile, K-4. The test was carried out by the DRDO from a submerged pontoon off the Visakhapatnam coast around noon.

K-4

  • K-4 is a nuclear-capable Intermediate-range submarine-launched ballistic missile developed and tested successfully in the month of January 2020 by DRDO.
  • The missile has a maximum range of about 3500 km.
  • Once inducted, these missiles will be the mainstay of the Arihant class of indigenous ballistic missile nuclear submarines (SSBN).
  • It will give India the standoff capability to launch nuclear weapons submerged in Indian waters.

What’s so special about K-4?

: Circular Error Probability

  • India’s Circular Error Probability (CEP) is much more sophisticated than Chinese missiles.
  • The CEP determines the accuracy of a missile.
  • The lower the CEP, the more accurate the missile is.
  • There are very few countries which have managed to achieve this technological breakthrough.

About INS Arihant

  • The Advanced Technology Project (ATV) began in the 1980s and the first of them, Arihant, was launched in 2009.
  • INS Arihant, the first and only operational SSBN is armed with K-15 Sagarika missiles with a range of 750 km.
  • Given India’s position of ‘No-First-Use’ (NFU) in launching nuclear weapons, the SSBN is the most dependable platform for a second-strike.
  • Because they are powered by nuclear reactors, these submarines can stay underwater indefinitely without the adversary detecting it.
  • The other two platforms — land based and air launched are far easier to detect.