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

    India Hypertension Control Initiative (IHCI)

    | Governance | Mains Paper 2: Health & Education

    The IHCI project has demonstrated that blood pressure treatment and control are feasible in primary care settings in diverse health systems across various States in India.

    India Hypertension Control Initiative (IHCI)

    • It is a multi-partner initiative involving the Indian Council of Medical Research, WHO-India, Ministry of Health and Family Welfare, and State governments.
    • It aims to improve blood pressure control for people with hypertension.
    • The project initiated in 26 districts in 2018 has expanded to more than 100 districts by 2022.
    • More than two million patients were started on treatment and tracked to see whether they achieved BP control.

    The project was built on five scalable strategies:

    1. Simple treatment protocol with three drugs was selected in consultation with the experts and non-communicable disease programme managers.
    2. Supply chain was strengthened to ensure the availability of adequate antihypertensive drugs.
    3. Patient-centric approaches were followed, such as refills for at least 30 days and assigning the patients to the closest primary health centre or health wellness centre to make follow-up easier.
    4. The focus was on building capacity of all health staff and sharing tasks such as BP measurement, documentation, and follow-up.
    5. There was minimal documentation using either paper-based or digital tools to track follow-up and BP control.

    Prevalence of hypertension in India

    • Cardiovascular diseases (CVD) are the leading cause of death among adults in India.
    • One of the major drivers of heart attack and stroke is untreated high blood pressure or hypertension.
    • Hypertension is a silent killer as most patients do not have any symptoms.
    • India has more than 200 million people with hypertension, and only 14.5% of individuals with hypertension are on treatment.

    Success of IHCI

    • Blood pressure treatment and control were feasibly controlled in primary care settings in diverse health systems across various States in India.
    • Before IHCI, many patients travelled to higher-level facilities such as community health centres (block level) or district hospitals in the public sector for hypertension treatment.
    • Over three years, all levels of health staff at the primary health centres and health wellness centres were trained to provide treatment and follow-up services for hypertension.
    • Nearly half (47%) of the patients under care achieved blood pressure control.
    • The BP control among people enrolled in treatment was 48% at primary health centres and 55% at the health wellness centres.

    Contributing to its success: A data-driven approach

    • One of the unique contributions of the project was a data-driven approach to improving care and overall programme management.
    • The list of people who did not return for treatment was generated through a digital system or on paper by the nurse/health workers.
    • Patients were reminded either over the phone or by home visit (if feasible).
    • This strategy motivated a large number of patients to continue treatment.
    • In addition, programme managers reviewed aggregate data at the district and State levels to assess the performance of facilities in terms of follow-up and BP control.
    • Patients were provided generic antihypertensive drugs costing only ₹200 per year.
    • In addition, E-Sanjeevani, a telemedicine initiative, facilitated teleconsultations.

    Back2Basics: Hypertension

    • Hypertension also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
    • High blood pressure usually does not cause symptoms.
    • Long-term high blood pressure, however, is a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.
    • High blood pressure is classified as primary (essential) hypertension or secondary hypertension.
    • For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.

     

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  • Foreign Policy Watch: India-China

    Illegal fishing by China in the Indo-Pacific

    IOCR | International Relations | Mains Paper 2: Bilateral, Regional and Global Groupings and agreements involving India

    In order to check China’s illegal fishing in the Indo-Pacific region, the Quadrilateral Security Alliance (Quad) has planned to launch a satellite-based surveillance initiative.

    What is the news?

    • The leaders of Quad are reported to be getting ready to unveil a maritime surveillance initiative to protect exclusive economic zones in the Indo-Pacific against environmental damage.

    How will the proposed maritime surveillance system work?

    • The initiative will use satellite technology to connect existing surveillance centres in India, Singapore and the Pacific.
    • This will help establish a tracking system to combat illegal, unregulated and unprotected (IUU) fishing.
    • The satellite-enabled dragnet will track IUU fishing activities from the Indian Ocean and South-east Asia to the South Pacific.
    • The idea is to monitor illicit fishing vessels that have their AIS (automatic identification system) transponders turned off to evade tracking.
    • The move by the Quad security group is also seen to be aimed at reducing the small Pacific island nations’ growing reliance on China.

    Why is illegal fishing seen as such a big threat?

    • The unregulated plunder of global fishing stock poses a grave threat to the livelihood and food security of millions of people.
    • Globally, fish provide about 3.3 billion people with 20% of their average animal protein intake.
    • According to an FAO report, around 60 million people are engaged in the sector of fisheries and aquaculture.
    • While the economic loss from illegal fishing has been difficult to precisely quantify, some estimates peg it around USD 20 billion annually.

    Threats posed by IUU Fishing

    • Illegal fishing has now replaced piracy as a global maritime threat.
    • In the Indo-Pacific region, like elsewhere, the collapse of fisheries can destabilise coastal nations.
    • It poses a much bigger security risk, as it can fuel human trafficking, drug crime and terror recruiting.

    Why is China in the dock?

    • The 2021 IUU Fishing Index, which maps 152 coastal countries, ranked China as the worst offender.
    • China is considered responsible for 80% to 95% illegal fishing in the region after having overfished its own waters.
    • It, in fact, is known to incentivise illegal fishing with generous subsidies to meet its growing domestic demand.

    China and distant-water fishing (DWF)

    • China’s DWF fleet has almost 17,000 vessels and is the largest in the world.
    • Vessel ownership is highly fragmented among many small companies and the fleet includes vessels registered in other jurisdictions.

    Issues with Chinese IUU Fishing

    • Chinese are often accused of pillaging ocean wealth with great sophistication and with little regard for maritime boundaries.
    • China also uses them to project strategic influence and to bully fishing vessels from weaker nations.
    • China uses destructive practises such as bottom trawling and forced, bonded and slave labour and trafficked crew, alongside the widespread abuse of migrant crewmembers.

     

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  • Minimum Support Prices for Agricultural Produce

    What is ‘Storage Gain’ in Wheat?

    Prelims Only | Agriculture | Mains Paper 3: Transport & Marketing Of Agricultural Produce

    Punjab’s state procurement agencies (SPAs) are seeking a waiver of ‘storage gain’.

    What is ‘storage gain’ in wheat?

    • Wheat, considered a ‘living grain’, tends to gain some weight during storage.
    • This is known as ‘storage gain’ and it mostly happens due to absorption of moisture.
    • There are three parts of the grain — bran (outer layer rich in fibre), germ (inner layer rich in nutrients) and endosperm (bulk of the kernel which contains minerals and vitamins).
    • The moisture is mostly absorbed by the endosperm.

    Who compensates whom for ‘storage gain’?

    • State procurement agencies, which purchase and store wheat at their facilities, are required to give one kg wheat extra per quintal to the Food Corporation of India (FCI).
    • While 20% of wheat, procured by the FCI and the SPAs, is moved immediately after procurement.
    • It is usually on the remaining 80%, which is moved out after July 1 every year that storage gain has to be accounted for due to longer storage duration.

     

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  • As Indian economy grows, Centre and states must work together

    op-ed snap | Polity | Mains Paper 2: Federalism

    Context

    The ongoing discords between the Centre and states over issues ranging from the allocation of financial resources to fixing of GST rates has once again brought to the fore issues pertaining to our federal structure, the resolution of which is essential for the country’s growth.

    Combination of cooperative and competitive spirit

    • Positive competition: It is undeniable that cooperation is key to the smooth functioning of federal design.
    • However, if it is coupled with positive competition among the states, then the overall result would be large-scale economic development across the country.
    • The competitive aspect of federalism can positively be harnessed by encouraging states to adopt each other’s best practices.
    • Exclusivity and mutualism: Indian federalism today enables the Centre and states to function with both exclusivity and mutualism.
    • Vertical and horizontal level: Cooperation between the Centre and states is required at both vertical (between Centre and states) and horizontal (among states) levels and on various fronts.
    • What does it mean? This includes fine-tuning of developmental measures for desired outcomes, development-related policy decisions, welfare measures, administrative reforms, strategic decisions, etc.

    Steps in the direction of cooperation

    • Recent efforts in this direction, such as according greater leeway to states in the functioning of the NITI Aayog, frequent meetings of the prime minister with chief ministers as well as with chief secretaries and district magistrates, periodic meetings of the President of India with governors, and the functioning of “PRAGATI” to review the progress of developmental efforts have generated the requisite synergy between the Centre and states.
    • Positive efforts of states towards attracting investment can create a conducive environment for economic activities in urban and backward regions alike.
    • Healthy competition coupled with a transparent ranking system would ensure the full materialisation of the vast but least utilised potential of the federal framework.
    • Sector specific indices: In this direction, NITI Aayog’s initiatives such as launching sector-specific indices like the School Education Quality Index, Sustainable Development Goals Index, State Health Index, India Innovation Index, Composite Water Management Index, Export Competitiveness Index, etc. could prove to be a great contribution.
    • Central efforts toward synchronisation of cooperation and competition can be observed in the implementation of the 14th and 15th Finance Commission reports, which have greatly contributed to resource devolution.
    • Recent reform measures in the form of the New Labour Code and other amendments/enactments by the legislature also exhibit this trend.

    Conclusion

    The rising stature of the Indian economy on the world stage can only be strengthened by a tailored approach to cooperation and competition. The mandate to marry the two would inevitably be the collective responsibility of the Centre and the states. Any ideological differences between them will have to be inevitably put on the backburner for the great Indian federal structure to succeed and prosper.

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  • Panchayati Raj Institutions: Issues and Challenges

    Structural interventions by state governments that can create higher-wage jobs

    op-ed snap | Governance | Mains Paper 2: Governance, Transparency & Accountability, Citizens Charters

    Context

    The recent decision to deduct off-budget borrowings from state borrowing limits reminds chief ministers to be good policy ancestors.

    Financing welfare state

    • In A Brief History of Equality, economist Thomas Piketty suggests that “the world of the early 2020s, no matter how unjust it may seem, is more egalitarian than that of 1950 or 1900, which were… more egalitarian than those of 1850 or 1780”.
    • But how the welfare state is financed matters.
    • Changes in state borrowing limits: Adjusting state borrowing limits for their off-budget borrowings leads to transparency because they are routinely breached through vehicles for schemes whose bill comes due far in the future.
    • The confiscation of future spending — interest payments crowd out expenditure and revenue expenditure crowd out capex — matters because our prosperity problem is productivity, wages, not jobs.

    5 Structural interventions that can create high wage jobs

    1] Reduce regulatory hurdles

    • States control 80 per cent of India’s employers’ compliance ecosystem of 67,000+ compliances, 6,500+ filings and 26,000+ criminal provisions.
    • State governments that rationalise, decriminalise, and digitise their compliance ecosystem will reap lower corruption and higher formality.

    2] Fix government schools

    • The most powerful tool for social mobility and employability is free and quality school education.
    • State governments that undertake a significant overhaul of school performance management (the fear of falling and hope of rising for teachers) and governance (the allocation of decision rights around resources and hiring) will create an unfair advantage in human capital.

    3] Converge education and employability

    • States should set up skill universities that create qualification modularity (between certificates, diplomas, advanced diplomas, and degrees), delivery flexibility (equate online, apprenticeships, on-site and on-campus classrooms), and pray to the one god of employers.
    • Degree apprentices innovate at the intersection of employment, employability and education.
    • State governments that remove barriers in their path will see their population of employed learners exceed full-time learners.

    4] Devolution of money and power

    • Cities drive productive job creation — New York City’s GDP is higher than Russia’s.
    •  It took 70 years after 1947 for the budget of 28 states to cross the central government’s budget.
    • The combined budget of state governments now exceeds Rs 45 lakh crore, but 2.5 lakh municipalities and panchayats have a budget of only Rs 3.7 lakh crore.
    • Governments that devolve money and power from state capitals to their towns will avoid the curse of megacities and create the competition that drove China’s growth (they have 375 cities with more than a million people versus our 52).

    5] Civil service reforms

    • State governments must sell their 1,500+ loss-making public sector units, cut civil service compensation to less than 40 per cent of budget spending, and replace expenditure with capex.
    • Moving from outlays to outcomes needs a new human capital regime for civil servants via seven interventions; structure, staffing, training, performance management, compensation, culture, and HR capabilities.

    Shifting resources to protective and productive  version of states

    • Nobel Laureate James Buchanan said any state had three versions — the protective state (police, rule of law, defence, courts), the productive state (common goods like roads, power, health, education, etc.), and the redistributive state.
    • Too many state governments accept the status quo in the first two and “innovate” in the third version.
    • It’s time to shift resources to the first two.

    Conclusion

    Chief Ministers ought to create high wage jobs, and not borrow money future generations will have to repay.

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  • Cyber Security – CERTs, Policy, etc

    SC tests phones for Pegasus Spyware

    | Security Issues | Mains Paper 3: Cyber Security

    The Supreme Court has said its technical committee had so far received and tested 29 mobile devices suspected to be infected by Pegasus malware.

    Why in news?

    • It was alleged that the government used the Israel-based spyware to snoop on journalists, parliamentarians, prominent citizens and even court staff.

    What is Pegasus?

    • Pegasus is a spyware developed by NSO Group, an Israeli surveillance firm that helps spies hack into phones.
    • In 2019, when WhatsApp sued the firm in a U.S. court, the matter came to light.
    • In July 2021, Amnesty International, along with 13 media outlets across the globe released a report on how the spyware was used to snoop hundreds of individuals, including Indians.
    • While the NSO claims its spyware is sold only to governments, none of the nations have come forward to accept the claims.

    Threats created by Pegasus

    • What makes Pegasus really dangerous is that it spares no aspect of a person’s identity.
    • It makes older techniques of spying seem relatively harmless.
    • It can intercept every call and SMS, read every email and monitor each messaging app.
    • Pegasus can also control the phone’s camera and microphone and has access to the device’s location data.
    • The app advertises that it can carry out “file retrieval”, which means it could access any document that a target might have stored on their phone.

    Dysfunctions created

    • Privacy breach: The very existence of a surveillance system, whether under a provision of law or without it, impacts the right to privacy under Article 21 and the exercise of free speech under Article 19.
    • Curbing Dissent: It reflects a disturbing trend with regard to the use of hacking software against dissidents and adversaries. In 2019 also, Pegasus software was used to hack into HR & Dalit activists.
    • Individual safety: In the absence of privacy, the safety of journalists, especially those whose work criticizes the government, and the personal safety of their sources is jeopardised.
    • Self-Censorship: Consistent fear over espionage may grapple individuals. This may impact their ability to express, receive and discuss such ideas.
    • State-sponsored mass surveillance: The spyware coupled with AI can manipulate digital content in users’ smartphones. This in turn can polarize their opinion by the distant controllers.
    • National security: The potential misuse or proliferation has the same, if not more, ramifications as advanced nuclear technology falling into the wrong hands.

    Snooping in India:  A Legality check

    For Pegasus-like spyware to be used lawfully, the government would have to invoke both the IT Act and the Telegraph Act. Communication surveillance in India takes place primarily under two laws:

    1. Telegraph Act, 1885: It deals with interception of calls.
    2. Information Technology Act, 2000: It was enacted to deal with surveillance of all electronic communication, following the Supreme Court’s intervention in 1996.

    Cyber security safeguards in India

    • National Cyber Security Policy: The policy was developed in 2013 to build secure and resilient cyberspace for India’s citizens and businesses.
    • Indian Computer Emergency Response Team (CERT-In): The CERT-In is responsible for incident responses including analysis, forecasts, and alerts on cybersecurity issues and breaches.
    • Indian Cyber Crime Coordination Centre (I4C): The Central Government has rolled out a scheme for the establishment of the I4C to handle issues related to cybercrime in the country in a comprehensive and coordinated manner.
    • Budapest Convention: There also exists Budapest Convention on Cybercrime. However, India is not a signatory to this convention.

    Issues over government involvement

    • It is worth asking why the government would need to hack phones and install spyware when existing laws already offer impunity for surveillance.
    • In the absence of parliamentary or judicial oversight, electronic surveillance gives the executive the power to influence both the subject of surveillance and all classes of individuals, resulting in a chilling effect on free speech.

    Way forward

    • The security of a device becomes one of the fundamental bedrock of maintaining user trust as society becomes more and more digitized.
    • Constituting an independent high-level inquiry with credible members and experts that can restore confidence and conduct its proceedings transparently.
    • The need for judicial oversight over surveillance systems in general, and judicial investigation into the Pegasus hacking, in particular, is very essential.

    Conclusion

    • We must recognize that national security starts with securing the smartphones of every single Indian by embracing technologies such as encryption rather than deploying spyware.
    • This is a core part of our fundamental right to privacy.
    • This intrusion by spyware is not merely an infringement of the rights of the citizens of the country but also a worrying development for India’s national security apparatus.

     

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  • Indian Army Updates

    Project WARDEC: India’s upcoming AI-powered Wargame Centre

    Prelims Only | Security Issues | Mains Paper 3: Various Security Forces, Agencies & Their Mandates

    The Army Training Command signed a memorandum of understanding (MoU) with Gandhinagar-based Rashtriya Raksha University (RRU) to develop a ‘Wargame Research and Development Centre (WARDEC)’ in New Delhi.

    What is Project WARDEC?

    • The project ‘WARDEC’ will be a first-of-its-kind simulation-based training centre in India that will use artificial intelligence (AI) to design virtual reality war-games.
    • The Wargame Research and Development Centre will be used by the Army to train its soldiers and test their strategies through “metaverse-enabled gameplay”.
    • The wargame models will be designed to prepare for wars as well as counter-terror and counter-insurgency operations.

    Where will the centre come up and when?

    • The centre will come up in a military zone in New Delhi, confirmed RRU officials privy to the development.
    • The RRU will join hands with Tech Mahindra to develop the centre in the coming three to four months.
    • The RRU, an institute under the Ministry of Home Affairs (MHA), specialises in national security and policing.
    • Located in Gandhinagar’s Lavad village, it is an “institute of national importance” – a status granted to it by an Act of Parliament.

    How will these simulation exercises play out?

    • Soldiers will test their skills in the metaverse where their surroundings will be simulated using a combination of virtual reality (VR) and augmented reality (AR).
    • In metaverse, the players will get a realistic experience of the actual situation.
    • If a weapon weighing 5 kg drops or the air pressure falls, they will feel it like anyone would in a live situation, real-time.
    • The game would play out player versus player, player versus computer or even computer versus computer.

    How will the centre help the Army?

    • The Army intends to use the war-game centre to train its officers in military strategies.
    • Indian Army will provide data to set the backdrop of the gameplay, so that participants get a realistic experience.
    • In Army, it is often said that the enemy can ambush you from 361 directions, where 360 sides are around the soldier, and one is above in case there is an airdrop.
    • So, wargame simulation helps the Army think of all possible scenarios.

    What promise does AI-based wargame simulation hold?

    • Apart from the armed forces, the BSF, CRPF, CISF, ITBP and SSB can also use the metaverse-enabled simulation exercises for better training.
    • The use of AI can provide a totally immersive training experience as it can simulate a battlefield close to reality and map several eventualities in the probable event of a war.

    How many countries use such wargaming drills?

    • Since the 9/11 attacks, use of information technology-enabled wargaming is preferred by several countries like the US, Israel, the UK to prepare for possibilities in case of terror attacks or war.
    • In March 2014, several world leaders, including former German chancellor Angela Merkel, former US president Barack Obama and Chinese president Xi Jinping had played a war simulation game.
    • It was during the Hague Summit about how to react in case of a nuclear attack.
    • In that case, the target of the nuclear attack was a fictional country named Brinia.

     

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  • The constitutional battle between governor and government

    op-ed snap | Polity | Mains Paper 2: Executive & Judiciary

    Context

    The Supreme Court’s action in ordering the release of A G Perarivalan, a convict in the Rajiv Gandhi assassination case, has resulted in mixed reactions.

    Background

    • After the assassination of Rajiv Gandhi, the assailants were tried under the notorious Terrorist and Disruptive Activities (Prevention) Act, 1987 (TADA).
    • All 26 accused were given the death sentence by the Special Court for various offences, including under TADA (1998).
    • Fortunately, the SC held that the offences under TADA were not made out since there was no case to proceed for acts of terrorism.
    • It also modified the death penalty for 22 persons and confirmed the same only for Nalini, Perarivalan, Murugan and Santhan (1999).
    • Petition for mercy under Article 161: They petitioned the governor of Tamil Nadu for mercy under Article 161.
    • The then governor of Tamil Nadu dismissed their petition without any advice from the cabinet.
    • The Madras High Court ruled that the governor cannot exercise the power of pardon without the advice of the council of ministers.
    • The cabinet advised the governor to give reprieve only to Nalini Sriharan and rejected the case of the other three, including Perarivalan.
    • Perarivalan and the two other convicts appealed to the president with a mercy plea under Article 72. 
    •  Two successive presidents of India – K R Narayanan and APJ Abdul Kalam — did not pass any mercy orders.
    • But all of a sudden, their mercy pleas were rejected after a delay of 11 years by President Pratibha Patil.
    • When they were about to be executed, the convicts moved the Madras HC challenging the execution of the death warrant issued against them.
    • The cases were transferred to the SC, which decided that the president’s action in not considering the mercy plea within a reasonable time was improper and since the three prisoners had been on death row for 11 years, it was a fit case for commuting their sentence to life imprisonment.
    • Meanwhile, on February 19, 2014, the TN cabinet advised the governor to grant reprieve to all seven accused.
    • Once again, all of them applied for remission from the governor.
    • The state cabinet also advised the governor to grant pardon.
    • WhenPerarivalan’s mother, filed a case for parole, the court noting the inordinate delay observed: “the Governor of T N, a constitutional authority, cannot sit on the state’s recommendation on the release of all seven life convicts in the Rajiv Gandhi assassination case for so long” (July 2020).
    • The court was informed that the governor was awaiting the final report of the CBI’s Multi-Disciplinary Monitoring Agency (MDMA).

    Role of MDMA

    • The role of MDMA itself came up for criticism by the SC in January 2018 and it observed that the agency did not appear to have made “much headway”.
    • The court observed that the question of reopening the case against them will not arise as they had been already convicted for murder and conspiracy.
    • Article 20(2) of the Constitution guarantees that no person can be prosecuted and punished for the same offence more than once.

    Use of powers under Article 142 by the Supreme Court

    • Once again, the process of granting mercy to the seven accused began with a resolution passed by the T N Assembly on September 9, 2018.
    • On the same day, the state cabinet advised the governor to give reprieve to all seven prisoners.
    • On being compelled by the court, the governor stated that the matter was to be dealt with by the President.
    • It was at this stage the matter went back to the SC.
    • It was finally decided that the authority to grant pardon is with the governor and he is bound by the advice of the state government.
    • The court also ruled that the action of the governor in delaying the matter for more than 2.5 years was unacceptable.
    • Exercising its power under Article 142 as well as considering all the relevant circumstances, the SC ordered Perarivalan’s release.

    Limitations on governor’s power

    • Giving reprieve to persons sentenced to the death penalty, even in the exercise of the plenary powers by a governor, has limitations.
    • In 1978, Parliament amended the Criminal Procedure Code and introduced Sec 433A by which in such cases, prisoners cannot be released from prison unless they had served a minimum of 14 years in prison. 

    Reformatory penal system of India

    • India’s penal system is undoubtedly reformatory and not retributive.
    • The SC ruled on this issue by stating “a barbaric crime does not have to be visited with a barbaric penalty.”
    • It is also surprising that the successive governments at the Centre appeared to be guided in this case by geopolitical considerations rather than this country’s laws.

    Conclusion

    The question now is whether the six other prisoners will receive the same relief or will there be a confrontation between the state government and governor once again. Let us hope that wisdom prevails and the governor’s office is not manipulated for narrow political considerations.

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

    Bridging the health policy to execution chasm

    op-ed snap | Governance | Mains Paper 2: Health & Education

    Context

    In April this year, the Union government released a guidance document on the setting up of a ‘public health and management cadre’ (PHMC) as well as revised editions of the Indian Public Health Standards (IPHS) — for ensuring quality health care in government facilities.

    Background

    • The need for a public health cadre and services in India rarely got any policy attention.
    • Limited understanding: The reason was that even among policymakers, there was limited understanding on the roles and the functions of public health specialists and the relevance of such cadres, especially at the district and sub-district levels.
    • However, the last decade and a half was eventful.
    • The initial threat of avian flu in 2005-06, the Swine flu pandemic of 2009-10; five more public health emergencies of international concern between years 2009-19; the increasing risks and regular emergence and re-emergence of of new viruses and diseases (Zika, Ebola, Crimean-Congo Hemorrhagic fever, Nipah viruses, etc.) in animals and humans, resulted in increased attention on public health.
    • National Public health Act: In 2017, India’s National Health Policy 2017 proposed the formation of a public health cadre and enacting a National Public Health Act.
    • The COVID-19 pandemic changed the status quo.
    • In the absence of trained public health professionals at the policy and decision making levels, India’s pandemic response ended up becoming bureaucrat steered and clinician led.

    Different cadres and its implications

    • Lack of career progression opportunities: At present, most Indian States (with exceptions such as Tamil Nadu and Odisha) have a teaching cadre (of medical college faculty members) and a specialist cadre of doctors involved in clinical services.
    • This structure does not provide similar career progression opportunities for professionals trained in public health.
    • Limited interest: It is one of the reasons for limited interest by health-care professionals to opt for public health as a career choice.
    • The outcome has been costly for society: a perennial shortage of trained public health workforce.

    Public health cadre

    • The proposed public health cadre and the health management cadre have the potential to address some of these challenges.
    • With the release of guidance documents, the States have been advised to formulate an action plan, identify the cadre strengths, and fill up the vacant posts in the next six months to a year.
    • A public health workforce has a role even beyond epidemics and pandemics.
    • A trained public health workforce ensures that people receive holistic health care, of preventive and promotive services (largely in the domain of public health) as well as curative and diagnostic services (as part of medical care).

    Revised version of IPHS and significance

    • This is the second revision in the IPHS, which were first released in 2007 and then revised in 2012.
    • The regular need for a revision in the IPHS is a recognition of the fact that to be meaningful, quality improvement has to be an ongoing process.
    • The development of the IPHS itself was a major step.
    • The revised IPHS is an important development but not an end itself.
    • In the 15 years since the first release of the IPHS, only a small proportion — around 15% to 20% — of government health-care facilities meets these standards. .
    • If the pace of achieving IPHS is any criteria, there is a need for more accelerated interventions.
    • Opportunities such as a revision of the IPHS should also be used for an independent assessment on how the IPHS has improved the quality of health services.

    Implementation challenges

    • The effective part of implementation is interplay: policy formulation, financial allocation, and the availability of a trained workforce.
    • In this case, policy has been formulated.
    • Financial allocations: Then, though the Government’s spending on health in India is low and has increased only marginally in the last two decades; however, in the last two years, there have been a few additional — small but assured — sources of funding for public health services have become available.
    • The Fifteenth Finance Commission grant for the five-year period of 2021- 26 and the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) allocations are available for strengthening public health services and could be used  as States embark upon implementing the PHMC and a revised IPHS.
    • Availability of trained workforce: The third aspect of effective implementation, the availability of trained workforce, is the most critical.
    • As States develop plans for setting up the PHMC, all potential challenges in securing a trained workforce should be identified and actions initiated.

    Conclusion

    The public health and management cadres and the revised IPHS can help India to make progress towards the NHP goal. To ensure that, State governments need to act urgently and immediately.

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    Back2Basics: Indian Public Health Standards (IPHS)

    • IPHS are a set of uniform standards envisaged to improve the quality of health care delivery in the country.
    • The IPHS documents have been revised keeping in view the changing protocols of the existing programmes and introduction of new programmes especially for Non-Communicable Diseases.
    • Flexibility is allowed to suit the diverse needs of the States and regions.
    • These IPHS guidelines will act as the main driver for continuous improvement in quality and serve as the bench mark for assessing the functional status of health facilities.

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  • Goods and Services Tax (GST)

    States have equal powers to make GST-related Laws: SC

    SC Judgements | Economics | Mains Paper 3: Indian Economy

    The Supreme Court has held that Union and State legislatures have equal, simultaneous and unique powers to make laws on Goods and Services Tax (GST) and the recommendations of the GST Council are not binding on them.

    What is the case?

    • The apex court’s decision came while confirming a Gujarat High Court ruling that the Centre cannot levy Integrated Goods and Services Tax (IGST) on ocean freight from Indian importers.

    Key takeaways of the Judgment

    • The recommendations of the GST Council are the product of a collaborative dialogue involving the Union and the States.
    • They are recommendatory in nature. They only have a persuasive value.
    • To regard them as binding would disrupt fiscal federalism when both the Union and the States are conferred equal power to legislate on GST.

    Basis of the Judgment

    • The court emphasised that Article 246A of the Constitution gives the States power to make laws with respect to GST.
    • It treats the Union and the States as “equal units”.
    • It confers a simultaneous power (on Union and States) for enacting laws on GST.
    • Article 279A, in constituting the GST Council, envisions that neither the Centre nor the States are actually dependent on the other.

    What are the articles added/modified to the Constitution by the GST Act?

    (1) Article 246A: Special Provision for GST

    • This Article was newly inserted to give power to the Parliament and the respective State/Union Legislatures to make laws on GST respectively imposed by each of them.
    • However, the Parliament of India is given the exclusive power to make laws with respect to inter-state supplies.
    • The IGST Act deals with inter-state supplies. Thus, the power to make laws under the IGST Act will rest exclusively with the Parliament.
    • Further, the article excludes the following products from the scope of GST until a date recommended by the GST Council:
    1. Petroleum Crude
    2. High-Speed Diesel
    3. Motor Spirit
    4. Natural Gas
    5. Aviation Turbine Fuel

    (2) Article 269A: Levy and Collection of GST for Inter-State Supply

    • While Article 246A gives the Parliament the exclusive power to make laws with respect to inter-state supplies.
    • The manner of distribution of revenue from such supplies between the Centre and the State is covered in Article 269A.
    • It allows the GST Council to frame rules in this regard. Import of goods or services will also be called as inter-state supplies.
    • This gives the Central Government the power to levy IGST on import transactions.
    • Import of goods was subject to Countervailing Duty (CVD) in the earlier scheme of taxation.
    • IGST levy helps a taxpayer to avail the credit of IGST paid on import along the supply chain, which was not possible before.

    (3) Article 279A: GST Council

    • This Article gives power to the President to constitute a joint forum of the Centre and States called the GST Council.
    • The GST Council is an apex member committee to modify, reconcile or to procure any law or regulation based on the context of GST in India.

    (4) Article 286: Restrictions on Tax Imposition

    • This was an existing article which restricted states from passing any law that allowed them to collect tax on sale or purchase of goods either outside the state or in the case of import transactions.
    • It was further amended to restrict the passing of any laws in case of services too.
    • Further, the term ‘supply’ replaces ‘sale or purchase’.

    (5) Article 366: Addition of Important definitions

    Article 366 was an existing article amended to include the following definitions:

    1. GST means the tax on supply of goods, services or both. It is important to note that the supply of alcoholic liquor for human consumption is excluded from the purview of GST.
    2. Services refer to anything other than goods.
    3. State includes Union Territory with legislature.

    Back2Basics: GST Council

    • The GST Council is a federal body that aims to bring together states and the Centre on a common platform for the nationwide rollout of the indirect tax reform.
    • It is an apex member committee to modify, reconcile or to procure any law or regulation based on the context of goods and services tax in India.
    • The GST Council dictates tax rate, tax exemption, the due date of forms, tax laws, and tax deadlines, keeping in mind special rates and provisions for some states.
    • The predominant responsibility of the GST Council is to ensure to have one uniform tax rate for goods and services across the nation.

    How is the GST Council structured?

    • The GST is governed by the GST Council. Article 279 (1) of the amended Indian Constitution states that the GST Council has to be constituted by the President within 60 days of the commencement of the Article 279A.
    • According to the article, the GST Council will be a joint forum for the Centre and the States. It consists of the following members:
    1. The Union Finance Minister will be the Chairperson
    2. As a member, the Union Minister of State will be in charge of Revenue of Finance
    3. The Minister in charge of finance or taxation or any other Minister nominated by each State government, as members.

    Terms of reference

    • Article 279A (4) specifies that the Council will make recommendations to the Union and the States on the important issues related to GST, such as the goods and services will be subject or exempted from the Goods and Services Tax.
    • They lay down GST laws, principles that govern the following:
    1. Place of Supply
    2. Threshold limits
    3. GST rates on goods and services
    4. Special rates for raising additional resources during a natural calamity or disaster
    5. Special GST rates for certain States

     

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