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Subject: Governance

Important aspects of Society

  • Poverty and its measurement

    US President recently praised India for having lifted “over 270 million people out of poverty” in “a single decade”, and said that “12 Indian citizens are lifted out of extreme poverty every single minute of every single day”.

    What is poverty?

    • Poverty can be defined as a condition in which an individual or household lacks the financial resources to afford a basic minimum standard of living.
    • Economists and policymakers estimate “absolute” poverty as the shortfall in consumption expenditure from a threshold called the “poverty line”.
    • The “depth” of poverty indicates how far the poor are below the poverty line.

    Defining the poverty line

    • The official poverty line is the expenditure incurred to obtain the goods in a “poverty line basket” (PLB).
    • Poverty can be measured in terms of the number of people living below this line (with the incidence of poverty expressed as the head count ratio).

    Committees for poverty estimates

    • Six official committees have so far estimated the number of people living in poverty in India — the working group of 1962; V N Dandekar and N Rath in 1971; Y K Alagh in 1979; D T Lakdawala in 1993; Suresh Tendulkar in 2009; and C Rangarajan in 2014.
    • The government did not take a call on the report of the Rangarajan Committee; therefore, poverty is measured using the Tendulkar poverty line.
    • As per this, 21.9% of people in India live below the poverty line.

    Poverty Line Basket (PLB)

    • The PLB comprises goods and services considered essential to a basic minimum standard of living — food, clothing, rent, conveyance, and entertainment.
    • The price of the food component can be estimated using calorie norms or nutrition targets.
    • Until the 1990s, the calorie norms method was used — it was based on the minimum number of calories recommended by the Indian Council of Medical Research (ICMR) for a household of five members.
    • However, this method does not consider the different food groups that are essential for health — this is why the Tendulkar Committee targeted nutritional outcomes.
    • The Lakdawala Committee assumed that health and education is provided by the state — therefore, expenditure on these items was excluded from the consumption basket it proposed.
    • Since expenditure on health and education rose significantly in the 1990s, the Tendulkar Committee included them in the basket.
    • As a result of revisions to the basket and other changes in the method of estimation, the percentage of people living below the poverty line in 1993-94 rose from 35.97% to 45.3%.

    Issues with PLB

    • The PLB has been the subject of much debate. The 1962 group did not consider age and gender-specific calorie requirements.
    • Expenditure on health and education were not considered until the Tendulkar Committee — which was criticized for setting the poverty line at just Rs 32 per capita per day in urban India (and at Rs 27 in rural India).
    • And the Rangarajan Commission was criticized for selecting the food component arbitrarily — the emphasis on food as a source of nutrition overlooks the contribution of sanitation, healthcare, access to clean water, and prevalence of pollutants.

    Why are poverty numbers important?

    • Poverty numbers matter because central welfare schemes like Antyodaya Anna and Rashtriya Swasthya Bima Yojana use the definition of poverty given by the NITI Aayog or the erstwhile Planning Commission.
    • The Centre allocates funds for these schemes to states based on the numbers of their poor.
    • Errors of exclusion can deprive eligible households of benefits.

    Alternate measures of poverty: The MPI

    • In 2011, Oxford University researchers Sabina Alkire and James Foster devised the multidimensional poverty index (MPI) to capture poverty using 10 indicators.
    • These indicators include nutrition, child mortality, years of schooling, school attendance, ownership of assets, and access to proper house, electricity, drinking water, sanitation, and clean cooking fuel.
    • Poverty is measured in terms of deprivation in at least a third of these indicators.
    • The MPI is a more comprehensive measure of poverty because it includes components that capture the standard of living more effectively.
    • However, uses “outcomes” rather than expenditure — the presence of an undernourished person in the household will result in it being classified as “poor”, regardless of the expenditure on nutritious food.

    MPI measures of India

    • In 2015-16, 369.546 million (nearly 37 crore) Indians were estimated to meet the deprivation cut-off for three or more of the 10 indicators.
    • While the overall headcount multidimensional poverty ratio in 2015-16 was 27.9%, the number was 36.8% for rural and 9.2% for urban India.
    • There were wide variations across states — poverty was the highest for Bihar (52.5%), followed by Jharkhand (46.5%), Madhya Pradesh (41.1%), and Uttar Pradesh (40.8%).
    • It was the lowest for Kerala (1.1%), Delhi (4.2%), Punjab (6.1%), Tamil Nadu (7.3%) and Himachal Pradesh (8.1%).

    So what is the current “level” of poverty in India?

    • The National Statistical Office (NSO) Report on Household Consumer Expenditure for 2017-18 was junked in 2019 — so there are no data to update India’s poverty figures.
    • Even the MPI report published by Oxford Poverty and Human Development Initiative used data from the fourth round of the National Family Health Survey, figures for which are available only until 2015-16.
    • Social scientists used data from a leaked version of the consumer expenditure data to conclude that the incidence of poverty in India increased from 31.15% to 35.1% between 2011-12 and 2017-18.
    • The absolute number of poor people also increased from 270 million to 322.22 million over the same period, which translates to 52 million more poor people in six years.

  • The issues around data localisation

    Context

    The contentious clauses on local data storage in the revised Personal Data Protection Bill need re-examination.

    What Personal Data Protection Bill contains?

    • Greater control to an individual: The draft law is a comprehensive piece of legislation that seeks to give individuals greater control over how their personal data is collected, stored and used.
    • The promise of improvement over the current privacy law: Once passed, the law promises a huge improvement on current Indian privacy law, which is both inadequate and improperly enforced.
    • Criticism of the bill: The proposed bill has attracted criticism on various grounds such as-
      • The exceptions created for the state.
      • The limited checks imposed on state surveillance, and-
      • Regarding various deficiencies in the structures and processes of the proposed Data Protection Authority.

    The issue over the “data localisation”

    • Data within the country: The phrase, which can refer to any restrictions on cross-border transfer of data, has largely come to refer to the need to physically locate data within the country.
    • Provisions for the transfer of personal data outside India: The PDP Bill enables the transfer of personal data outside India, with the sub-category of sensitive personal data have to be mirrored in the country (e. a copy will have to be kept in the country).
      • Ban on transfer of critical data outside the country: Data processing/collecting entities will, however, be barred from transferring critical personal data (a category that the government can notify at a subsequent stage) outside the country.
      • Different from Justice Srikrishna committee report: These above provisions have been changed from the earlier version of the draft Bill, released by the Justice Srikrishna Committee in 2018. 
      • The 2018 draft imposed more stringent measures that required both personal and sensitive personal data to be mirrored in the country (subject to different conditions).
      • Welcome move: The move to liberalise the provisions in the 2019 version of the Bill is undoubtedly welcome, particularly for businesses and users.

    How removing the restriction matters?

    • Reduction in cost to business: Liberalised requirements will limit costs to business and ensure users have greater flexibility in choosing where to store their data.
    • More proportionate approach: The changes in the 2019 draft reflect a more proportionate approach to the issue as they implement a tiered system for cross-border data transfer, ostensibly based on the sensitivity/vulnerability of the data.
    • Move-in accordance with the right to privacy: This seems in accord with the Supreme Court’s dicta in the 2017 Puttaswamy case.
    • Conditions for interference in privacy: The Court had made it clear that interference in the fundamental right to privacy would only be permissible if inter alia deemed necessary and proportionate.

    Test of proportionality in the bill

    • On closer examination, it appears that even the revised law may not actually stand the test of proportionality.
    • The three-argument for imposing norms: There are broadly three sets of arguments advanced in favour of imposing stringent data localisation norms:
      • Sovereignty and government functions. Referring to the need to recognise Indian data as a resource to be used to further national interest (economically and strategically), and-
      • To enable enforcement of Indian law and state functions.
      • Accruing benefits to the local industry: The second claim is that economic benefits will accrue to local industry in terms of creating local infrastructure, employment and contributions to the AI ecosystem.
      • Protection of civil liberties: Regarding the protection of civil liberties, the argument is that local hosting of data will enhance its privacy and security by ensuring Indian law applies to the data and users can access local remedies.
    • Contradiction in the claim of protection? If data protection was required for the above purposes, it would make sense to ensure that local copies were retained of all the categories of personal data provided for in the Bill (as was the case with the previous draft of the law).
      • Sectoral obligations: In the alternative, sectoral obligations would also suffice as is currently the case with sectors such as digital payments data, certain types of telecom data, government data, etc.
    • Will data localisation lead to privacy protection? We note that the security of data is determined more by the technical measures, skills, cybersecurity protocols, etc. put in place rather than its mere location.
      • Localisation may make it easier for domestic surveillance over citizens.
      • Enabler of better exercise of privacy by citizens: It may also enable the better exercise of privacy rights by Indian citizens against any form of unauthorised access to data, including by foreign intelligence.
      • Effectiveness matters: The degree of protection afforded to data will depend on the effectiveness of the applicable data protection regime.
    • Protecting privacy through less intrusive measures: Insofar as privacy is concerned, this could be equally protected through less intrusive, suitable and equally effective measures such as requirements for contractual conditions and using adequacy tests for the jurisdiction of the transfer.
      • Such conditions are already provided for in the PDP Bill as a set of secondary conditions.
      • The European Union’s General Data Protection Regulation too uses a similar framework.
      • Extra-territorial operation: The extraterritorial application of the PDP Bill also ensures that the data protection obligations under the law continue to exist even if the data is transferred outside the country.
    • Giving an individual a choice: If privacy protection is the real consideration, individuals ought to be able to choose to store their data in any location which afford them the strongest privacy protections.
      • It is arguable that data of Indians will continue to be more secure if stored and processed in the European Union or California.
      • These two jurisdictions have strong data protection laws and advanced technical ecosystems.

    Way forward

    • Identification of the issues: The joint parliamentary committee ought to, ideally, identify the need, purpose and practicality of putting in place even the (relatively liberal) measures contained in the PDP Bill.
    • Broader thinking at policy level: Further, in order for localisation-related norms to bear fruit, either in terms of protecting citizen rights, enabling law enforcement access to data or enabling the development of the local economy, there has to be broader thinking at the policy level.
      • This may include for instance-
      • Reforming surveillance-related laws.
      • Entering into more detailed and up-to-date mutual legal assistance treaties.
      • Enabling the development of sufficient digital infrastructure, and
      • Creating appropriate data-sharing policies that preserve privacy and other third party rights, while enabling data to be used for socially useful purposes.

     

     

     

  • Youth can be a clear advantage for India

    Context

    The demographic dividend is close to five-decade-long demographic opportunities that can be leveraged only with suitable policies and programmes

     The youngest population in the world

    • Median age at 28 years: By 2022, the median age in India will be 28 years.
      • In comparison, it will be 37 in China and the United States.
      • 45 in western Europe, and 49 in Japan.
    • The demographic dividend
      • The working-age population more than non-working: India’s working-age population has numerically outstripped its non-working age population.
      • An extraordinary opportunity: A demographic dividend, said to have commenced around 2004-05, is available for close to five decades.

    The two caveats

    • The demographic dividend is an extraordinary opportunity. There are, however, two caveats.
    • First: Dividend available in different states at different times.
      • India’s population heterogeneity ensures that the window of demographic dividend becomes available at different times in different States.
      • Example of Kerala vs. Bihar: While Kerala’s population is already ageing, in Bihar the working-age cohort is predicted to continue increasing till 2051.
      • Decline in 11 major states by 2031: By 2031, the overall size of our vast working-age population would have declined in 11 of the 22 major States.
    • Second: Many factors that matter for harnessing the dividend
      • Factors that matter: Harnessing the demographic dividend will depend upon the-
      • Employability of the working-age population.
      • Health.
      • Education.
      • Vocational training and skill.
      • Besides appropriate land and labour policies, as well as good governance.
      • Demography is not destiny: India will gain from its demographic opportunity only if policies and programmes are aligned to this demographic shift. Demography is not destiny.

    Need for skills

    • Need for the additional jobs: The Economic Survey 2019 calls for additional jobs to keep pace with the projected annual increases in the working-age population.
    • Lack of education and skills: UNICEF 2019 reports that at least 47% of Indian youth are not on track to have the education and skills necessary for employment in 2030.
      • Possibility of demographic disaster: The projected demographic dividend would turn into a demographic disaster if an unskilled, under-utilised, and frustrated young population undermines social harmony and economic growth.
    • Poor learning outcomes: While over 95% of India’s children attend primary school, the National Family Health Surveys (completed up to 2015-16) confirm that poor infrastructure in government schools, malnutrition, and scarcity of trained teachers have ensured poor learning outcomes.

    What needs to be done?

    • Adopt a uniform school system: A coordinated incentive structure prompting States to adopt a broadly uniform public school system focusing on equity and quality will yield a knowledge society faster than privatising school education can accomplish.
    • Ensure training in line with the market demand: Most districts now have excellent broadband connectivity-
      • Let geography not trump demography: Irrespective of a rural or urban setting, the public school system must ensure that every child completes high school education, and is pushed into appropriate skilling, training and vocational education in line with market demand.
    • Invest and modernise: Modernise school curricula, systematically invest in teacher training so that they grow in their jobs to assume leadership roles while moving beyond the tyranny of the syllabus.
    • Use of technology: Deploy new technology to accelerate the pace of building human capital by putting in place virtual classrooms together with massive open online courses (MOOCS) to help prepare this huge workforce for next-generation jobs.
      • Investing in open digital universities would further help yield a higher educated workforce.

    Focus on women

    • Translating literacy into skill: Growing female literacy is not translating into relevant and marketable skills.
      • A comprehensive approach is needed to improve their prospects vis-à-vis gainful employment.
      • Need of the flexible policies: Flexible entry and exit policies for women into virtual classrooms, and into modules for open digital training, and vocational education would help them access contemporary vocations.
    • The need for equal pay: Equal pay for women will make it worth their while to stay longer in the workforce.
    • The deferred bonus: Economist Yogendra Alagh has written that the significance of this “deferred bonus” (women entering the workforce), could be higher than the immediate benefits of the dividend from shifts in population age structure.

    Health care

    • In India, population health is caught between the rising demand for health services and competition for scarce resources.
    • Impact of economy on rural health: The National Sample Survey Office data on health (75th round, 2018), shows that a deep-rooted downturn in the rural economy is making quality health-care unaffordable.
      • People are availing of private hospitals less than they used to, and are moving towards public health systems.
      • Diverting public investment from However, central budget 2020-21 lays emphasis on private provisioning of health care which will necessarily divert public investment away from public health infrastructure.
    • The Ayushman Bharat Yojana: It links demand to tertiary in-patient care.
      • This promotes earnings of under-utilised private hospitals, instead of modernising and up-grading public health systems in each district.
    • We need to assign 70% of health sector budgets to integrate and strengthen primary and integrated public health-care services and systems up to district hospital levels.
      • Include out-patient department and diagnostic services in every health insurance model adopted, and-
      • Implement in ‘mission mode’ the Report of the High-Level Group, 2019, submitted to the XV Finance Commission.
    • The elderly population in India is projected to double from 8.6% in 2011 to 16% in 2040.
      • This will sharply reduce the per capita availability of hospital beds in India across all major States unless investments in health systems address these infirmities.

    Conclusion

    The policies that we adopt and their effective implementation will ensure that our demographic dividend, a time-limited opportunity, becomes a boon for India.

     

     

     

  • Delhi’s ‘Happiness Class’

    On the upcoming visit to India, US President Trump will visit a Delhi government school, where they will attend a happiness curriculum class.

    What is Delhi’s ‘happiness curriculum’?

    • The curriculum calls for schools in India to promote development in cognition, language, literacy, numeracy and the arts along with addressing the well-being and happiness of students.
    • It further says that future citizens need to be “mindful, aware, awakened, empathetic, firmly rooted in their identity…” based on the premise that education has a larger purpose, which cannot be in isolation from the “dire needs” of today’s society.
    • For the evaluation, no examinations are conducted, neither will marks be awarded.
    • The assessment under this curriculum is qualitative, focusing on the “process rather than the outcome” and noting that each student’s journey is unique and different.

    Objectives of the curriculum

    The objectives of this curriculum include:

    • developing self-awareness and mindfulness,
    • inculcating skills of critical thinking and inquiry,
    • enabling learners to communicate effectively and
    • helping learners to apply life skills to deal with stressful and conflicting situations around them

    Learning outcomes of this curriculum

    The learning outcomes of this curriculum are spread across four categories:

    • becoming mindful and attentive (developing increased levels of self-awareness, developing active listening, remaining in the present);
    • developing critical thinking and reflection (developing strong abilities to reflect on one’s own thoughts and behaviours, thinking beyond stereotypes and assumptions);
    • developing social-emotional skills (demonstrating empathy, coping with anxiety and stress, developing better communication skills) and
    • developing a confident and pleasant personality (developing a balanced outlook on daily life reflecting self-confidence, becoming responsible and reflecting awareness towards cleanliness, health and hygiene).

    How is the curriculum implemented?

    • The curriculum is designed for students of classes nursery through the eighth standard.
    • Group 1 consists of students in nursery and KG, who have bi-weekly classes (45 minutes each for one session, which is supervised by a teacher) involving mindfulness activities and exercise.
    • Children between classes 1-2 attend classes on weekdays, which involves mindfulness activities and exercises along with taking up reflective questions.
    • The second group comprises students from classes 3-5 and the third group is comprised of students from classes 6-8 who apart from the aforementioned activities, take part in self-expression and reflect on their behavioural changes.

  • Jalyukta Shivar Abhiyan

     Jalyukta Shivar, the flagship water conservation project launched by the earlier government has been officially scrapped by the present Maha government.

    What is Jalyukta Shivar?

    • Launched in December 2014 after Maharashtra experienced consecutive droughts, the project aimed at rolling out measures that could potentially mitigate water scarcity in the most drought-prone villages in a systematic manner.
    • Nearly 52 per cent of the state’s geographical area is prone to drought, either naturally or due to poor rainfall.
    • This includes Marathwada and adjoining areas of Madhya Maharashtra and large parts of Vidarbha.
    • The project targeted strengthening and streamlining existing water resources like canals, bunds and ponds by arresting maximum run-off rainwater during monsoon.
    • Tasks to widen and deepen natural water streams and connect them to nearby water storage facilities like earthen or concrete check-dams were proposed.
    • In the first phase, planned during 2015 – 2019, Jalyukta Shivar envisaged making 5,000 villages drought-free, every year.
    • During its proposed tenure, the government eyed at making 25,000 drought-prone villages water-sufficient.

    Was Jalyukta Shivar beneficial?

    • While the exact number of villages that were declared drought-free remains unknown, the programme attempted to bring water stress down in a majority of the most water-scarce villages in the state.
    • In January last year, then CM had announced that the scheme had transformed 16,000 drought-prone villages of Maharashtra.

    What is the future of water conservation in the state?

    • Geologists and hydrologists, who worked on implementing the project, shared similar views and hailed Jalyukta Shivar.
    • This was mainly due to the interventions undertaken in the existing water reserves, planned de-silting activities, among many others.
    • However, experts agreed that the scheme was not appropriately implemented.
    • Now with Jalyukta Shivar no longer in existence, focused efforts of the past five years, in most likelihood, will go down the drain unless a similar scheme is introduced.
    • With rainfall variations getting more pronounced, in addition to depleting groundwater reserves, the state will need concrete interventions to tackle future water requirements.

  • The next mission

    Context

    After the success of the SBM, government is looking for the next mission in the form of Jal Jeevan Mission.

    Investment in Sanitation

    • Investment of over 1 lakh crore: The central and state governments have invested in excess of one lakh crore on sanitation over the past five years.
    • Where the fund was used? A majority of these funds have gone towards-
      • Incentivising the poor and marginalised households to construct and use household toilets.
      • Bringing about behaviour change, and-
      • Building capacities of field functionaries.
    • The success of the mission: Over 10 crore toilets have been built in rural India and nearly 55 crore people have stopped defecating in the open, all in just five years.
      • This has contributed in bringing down global open defecation by more than half.
    • Return on the investment in sanitation: The returns on these investments have been manifold, and their effects on the broader economy, markets and employment have been significant.
      • 400 % return: The UNICEF recently estimated that investments in sanitation in India are yielding a 400 per cent return with each rural household in an open-defecation-free village saving Rs 50,000 on account of avoided medical costs and time savings.
    • Future prospects for the sanitation infrastructure: The Toilet Board Coalition has estimated that the sanitation infrastructure and services market in India will be worth over $60 billion by 2021.
      • Many new jobs, even in the most rural areas of the country, apart from reducing health and environmental costs and generating savings for households.
    • Growth in the sanitation-related business: The business of manufacturing toilet-related hardware accessories have reported huge growth in sales during the SBM period.
      • They project a continued uptrend through retrofitting and upgrades.
      • This has been corroborated by another recent study by UNICEF in which they have estimated that SBM has resulted in creating over 75 lakh full-time equivalent jobs over the past five years, giving the rural economy a major boost.

    A milestone, not a finish-line

    • Sustaining the success: The government is committed to ensuring that this success is sustained.
    • On October 2, 2019, the prime minister said that we must all ensure that people continue to use toilets and that no one is left behind.
    • Allocation of 10,000 crores in the Budget: This has been backed up by the finance minister in the budget for 2020-21.
      • In the budget, she announced about Rs 10,000 crore for rural sanitation to focus on-
      • ODF sustainability.
      • Bio-degradable waste management.
      • Greywater management.
      • Sludge management and-
      • Plastic waste management for all villages by 2024.

    Next Mission- Piped Water Supply

    • Jal Jeevan Mission: The next critical basic service, is piped water supply. On Independence day this year, the prime minister announced the Jal Jeevan Mission (JJM).
      • With the goal of ensuring piped water supply for all households of India by 2024 and with a commitment of Rs 3.6 lakh crore of central and state funds for the scheme.
      • The budgetary allocation of 12,000 crores: In the Union budget for 2020-2021, the government has already allocated Rs 11,500 crore for JJM, with an additional Rs 12,000 crore being made available through extra-budgetary resources.
    • Earmarking 50% grants for drinking water and sanitation: In addition, a huge impetus to the rural water supply and sanitation sector is the earmarking of 50 per cent of the Rs 60,750 crore grant for rural local bodies provided under the Fifteenth Finance Commission for drinking water and sanitation.
      • Making local bodies more responsible: This will ensure that the gram panchayats and local communities are responsible for the upkeep of their water and sanitation infrastructure, providing a boost to the sustainability of service delivery to people.
      • Making sanitation and water supply everyone’s business: This approach will ensure that just like sanitation, provision of water supply and its upkeep will also become everyone’s business.

    Conclusion

    It is fairly clear now that investment in sanitation is actually a facilitator for broader economic, health and social gains. The government should ensure the sustainability of SBM and replicate its success in implementing the JJM.

     

  • Worldwide Educating for the Future Index (WEFFI) 2019

     

     

    India has jumped five ranks in the Worldwide Educating for the Future Index (WEFFI) 2019.

    About WEFFI

    • The report is published by The Economist Intelligence Unit. The report and index were commissioned by the Yidan Prize Foundation.
    • The index ranks countries based on their abilities to equip students with skill-based education.
    • The report analyses the education system from the perspective of skill-based education “in areas such as critical thinking, problem-solving, leadership, collaboration, creativity and entrepreneurship, as well as digital and technical skills.”

    Global scenario

    • Among the world’s largest economies, the US, UK, France and Russia all fell back in the index, while China, India and Indonesia took steps forward.
    • Finland was at the apex of the index, with strengths across each category followed by Sweden.

    India’s performance

    • India ranked 35th on the overall index in 2019 with a total score of 53, based on three categories – policy environment, teaching environment and overall socio-economic environment.
    • India scored 56.3 in policy environment falling from a 61.5 score in 2018.
    • India’s score of 52.2 in the teaching environment category and 50.1 in the socio-economic environment category increased significantly from 32.2 and 33.3 in 2018 respectively.
    • Earlier, India ranked 40th with an overall score of 41.2 across categories in 2018.

    What made India progress?

    • The report attributed India’s growth to the new education policy introduced by the government.
    • India’s Finance Minister Nirmala Sitharaman, in the Union Budget 2020, had highlighted a
    • The New Education Policy announced in this year budget under ‘Aspirational India’ will focus on “greater inflow of finance to attract talented teachers, innovate and build better labs.
    • The policy will focus further on skill-based education.

    Various shortcomings highlighted

    • The 2018 WEFFI report had highlighted the shortcomings in India’s education system emphasizing upon its inability to utilise the opportunity of internationalizing its higher education system.
    • A decentralized education system is another shortcoming of India’s education policy according to the 2019 report.
    • Well-intentioned policy goals relating to future skills development often do not get filtered downward, a hazard in economies such as the US and India that have large, decentralized education systems, the report said.

  • Gearing up to fight the next big viral outbreak

    Context

    India is ill-prepared to deal with the new strain of coronavirus (SARS-CoV-2) that is causing worldwide panic. Policymakers must take forceful action to prevent the spread of the new virus and heed the urgent warnings of global public health professionals about new pathogens.

    No country is adequately prepared

    • Finding of the Global Health Security Index: The World Health Organization (WHO)’s Global Health Security Index finds that no country is adequately prepared.
    • It assesses 195 countries across six categories–
      • Prevention
      • Early detection.
      • Rapid response.
      • Health system quality.
      • Standards.
      • Risk environment.
    • India’s dismal rank: India is ranked 57th.
      • That the country scores around the global average is no comfort, because the global average is a low 40.2 out of 100, and India’s score is 46.5. (For the record, the U.S. is ranked first and China 51st).

    Four-point health agenda

    • The prospect of new outbreaks puts four items on the health agenda in the spotlight that require both immediate and longer-term action:
      • Early detection and prevention.
      • Better collaboration across health service providers.
      • More investment in health systems; outcomes, and education; and-
      • Better care of the environment and biodiversity, which directly affects people’s health safety.

    Thailand’s outstanding example

    • Sixth rank on Health Security Index: That Thailand is ranked sixth in the Health Security Index- the highest ranking for an Asian country.
      • The rank says a great deal about the country’s track record in disease prevention, early detection, and rapid response linked to investments in its public health system.
      • When the deadly Middle East Respiratory Syndrome (MERS), also caused by a coronavirus, broke out in 2015, Thailand quickly notified the WHO of its first confirmed case and acted transparently to arrest the spread.
      • This is in stark contrast to delayed notification by China’s officials of the recent outbreak.

    India’s record in past outbreaks

    • Underscoring inadequacies: The influenza A (H1N1) outbreaks since 2009 in Rajasthan, Maharashtra, Tamil Nadu and other States have acutely underscored the need for better detection, awareness of symptoms and quarantining.
    • Protocols for surveillance: Clearer protocols for all three types of surveillance are needed in all States.
      • And these protocols need to be communicated to health professionals at all levels and the public in local languages.

    Conducting stress tests on health system

    • Countries need to do the stress tests for their preparedness to deal with health emergencies.
    • Exposing the crucial gap: Each State in India should do this to expose crucial gaps in areas such as-
      • Adequacy and supply of diagnostic equipment.
      • Health facilities.
      • Hygienic practices, and-
      • Prevention and treatment protocols.
    • Ensuring strong supply chains: Queues of desperate shoppers trying to buy hand sanitizer, face masks and other protective products in Hong Kong and China highlight the need for strong supply chains for products that people need during health emergencies.

    The partnership between countries and with the private sector

    • Partnership to ensure supply chains: Partnerships between private and public sectors, and between countries– that can sustain supply chains and bolster the medical capacity of countries struggling to cope.
      • Collaborative approach in Asia: In Asia, collaborative approaches exist, for example, for combating tuberculosis, AIDS and malaria.
    • Need to do more: More is needed to tackle health emergencies on the scale of recent outbreak, particularly on funding.
      • Emergency loan option: There could be an emergency loan facility, with a “deferred drawdown option” as the World Bank uses for disasters, natural or health.
      • The loan option can help augment own resources in times of a public health catastrophe.
    • Investment is the best defence: But the best defence of all is to invest more, and more efficiently, in health and education to prepare populations and strengthen health services.
      • Low health expenditure: Health expenditure by the government in India is less than 5% of Gross Domestic Product, which is low for a middle-income country.
      • Spending at that level limits, among other things, the availability of health professionals during crises.
      • According to WHO, India has only 80 doctors per 1,00,000 people.

    Investment in health, education

    • Kerala’s experience: Kerala’s experience in 2018 with the deadly Nipah virus showed the value of investing in education and health over the long term.
    • What measures were taken in Kerala? The availability of equipment for-
      • Quick diagnosis.
      • Measures to prevent diseases from spreading and-
      • Public information campaigns- all helped to keep the mortality rate from the Nipah virus relatively low.
      • Having capable public health professionals helped in the information exchange with WHO and other international bodies.

    The relation between environmental degradation and health

    • A new dimension of new pathogens: One of the many dimensions of new pathogens that is getting increased attention is the link with environmental degradation.
    • The relation between pollution and viral respiratory infection: The interaction between particulate matter from pollution and viral respiratory tract infections, especially in the young and the elderly, as well as the malnourished, has been increasingly noted in epidemiological studies.
      • Many of the highest air pollution readings are being recorded in Indian cities.
    • Most vulnerable country: An HSBC study of 67 countries ranks India as the most climate-vulnerable one because of the impact of severe temperature increases and declines in rainfalls.
      • Reasons for vulnerability: The effects of such occurrences are magnified by the high density of the country’s population, the sheer number of people in harm’s way, and the high incidence of poverty.
      • Research is increasingly connecting global warming to vector-borne viruses.

    Conclusion

    The dangerous trend for disease spillovers from animals to humans can be traced to increased human encroachment on wildlife territory; land-use changes that increase the rate of human-wildlife and wildlife-livestock interactions; and climate change. Protecting the precious biodiversity should be a priority.

     

     

     

     

     

     

     

  • Assisted Reproductive Technology Regulation Bill, 2020

     

    The Union Cabinet has approved the Assisted Reproductive Technology Regulation Bill, 2020 to monitor medical procedures used to assist people to achieve pregnancy.

    What is ART?

    • Assisted reproductive technology (ART) is used to treat infertility.
    • Assisted reproductive technology includes medical procedures used primarily to address infertility.
    • This subject involves procedures such as in vitro fertilization, intracytoplasmic sperm injection, cryopreservation of gametes or embryos, and/or the use of fertility medication.

    Highlights of the bill

    • National Board: The Bill provides for a national Board which will lay down a code of conduct to be observed by those operating clinics.
    • Standardization: It will also formulate minimum standards for laboratory and diagnostic equipment and practices to be followed by human resources employed by clinics and banks.
    • National registry: Under the proposed law, a national registry and registration authority will maintain a database to assist the national Board to perform its functions.
    • Confidentiality clause: The Bill will also ensure confidentiality of intending couples and protect the rights of the child.

    Strict punishment:

    • India has one of the highest growths in the number of ART centres and ART cycles performed every year.
    • India has become one of the major centres of this global fertility industry, with reproductive medical tourism becoming a significant activity.
    • This has also introduced a plethora of legal, ethical and social issues; yet, there is no standardisation of protocols and reporting is still very inadequate.
    • The Bill thus proposes stringent punishment for those who practise sex selection; indulge in sale of human embryos or gametes and those who operate rackets.

    Other such Bills

    Taken together, theses proposed legislations create an environment of safeguards for women’s reproductive rights, addressing changing social contexts and technological advances.

    Surrogacy Regulation Bill 2020

    • The Surrogacy (Regulation) Bill, 2020 proposes to regulate surrogacy in India by establishing National Board at the central level and State Boards and Appropriate Authorities in the States and Union Territories.
    • The major benefit of the Act would be that it will regulate the surrogacy services in the country.
    • While commercial surrogacy will be prohibited including sale and purchase of human embryos and gametes, ethical surrogacy to the Indian Married couple, Indian Origin Married Couple and Indian Single Woman (only widow or Divorcee) will be allowed on fulfillment of certain conditions.
    • As such, it will control the unethical practices in surrogacy, prevent commercialization of surrogacy and will prohibit potential exploitation of surrogate mothers and children born through surrogacy.

    Medical Termination Pregnancy Amendment Bill 2020

    • The Medical Termination of Pregnancy Act, 1971 (34 of 1971) was enacted to provide for the termination of certain pregnancies by registered medical practitioners and for matters connected therewith or incidental thereto.
    • The said Act recognised the importance of safe, affordable, accessible abortion services to women who need to terminate pregnancy under certain specified conditions.
    • Besides this, several Writ Petitions have been filed before the Supreme Court and various High Courts seeking permission for aborting pregnancies at gestational age beyond the present permissible limit on the grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.

  • Powering the health-care engine with innovation

    Context

    India needs to tap the potential of the health-care start-ups in India and make the necessary provision to deal with the problems in the adoption of innovations in health-care.

    Expanding the supply side

    • Need to increase the hospital empanelled: As the scale of this scheme grows, a key area of focus is-
      • To expand the secondary and tertiary hospitals empanelled under PM-JAY and
      • To ensure their quality and capacity while keeping the costs down.
    • The ratio of doctors and beds: At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
    • 3% hospitalisation under the scheme: In the coming years, considering 3% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
      • This means physical and human infrastructure capacity would need to be augmented vastly.
    • Need for more beds: Conservative estimates suggest that we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
    • Long-term strategy: While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.
    • Mainstreaming innovation: A strong, yet under-tapped lever for accelerating health system efficiency and bridging these gaps is mainstreaming innovation in the Indian health system.

    Transformative solutions

    • India’s burgeoning entrepreneurial spirit combined with a systematic push for the development of a start-up ecosystem has led to a plethora of innovations in health care.
    • It is estimated that there are more than 4,000 health-care technology start-ups in India.
    • How do start-ups help? Today, start-ups are working to bring-
      • Innovative technologies and business models that leapfrog infrastructure.
      • Human resources.
      • Cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
    • How other innovations could help?
      • Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings.
      • Tele-ICU platforms to bridge the gap in high-skilled critical care personnel.
      • Centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably are all no longer just theoretical ideas.
    • Time to implement transformative solutions: It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.

    Challenges in mainstreaming healthcare innovations

    • Lack of uniform regulatory standards: One challenge is non-uniform regulatory and validation standards.
      • Regulations evolving in India: Regulatory requirements, specifically for biomedical start-ups, are still evolving in India.
      • As a result, hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
      • Government to overhaul standards: The government is now pushing ahead to overhaul Indian med-tech regulatory standards and product standards which will help bridge this trust-deficit.
    • Difficulty in the promotion of start-ups: Another problem in promoting start-ups is the operational liquidity crunch due to a long gestation period.
      • Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned.
      • Long gestation period: The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
    • Lack of framework to adopt innovation: Another hurdle is the lack of incentives and adequate frameworks to grade and adopt innovations.
      • Health-care providers and clinicians, given limited bandwidth, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations.
      • This leads to limited traction for start-ups promoting innovative solutions.
    • Procurement challenges: Start-ups also face procurement challenges in both public and private procurement.
      • They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.
      • Private procurement is complicated by the presence of a fragmented customer base and limited systematic channels for distribution.

    Way forward

    • Identify promising market-ready products: To accelerate the process of mainstreaming innovations within the hospital system in India-
      • We need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
    • Facilitate standard operational validation studies: There is a need to-
      • Facilitate standardised operational validation studies that are required for market adoption.
      • To help ease out the start-up procurement process such that these solutions can be adopted with confidence.
      • This, in effect, will serve the entire ecosystem of health-care innovators by opening up health-care markets for all.
    • Need to develop an interface between hospital and start-ups: A strong theme in mature health-care systems in other parts of the world is a vibrant and seamless interface between hospitals and health-care start-ups.
      • Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where-
      • Hospitals actively engage with health-care start-ups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
      • Start-ups as collaborators: Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals.

    Conclusion

    The dream of an accessible, affordable and high-quality health-care system for all, will be achieved when we work in alignment to complement each other and jointly undertake the mission of creating an Ayushman Bharat.