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Subject: Governance

Important aspects of Society

  • Why the Centre has extended the Digital Health Incentive Scheme?

    Why in the News?

    The central government has granted a one-year extension to the Digital Health Incentive Scheme (DHIS), aimed at digitizing patients’ health records and integrating them with the Ayushman Bharat Digital Health Account (ABHA ID).

    About the Digital Health Incentive Scheme:   

    • The National Health Authority (NHA) launched the Digital Health Incentive Scheme on January 1, 2023, to implement the Ayushman Bharat Digital Mission (ABDM) to create a digital health ecosystem in the country.
      • ABDM intends to support different healthcare facilities like clinics, diagnostic centers, hospitals, laboratories and pharmacies in adopting the ABDM ecosystem to make available the benefits of digital health for all the citizens of India.
    • It encourages the adoption of digital health solutions like Health Management Information Systems (HMIS) and Laboratory Management Information Systems (LMIS) by offering financial incentives for each additional record digitized beyond a specified threshold.
    • Benefits of the Digital Health Incentive Scheme:
      • Earn incentives for Digitization: Reimburse the expenses incurred for digitization to all the participating healthcare facilities and digital Solution Companies.
      • Efficiency in Healthcare Delivery: Seamless access to patient’s longitudinal health records; Removes hassles in the healthcare process (registration, appointment, consultation, IPD admission, discharge, etc).
      • Building a Robust Digital Health Ecosystem: Building a robust digital health ecosystem across different levels of healthcare facilities.
      • Improved Quality of Care: Evidence-based, accessible, and good quality care. Patient’s ease of access to digitized health records and improved healthcare delivery.

    Why has the scheme been extended? 

    • The extension aims to sustain momentum in the adoption of digital health technologies. By providing additional time, the scheme supports more healthcare providers, both public and private, in overcoming financial barriers associated with digitization and promoting a digital-first approach to healthcare delivery.
    •  Extending the scheme allows for incorporating feedback from stakeholders and refining its implementation based on operational insights. This iterative process ensures that the scheme remains effective in enhancing healthcare efficiency, patient care, and accessibility to medical records across the country.

    How many Hospitals and Digital Health Companies have availed of the incentive? 

    • Registered Facilities: A total of 4,005 healthcare facilities have registered for the Digital Health Incentive Scheme (DHIS). This includes 1,085 private healthcare facilities.
    • Digital Solution Companies (DSCs): There are 41 digital solution companies (DSCs) registered under the scheme, out of which 36 are private companies.
    • Availed the Scheme: Among the registered facilities and companies, 584 healthcare facilities have availed the scheme so far. This includes 83 private healthcare facilities. Additionally, 12 DSCs, including 10 private companies, have also availed the incentive.

    How can it be beneficial for the patients?                                     

    • Quick Registration: Patients can benefit from quicker OPD registrations through digital systems, reducing waiting times at hospitals and clinics.
    • Digital Transactions: Digital health records enable easier access to medical history and facilitate seamless sharing of information between healthcare providers, ensuring continuity of care.
    • Reduced Redundancy: Digital records help in avoiding duplicate tests and procedures due to lost or misplaced paper records, which is particularly beneficial for patients who move between healthcare facilities or states.
    • Better Coordination: Healthcare providers can access comprehensive patient records quickly, leading to more coordinated and effective treatment plans.
    • Prevention of Additional Costs: By reducing the need for repeat tests and administrative overheads associated with paper-based records, patients are less likely to incur unnecessary expenses.
    • Clear Communication: Patients can securely view, access, and share their health records with healthcare providers, promoting transparency and informed decision-making about their care.
    • Secure Storage: Digital health records stored under the Ayushman Bharat Digital Health Account (ABHA ID) ensure data security and privacy, adhering to regulatory standards.

    Do you know what is ‘ABHA ID’? 

    • ABHA ID, or Ayushman Bharat Digital Health Account ID, is a unique digital identifier issued to individuals in India.
    • It serves as a centralized platform for individuals to store and manage their medical records digitally, including doctor consultations, prescriptions, and diagnostic test results.
    • ABHA ID facilitates easy access to health information across different healthcare providers, promotes continuity of care, and supports informed decision-making during medical treatments.

    Conclusion: The extension of the Digital Health Incentive Scheme aims to boost adoption of digital health solutions, benefiting patients with improved access and care coordination. Challenges include ensuring equitable access and addressing digital literacy barriers.

     

    Mains PYQ:

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

     

  • The allegations over NEET-UG 2024 | Explained

    Why in the news?

    On June 13, the Union government informed the Supreme Court that the scorecards of 1,563 candidates who received compensatory marks in the NEET-UG 2024 exam, held on May 5, will be cancelled.

    About National Testing Agency:

    • National Testing Agency (NTA) has been established as a premier, specialist, autonomous and self-sustained testing organization to conduct entrance examinations for admission/fellowship in higher educational institutions.
    • The NTA was established in 2017 by the Ministry of Education.
    • NTA is responsible for conducting the
      • Joint Entrance Examination – Main (JEE Main)
      • National Eligibility cum Entrance Test-Undergraduate (NEET-UG)
      • National Eligibility Test (NET)
      • Common Management Admission Test (CMAT)
      • Graduate Pharmacy Aptitude Test (GPAT).
    • The NTA is chaired by an eminent educationist who will be appointed by the Ministry of Education.

    Why has the Union government told the Supreme Court that it will cancel the scorecards of candidates who have been awarded grace marks?

    • Technical Issues During Exam: The cancellation stems from petitions challenging the award of grace marks to 1,563 candidates from six NEET centers due to technical issues that did not allow them the full 3.2 hours to complete the exam.
    • Compensatory Marks Controversy: Grace marks were awarded based on a court order and the recommendation of a committee constituted by the National Testing Agency (NTA). This move was challenged as arbitrary and lacking transparency.
    • Skewed Results: The committee found that the compensatory marks led to a skewed situation, thus recommending the cancellation of the scorecards for these candidates and conducting a re-test on June 23.

    How did the National Testing Agency respond to the various charges against the conduct of the exams?

    • Formation of Committee: In response to the allegations, the NTA constituted a four-member committee to investigate the truth behind the claims, including the award of grace marks and other issues related to the conduct of NEET 2024.
    • Admission of Irregularities: The NTA admitted that the grace marks caused confusion and contributed to skewed results. They acknowledged technical issues and the improper awarding of grace marks.
    • Panel Recommendations: The panel recommended limiting grace marks to the attempted questions and concluded that it would be best to cancel the test for the affected 1,563 students.
    • Explanations for High Scores: NTA officials attributed the unusually high number of perfect scores (67 students scoring 720/720) to an ‘easy paper’, but still took steps to address the fairness and validity of the results by planning a re-test.
    • Addressing Other Allegations: The NTA’s response included acknowledging various logistical issues such as slow distribution of question papers, wrong OMR sheets, and technical delays, and they aimed to ensure better planning and execution in future exams.

    Way forward: 

    • Calls for a Re-test for All Candidates: Students and education experts argue that if the exam can be cancelled for 1,563 candidates, it should be cancelled for all 23 lakh candidates to maintain fairness. They believe that the logical step is to conduct a re-test for everyone who took the May 5 exam.
    • Restoring Faith in the System: The dissatisfaction expressed on social media highlights a loss of faith in the examination system. To restore confidence, students demand comprehensive measures to address the flaws and ensure a fair and transparent testing process for all candidates.
    • Improving Examination Conduct: For an exam of NEET’s scale and history, it is expected that organizational issues should be resolved. The NTA and government agencies need to enhance measures to prevent fraud, ensure the timely distribution of materials, and apply proper judgment to address any technical issues during the exam, aiming for a smooth and reliable process in future examinations.

    Mains PYQ:

    Q National Education Policy 2020 is in conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient the education system in India. Critically examine the statement. (UPSC IAS/2020)

  • IRDAI’s new health insurance rules   

    Why in the news?

    Recently, the Insurance Regulatory and Development Authority (IRDAI) introduced a set of reforms in the health insurance sector aimed at significantly enhancing service standards for policyholders.

    The recent rules highlighted by IRDAI (Insurance Regulatory and Development Authority of India) include:

    • Cashless processing: Insurers are mandated to accept or reject cashless claims immediately, within one hour, and settle such claims on discharge within three hours. Any delay beyond this period would result in the insurer bearing the additional costs, if any.
    • Claim settlement: Insurers cannot repudiate a claim without the approval of their claims review panel. Documents for claim settlement must be collected from hospitals or third-party administrators, not from the insured.
    • Policyholders with multiple health policies: They can select the policy under which they want to make a claim, with the primary insurer coordinating the settlement of the balance amount from other insurers.
    • Reward for No claims: Policyholders with no claims during the policy period may receive either an increased sum insured or discounted premium amounts.
    • Renewal policies: All individual health policies are renewable and cannot be denied based on previous claims, except in cases of fraud, non-disclosures, or misrepresentation. No fresh underwriting is required for renewal policies unless there is an increase in the sum insured.
    • Portability requests: Stricter timelines are imposed on portability requests via the Insurance Information Bureau of India portal.
    • Customer information sheet: Insurers are required to include a customer information sheet as part of the policy document, explaining all customer-facing details such as policy type, sum assured, coverage details, exclusions, deductibles, and waiting periods.

    Challenges related to health insurance in India 

    • Opaque Policy Details and Claim Processes: Policyholders often struggle to understand the intricacies of insurance contracts, leading to uncertainty about coverage entitlements and reimbursement procedures.
    • Claim Rejections: Policyholders frequently face claim rejections due to inadequate documentation and ambiguous claims processes.
    • Delays in Claim Settlement: Insurance companies often take a long time to process claims, causing inconvenience and financial stress for policyholders

    IRDAI and its composition:

    • The Insurance Regulatory and Development Authority of India (IRDAI) is the regulatory body overseeing the insurance sector in India. It was constituted under the Insurance Regulatory and Development Authority Act, 1999.
    • The composition of IRDAI typically includes a Chairman and members appointed by the Government of India. The authority regulates various aspects of insurance, including licensing, pricing, and policyholder protection, to ensure the stability and growth of the insurance industry while safeguarding the interests of policyholders.

    Conclusion: IRDAI’s recent health insurance reforms aim to improve service standards by mandating timely cashless claim processing, transparent claim settlement, and policyholder rewards for no claims. These changes address challenges like opaque policies and claim rejections, enhancing customer trust. IRDAI plays a vital role in ensuring a fair and efficient insurance sector.

    Mains PYQ:

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • [10 June 2024] The Hindu Op-ed: The Bareilly case and a flawed criminal justice system

    [10 June 2024] The Hindu Op-ed: The Bareilly case and a flawed criminal justice system


    PYQ Relevance:

    Prelims:

    Q) Consider the following statements: (UPSC CSE 2023)
    Statement-1: In India, prisons are managed State Governments with their own rules and regulations for the day-to-day administration of prisons.
    Statement-2: In India, prisons are governed by the Prisons Act, 1894 which expressly kept the subject of prisons in the control of Provincial Governments.
    Which one of the following is correct in respect of the above statements?
    (a) Both Statement-I and Statement-2 are correct and Statement-2 is the correct explanation for Statement-1
    (b) Both Statement-1 and Statement-2 are correct and Statement-2 is not the correct explanation for Statement-1
    (c) Statement-1 1s correct but Statement-2 is incorrect
    (d) Statement-1 Is incorrect but Statement-2 is correct

    Q) Consider the following statements: (UPSC CSE 2023)

    1. According to the Constitution of India, the Central Government has a duty to protect States from internal disturbances. 
    2. The Constitution of India exempts the States from providing legal counsel to a person being held for preventive detention. 
    3. According to the Prevention of Terrorism Act, of 2002, confession of the accused before the police cannot be used as evidence. 
    How many of the above statements are correct? 
    (a) Only one 
    (b) Only two 
    (c) All three 
    (d) None 

    Note4Students: 

    Prelims: Preventive Detention; 

    Mains: Criminal Justice System in India; Challenges with Fast Track Courts; 

    Mentor comment: Preventive Detention law was passed in1950 for the first time. The aim of implementing the Preventive detention was not to punish the individual but to prevent that person from doing a wrong and unconstitutional act. According to Finley, “it is not punitive but a precautionary measure”.

    The Indian criminal justice system faces several other challenges too. One of the major challenges is a large backlog of pending cases, which can result in long delays and delays in the delivery of justice. The Indian criminal justice system is also criticized for being slow, inefficient and prone to corruption, that is why, we introduced Fast Track Court system. Investigations are often incomplete or either lack thoroughness, leading to weak cases and wrongful detentions in this type of courts too. One of the live example of this is being highlighted in today’s editorial.

    Let’s learn.

    –

    Why in the News?

    A woman who had filed a rape case was sentenced to imprisonment and fined by a court in Bareilly, Uttar Pradesh, leading to a narrative that perpetuated the stereotype that false rape claims are common. 

    • However, a closer examination of the trial proceedings highlights systemic shortcomings in law enforcement and social complexities that require urgent attention.
    BACKGROUND STORY:

    About Lack of Spirit or Liveliness in the Investigation process:

    •Initial Complaint: The girl’s mother filed a missing person’s complaint stating that her 15-year-old daughter (medical examination showed her to be 18 years old) was missing and suspected a person kidnapping her. However, the girl appeared a few days later, claiming she was taken to Delhi by the same suspected person and raped by him.
    •Lack of Medical Evidence: The Girl refused to undergo a thorough medical examination, crucial for the prosecution’s case (in fact clothes were not collected for forensic analysis). Hence, the lack of medical evidence due to the negligence of the investigating officer and Pooja’s refusal to undergo a medical examination weakened the prosecution’s case.
    •Administrative Failure: The respective magistrate did not direct further investigation despite glaring gaps. Moreover, the public prosecutor endorsed a weak charge sheet, failing to fulfill their duty to the court and the public.
    ○ Section 173(8) of the CrPC allows a magistrate to direct further investigation in case of a flawed investigation. 
    Further, the magistrate could call for the case diary under Section ○ (172(2) of the CrPC, which may have revealed discrepancies or inadequacies in the investigation.

    The Issue with Undertrial Detention

    • Prolonged Incarceration: One of the tragedies of the Indian prison system is the high proportion of undertrial prisoners (around two-thirds). Undertrial prisoners are kept in prison while awaiting trial or during their trial. The accused boy in this case remained in jail for over four years without accountability for the investigating officers or prosecution.
    • Lack of Accountability: There were no repercussions for those responsible for wrongful detentions, perpetuating a culture of impunity and undermining public confidence in the integrity of judicial processes.
      • His trial dragged on in a fast-track court in Bareilly amidst the disruptive backdrop of the COVID-19 pandemic.
    • Violates the Fundamental Right: Prolonged undertrial detention violates their Rights to Liberty and Fair trial, adversely impacting their lives and livelihood.
      • The trial in this case spanned 1,559 days, in which there were 109 hearings (data from the e-Courts portal).
      • The overuse of undertrial detention effectively ends up punishing people before they are convicted and makes a mockery of their right to be presumed innocent until proven guilty.

    The state of Fast-track courts in India

    • Budgetary Allocation: The centrally sponsored scheme for Fast Track Special Courts (FTSC) has been extended till 2026 with a budgetary allocation of around ₹2,000 crore, despite systemic challenges.
    • Inadequate Infrastructure: Fast-track courts lack dedicated infrastructure and judges, leading to existing courts being designated for these cases, causing judges to manage both regular and expedited cases.
    • Bail Issues: In this case, the accused person’s bail application was rejected due to the serious nature of the offense, and he remained in jail until his acquittal. His family lacked the means to file an appeal. Indifference and poverty prolong undertrial detention.
    • Reforms Needed: The case highlights the need for enhancements in police investigation protocols, prosecutorial autonomy, and judicial supervision to mitigate the risk of wrongful and protracted imprisonments.

    Conclusion: Ultimately, the notoriety surrounding this case is cited to bolster the stereotype of women lodging false accusations against men, which highlights a critical call for reforms within the criminal justice system. This case highlights the necessity for enhancements in police investigation protocols, prosecutorial autonomy, and judicial supervision to mitigate the risk of wrongful and protracted imprisonments. 

  • [8 June 2024] The Hindu Op-ed: The Centre is notional, the States the real entities

    [8 June 2024] The Hindu Op-ed: The Centre is notional, the States the real entities

    PYQ Relevance:

    Mains: 
    Q) From the resolution of contentious issues regarding the distribution of legislative powers by the courts, the ‘Principle of Federal Supremacy’ and ‘Harmonious Construction’ have emerged. Explain. (UPSC CSE 2019)

    Q) Explain the rationale behind the Goods and Services Tax (Compensation to States) Act of 2017. How has COVID-19 impacted the GST compensation fund and created new federal tensions? (UPSC CSE 2020)

    Prelims:

    Q) Which one of the following in Indian polity is an essential feature that indicates that it is federal in character?​ (UPSC CSE 2021)
    (a) The independence of the judiciary is safeguarded.​
    (b) The Union Legislature has elected representatives from constituent units.​
    (c) The Union Cabinet can have elected representatives from regional parties.​
    (d) The Fundamental Rights are enforceable by Courts of Law.

    Note4Students: 

    Prelims: Co-perative federalism; NITI Aayog; GST System; 

    Mains: Federal Issues; Governance Issues; Regional Disparities; 

    Mentor comment: India is a vast and diverse country with different regions, cultures, and languages. To govern such a complex society, the Indian Constitution established a federal system of governance, dividing power between the central government and the states. This system is known as a quasi-federal system because it contains elements of both a federation and a union. Despite its importance, Indian federalism faces several challenges regional differences, centralized power, Economic insecurities for states, and communication barriers. These challenges can lead to issues like conflicts over resource allocation and decision-making.

    There is a need for the even-handed treatment of all the States by the Centre and also less friction among the rich and poor States when proportionately more resources are transferred to poor States to keep rising inequality in check. The issue of governance, both at the Centre and in the States, needs to be flagged. It determines investment productivity and the pace of development. Corruption and cronyism lead to resources being wasted and a loss of social welfare.

    Let’s learn.

    –

    Why in the News?

    The results of the 2024 general election in India have led to a surprise, with regional parties performing well and set to share space in both the ruling and opposition benches in Parliament.

    • This development is expected to strengthen federalism, which has been fraying due to contentious Centre-State relations and the dominant Centre’s attempts to impose its will on the states.

    The recent challenges faced by regional states:

    • Democratic Issues: The Opposition-ruled States have been complaining about stepmotherly treatment by the Centre. Protests have been held in Delhi and the State capitals.
      • There is a huge diversity among the States. For example, Assam is unlike Gujarat and Himachal Pradesh is very different from Tamil Nadu. A common approach is not conducive to the progress of such diverse States.
      • They need greater autonomy to address their issues in their unique ways.
    • Fiscal-Federal Issues:Kerala has complained about the inadequate transfer of resources, Karnataka about drought relief, and West Bengal about funds for the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS).
      • The Supreme Court, expressing its helplessness, recently said that Centre-State issues need to be sorted out immediately. 
    About Co-operative Federalism:
    The Constitution of India does not explicitly contain the phrase ‘cooperative federalism,’ but the functioning of the governance and evolution of our Constitution implicitly resulted in building ‘cooperative federalism.’

    Significance of Cooperative Federalism:

    • Need for Robust Institutions and Mechanisms:
      • Revenue has to be raised through taxes, non-tax sources, and borrowings. The Centre has been given a predominant role in raising resources due to its efficiency in collecting taxes centrally. 
      • Among the major taxes, personal income tax (PIT), corporation tax, customs duty, and excise duty are collected by the Centre. So, the Centre controls most of the resources, and they have to be devolved to the States to enable them to fulfill their responsibilities.
    • Need for Promoting Intergovernmental Relations:
      • The Centre-State relations in India are plagued by inter-state tussles and resource disparities. The Finance Commission’s efforts to devolve funds proportionally to poorer States have been unsuccessful, leading to resentment from richer States. 
      • The Centre’s allocation of resources, including expenditures and schemes, can be used to play politics and favor certain States, undermining Federalism and Autonomy.

    Initiatives taken by the Government:

    • NITI Aayog:
      • NITI Aayog acts as the quintessential platform for the Government of India by bringing States together as ‘Team India’ to work towards the national development agenda.
      • NITI has also established models and programs for the development of infrastructure and to reignite and establish private-public partnerships, such as the Centre-state partnership model Development Support Services to States and Union Territories (DSSS) and the Sustainable Action for Transforming Human Capital (SATH) program.
    • Goods and Service Tax (GST) System:
      • The 101st Amendment to the Constitution, which introduced the GST regime, is a watershed moment in the evolution of cooperative Federalism as enshrined in the Constitution of India.
    • Before the implementation of GST, the Indian taxation system was a medley of Central, State, and Local area levies.

    Judicial Contribution for Co-operative Federalism:

    • In the case of State of Rajasthan v Union of India (1977) which some state governments brought against the Janata government’s dissolution of state legislatures, the Supreme Court upheld its right to strike down a proclamation imposing the President’s rule if the action was mala fide or irrelevant considerations.
    • It was held that the ‘maintenance of democratic norms’ could not be regarded as an irrelevant ground for the exercise of the power of proclamation. Since then, the Indian model of federalism has been predominantly ‘cooperative’ as laid down by the Supreme Court in 1977.
    Recommendations by Sarkaria Commission on Federalism (1988):

    * The Indian government constituted the Sarkaria Commission in 1983 mainly created to explore the relationship between the states and the central government.
    * The Sarkaria Commission did not favor structural changes and regarded the existing constitutional principles and arrangements relating to the instructions as sound. However, it emphasized the need for changes in the functional or operational aspects.
    * It discusses the relations between the states and the center by the 8th to 12th Finance Commissions to maintain the dependence on several funds from the center.

    Way Forward: 

    • The Sixteenth Finance Commission has begun work, aiming to strengthen federalism and address the fraying of Centre-State relations.
      • It should ensure even-handed treatment of all states, proportionate resource transfers to poorer states, and reduce Centre domination over states.
    • To reduce the domination of the Centre over the States, the devolution of resources from the Centre to the States could be raised substantially from its current level of 41%.
      • For example, the Public Distribution System or MGNREGS are joint scheme, but the Centre asserts that it be given credit. It has penalized States that have not done so.

    https://www.thehindu.com/opinion/lead/the-centre-is-notional-the-states-the-real-entities/article68264096.ece

    https://indiankanoon.org/doc/174974/

    https://www.niti.gov.in/cooperative-federalism

  • Tele MANAS cell for Armed Forces

    Why in the News?

    • The Ministry of Health and Family Welfare (MoHFW) and the Ministry of Defence (MoD) have entered into a Memorandum of Understanding (MoU) to foster collaboration in operating a special cell of Tele MANAS.
      • This collaboration, spanning two years, aims to establish a pilot project at the Armed Forces Medical College in Pune.

    Suicides and Fratricides in Armed Forces: A Global Issue

    • As per information given in Parliament in April 2022, there were two cases of fratricide each year from 2019 to 2021 and one case in 2021.
    • In an older reply in Rajya Sabha on suspected suicide cases in the Army, the Government informed that during the years 2016 to 2018 there were 104, 75 and 80 cases, respectively.
    • A 2018 study correlated extended deployment to a 15% increased suicide risk in the U.S. military, the U.S. Department of Defence recorded 503 suicides among active-duty personnel in 2019.
    • Common reasons that forces an individual to take extreme steps are:
      • Family issues,
      • Family separation,
      • Prolonged deployment in difficult areas,
      • Continuous exposure to hazardous situations,
      • Traumas originated in Counter Insurgency or Counter Terrorism operations and
      • Wide range of Human Resource management issues.
    • Preventive Measures: The Army in its latest advisory issued in August 2023 stated that officers and religious teachers – at least one Pandit, Maulvi, Granthi or Pastor – are posted in each unit and selected other ranks are being trained on the nuances of counselling.

    What is the Tele MANAS Initiative?

    • Tele MANAS, or Tele Mental Health Assistance and Networking across States, stands as India’s National Tele Mental Health Programme.
    • It is envisioned as the digital extension of the District Mental Health Programme (DMHP).
    • Its announcement came in the Union Budget of 2022.
    • The Ministry of Health and Family Welfare (MoHFW) serves as the nodal agency overseeing its implementation.
    • The primary aim is to ensure universal access to equitable, accessible, affordable, and high-quality mental health care through round-the-clock tele-mental health services.
    • The International Institute of Information Technology, Bengaluru, serves as the technology partner.
    • The nodal centre for Tele MANAS operations is located at NIMHANS, Bengaluru.
    • The National Health Systems Resource Centre operates within the health system domain.
    • Helpline numbers for assistance are 14416 and 18008914416.
    • The implementation structure comprises two tiers:
    1. Tier 1: Consists of State Tele MANAS cells comprising trained counsellors and mental health specialists,
    2. Tier 2: Comprises resources from the District Mental Health Program (DMHP) and medical colleges.

    Reach and Impact

    • Nationwide Presence: Currently, 51 operational Tele MANAS cells operate across all 36 States and UTs, delivering services in 20 diverse languages.
    • Remarkable Response: Since its inception in October 2022, Tele MANAS has received over 10 lakh calls and manages a daily average of more than 3,500 calls.

    National Mental Health Programme (NMHP):

    • The NMHP was launched by the Government of India in 1982.
    • It was initiated to address the significant burden of mental disorders in the population.
    • Mental disorders affect approximately 6-7% of the population in India.
      • Objectives of NMHP: Ensuring the availability and accessibility of minimum mental healthcare to all, particularly the vulnerable and underprivileged sections of the population.
    • As part of NMHP, the District Mental Health Program (DMHP) was introduced in 1996 during the IX Five Year Plan based on the ‘Bellary Model’:
      • The Bellary Model emphasizes the importance of early detection, short-term training for physicians, and health worker training in identifying individuals with mental health issues.

     

    PYQ:

    [2023] Why suicide among young women is increasing in Indian society?

  • Mission Karmayogi: For civil servants who are better prepared and citizen-oriented

    Why in the news?

    The” Indian Institute of Public Administration” evaluated the impact by gathering feedback from supervisors on recently trained staff, and reported enhanced proficiency in data analytics and e-governance tools.

    Observations Assessed by the Indian Institute of Public Administration

    • Increased Proficiency: The Indian Institute of Public Administration (IIPA) observed increased proficiency in data analytics and e-governance tools among recently trained staff.
    • Skill Development: Section officers and administration assistants across the country have completed 15 lakh online learning modules on data analytics, Government e Marketplace (GeM) modules, and advanced software tools like Excel, leading to enhanced skill levels.
    • Supervisor Feedback: Feedback from supervisors indicated noticeable improvements in the capabilities and efficiency of the trained staff, reflecting the positive impact of the training programs.

    About Mission Karmayogi and Gati Shakti

    • Mission Karmayogi: Launched by Prime Minister Narendra Modi, this initiative aims to transform India’s three million civil servants into citizen-centric, future-ready, and result-oriented professionals. It includes digital training courses and the use of an online learning portal, iGOT Karmayogi Bharat.
    • Capacity Building Commission (CBC): Constituted in 2021, the CBC provides policy guidance and tools to enhance the capabilities of all levels of India’s civil services, collaborating with various ministries and training institutions.
    • PM Gati Shakti: This platform integrates legal and geographic layers to plan and execute mega infrastructure projects efficiently. It promotes a “whole of government” approach for de-siloed, harmonized national priorities.
    • Training and Certification: Over 24,000 officials have completed PM Gati Shakti learning modules, and over 3,88,000 personnel have been certified in emerging technologies through iGOT Karmayogi Bharat.

    Issues and challenges 

    • Resistance to Change: Bureaucracy often resists change due to a preference for the status quo, which can hinder the adoption of new approaches and technologies.
    • Shift from Generalist to Specialist Approach: Moving from generalist to specialist roles can encounter resistance despite the need for domain expertise, which may slow down the development of specialized skills.
    • Technical Governance Demands: Effective governance today requires technical proficiency, necessitating skilled personnel. The lack of such skills can hinder the effective implementation of the mission

    What is Needed to Achieve the $30 Trillion Economy by 2047?

    • Improved Governance: Efficient and competent civil services are essential for achieving India’s ambitions. Civil servants must be trained to be citizen-centric, future-ready, and result-oriented.
    • Infrastructure Development: Speed up the construction of mega infrastructure projects such as railways and highways.Overcome delays caused by inter-ministerial permissions through integrated planning.
    • Skill Development and Training: Equip civil servants with skills in emerging technologies like AI, IoT, and Big Data. Ensure continuous learning and skill enhancement for civil servants through platforms like iGOT Karmayogi Bharat.
    • Citizen-Centric Approaches: Promote citizen-centric approaches among civil servants to improve public service delivery.Enhance the capacity of police personnel and other frontline workers to address citizen concerns effectively.
    • State and Municipal Roles: Strengthen the role of state governments and municipal corporations in delivering services and infrastructure.Implement capacity-building programs at the municipal level for better service delivery.
    • Tax System Reforms:Develop a tax system that is painless and rewards honest taxpayers. Train tax personnel to address systemic taxpayer grievances effectively.

    Way forward:

    • Continuous Training and Development: Expand online learning platforms like iGOT Karmayogi Bharat to offer specialized courses in emerging technologies, leadership, and governance for civil servants at all levels.
    • Performance Evaluation and Feedback Mechanisms: Establish robust performance evaluation systems to assess the effectiveness of training programs and identify areas for improvement.

    Mains PYQ:

    Q Initially Civil Services in India were designed to achieve the goals of neutrality and effectiveness, which seems to be lacking in the present context. Do you agree with the view that drastic reforms are required in Civil Services. Comment (UPSC IAS/2017)

  • Why Federal Polity is the key to more jobs? 

    Why in the news?

    India’s general election results were surprising, defying exit poll predictions. Despite high economic growth, voters, especially informal workers earning under ₹10,000 monthly, expressed economic concerns.

    About the 8% Real GDP Growth in FY24:

    • Growth Not Inclusive: The 8% real GDP growth has not reached the majority of the population, especially informal-sector workers.
    • Rural Wages: There’s a contraction in real rural wages, highlighting the dire state of the rural economy.
    • Income Inequality: High economic growth has not alleviated income inequality, which is reflected in the election results.

    The Plight of Taking the Masses into Consideration:

    • Economic Concerns: Despite the hype around economic growth, voters expressed deep concerns over the state of the economy.
    • Low Incomes: Over 90% of informal-sector workers registered on the e-Shram portal have a monthly income of ₹10,000 or less.
    • Election Results: Voters in poorer states have different perceptions; some still support the incumbent government in the hope of better employment and future prospects.
    • Policy Priorities: The new government must prioritize creating employment opportunities and addressing the economic challenges faced by the masses.

    CASE STUDY: Bangladesh:

    • Role of NGOs: In Bangladesh, NGOs have significantly contributed to social development, especially for women.
    • Employment Generation: NGOs have provided skilled women power to the apparel industry, enhancing employment opportunities.
    • NGOs in India: The NGO sector in India has faced scrutiny and high-handedness. The new government should collaborate with NGOs for development programs and employment generation activities.

    The Centre has to Work Through the States for Reforms:

    • Agricultural Sector: With a significant workforce employed in agriculture but contributing minimally to the GVA, reforms in agriculture and allied sectors are essential.
    • Animal Husbandry and Fisheries: Encouraging growth in animal husbandry, fisheries, and poultry can provide additional income to farmers.
    • Employment in Other Sectors: To address the surplus workforce in agriculture, employment opportunities must be created in other sectors like textiles, leather, construction, and food processing.
    • Incentives for Investment: Correcting past policy mistakes and providing incentives for investment in key sectors is crucial.
    • Infrastructure Development: Improving infrastructure in smaller towns can boost the handicraft, tourism, and hospitality sectors, generating higher incomes and better market access.
    • Open Network for Digital Commerce (ONDC): Utilizing ONDC to provide new opportunities for craftsmen to access broader markets.
    • Government Vacancies: Filling government vacancies transparently can address educated unemployment and prevent demotivation among young people.

    Conclusion: Develop schemes that specifically cater to informal-sector workers, ensuring they benefit from economic growth. This could include social security measures, skill development programs, and financial inclusion initiatives.

    Mains PYQ:

    Q ”Economic growth in the recent past has been led by increase in labour productivity.” Explain this statement. Suggest the growth pattern that will lead to creation of more jobs without compromising labour productivity. (UPSC IAS/2022)

  • The delicate balancing of health-care costs    

    Why in the news?

    With growing health disparities and inconsistent access to medical services, the need for fair and sustainable healthcare policies has never been more pressing.

    Private Healthcare System in India

    • Private hospitals in India, especially those accredited by the Joint Commission International (JCI) and National Accreditation Board for Hospitals (NABH), are hubs of specialised care and innovation.
    • These institutions invest heavily in top-tier infrastructure and advanced technologies, significantly enhancing patient outcomes, particularly in complex procedures. Integration of telemedicine and remote care is common, broadening access and building patient trust.

    Price Caps, Quality, and Innovation

    • Affordability vs. Quality: The Supreme Court’s deliberation on standardising medical procedure rates across government and private sectors highlights the tension between affordability and quality. A study indicates a 15% increase in patient dissatisfaction in hospitals under financial pressure from price caps
    • Impact on Innovation: Price caps could slow the development of new treatments and technologies, particularly in high-investment fields like cancer research and robotic surgery. Value-based pricing, where payments reflect health outcomes rather than service volume, is proposed as a potential solution.
    • Economic Implications: Properly implemented rate standardisation can alleviate healthcare disparities but must avoid destabilising providers’ economic health. Dynamic pricing models, which adjust based on medical complexity and patient financial status, are recommended. Thailand’s tiered pricing system is cited as a successful example.

    Legal and regulatory challenges

    • No regulation on Rate Fixation: States like Rajasthan and Tamil Nadu have identified significant gaps in the provisions for rate fixation, indicating a need for more robust legal frameworks to ensure fair and standardised pricing across different regions.
    • Inadequate Laws as per Local Conditions: Current laws may not adequately consider local demographic and economic conditions, necessitating reforms that allow for more customised approaches to healthcare cost management.
    • Lack in uniform regulation: Moreover,” the Clinical Establishment Act of 2011″, aimed at setting standards for quality, transparency, and accountability, has been adopted by only a few states, and its implementation remains lax​​. This lack of uniform regulation allows for wide disparities in service costs and quality.

    Role of Data in Shaping Policies

    • Data-Driven Insights: Predictive analytics can foresee the long-term impacts of rate fixation on healthcare innovations, helping policymakers adjust regulations to encourage innovation and accessibility.
    • Pilot Projects: Implementing pilot projects in select districts can gauge the impact of rate caps on healthcare quality and innovation.

    Way Forward 

    • Balanced Pricing Models: Implement value-based pricing where payments are linked to health outcomes rather than the volume of services provided.
    • Supporting Innovation: Allocate government subsidies and grants for research and development in private hospitals.

    Mains PYQ

    Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

  • India and the ‘managed care’ promise

    PYQ Relevance

    Q Public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

    Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)

    Mentor Comment: Health insurance, now central to India’s UHC policy, is being enhanced by digital advancements, enabling reforms akin to the U.S. but with cost-effective local adaptations. A South Indian healthcare chain recently integrated insurance and care provision, forming an Indian-style MCO. This prompts reflection on MCOs’ potential to extend universal health care in India significantly.

    Let’s learn_ _ 

    Why in the news?

    Universal healthcare poses a multifaceted challenge, yet managed care organizations may offer a piece of the solution that Indian healthcare requires.

    What is a Managed Care Organization?

    • A Managed Care Organization (MCO) is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.

    The background of Managed Care Organizations (MCOs) in the United States and India:

    Evolution of MCOs in the United States:

    •  MCOs have their origins in rudimentary prepaid healthcare practices in the 20th century.
    • The mainstreaming of MCOs gained momentum in the 1970s due to concerns over healthcare costs.The economic slowdown post-1970s made high insurance premiums less attractive to purchasers.
    • A shift occurred towards integrating insurance and healthcare provisioning functions. Focus areas included prevention, early management, and cost control, all under a fixed premium paid by enrollees.
    • MCOs have evolved through multiple generations and forms, deeply penetrating the health insurance market. While evidence of their effectiveness in improving health outcomes and prioritizing preventive care is mixed, they have been effective in reducing costly hospitalizations and associated costs.

    Evolution of MCOs in India:

    • The first public commercial health insurance emerged in the 1980s.The focus has primarily been on indemnity insurance and covering hospitalization costs.
    • There is a significant market for outpatient consultations, valued at nearly $26 billion.
    • Health insurance in India has traditionally lagged behind life and general insurance. The sector faces issues such as lack of innovation and high, often unsustainable, operational costs.
    • As per Thomas (2011), Health insurance has played a secondary role to other forms of insurance. The industry’s operational inefficiencies and high costs have been persistent issues.

    Challenges in India:

    • Lack of Natural Incentives for Cost Control: The evolutionary trajectory of Indian health insurance has not incentivized consumer-driven cost control.
    • Target Demographic: Health insurance has mainly targeted a thin, urban, well-off segment, neglecting broader demographics.
    • Informality in Outpatient Practices: There is widespread informality among outpatient practices, complicating efforts to standardize and regulate care.
    • Lack of Clinical Protocols: The absence of widely accepted clinical protocols hampers the quality and consistency of care.
    • Economic Viability: Unprofitable operations and unaffordable premiums pose significant economic challenges, preventing sustainable growth and systemic improvement.
    • Limited Impact on UHC: Private initiatives, despite their potential, are unlikely to significantly contribute to Universal Health Coverage (UHC) without public support.
    • Insufficient Control Over Patient Journeys: Health insurers have little control over the patient’s journey before hospitalization, limiting their ability to manage early interventions and reduce costs through comprehensive outpatient care.

    Prospective Solutions and Remaining Issues:

    • Potential for Big Healthcare Brands: Large healthcare brands with loyal urban patient bases and substantial resources may initiate successful managed care projects.
    • Need for Public Patronage: Exploring managed care with cautious and incremental public patronage could be promising, indicating a need for government involvement to achieve broader impacts.
    • Underutilization of Outpatient Insurance: Given the low share of insurance in outpatient care spending and the average of three consultations per year per person, there is significant potential to reduce healthcare costs through early interventions and comprehensive outpatient care coverage.

     NITI Aayog Report:

    • Outpatient care insurance scheme: In 2021, NITI Aayog released a report advocating for an outpatient care insurance scheme based on a subscription model to enhance savings through improved care integration.
    • Yield significant benefits: A well-functioning managed care system can yield significant benefits, including consolidating practices, streamlining management protocols, and emphasizing preventive care in the private sector.
    • Catering for the beneficiaries of PMJAY: The report highlights the potential of incentives under the Ayushman Bharat Mission to encourage the establishment of hospitals in underserved areas catering to beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY).

    Conclusion: While Managed Care Organizations are not a perfect solution, they can play a role in addressing the complexities of achieving Universal Health Coverage (UHC) in India by being part of a broader strategy.