- In the light of the recent deaths of several children over a short period in Gorakhpur, the country demands for equity in access to doctors, diagnostics and medicines in rural India.
- The weak nature of rural India’s health systems and the extraordinary patient load on a few referral hospitals has become even more evident from the crisis at the Baba Raghav Das Medical College in Gorakhpur.
- The incident is beyond the lack of oxygen supply, the dysfunctional aspects of the health system are evident from the Comptroller and Auditor General’s report on reproductive and child health under the National Rural Health Mission for the year ended March 2016.
- The picture that emerges in several States is one of inability to absorb the funds allocated, shortage of staff at primary health centres (PHCs), community health centres (CHCs) and district hospitals, lack of essential medicines, broken-down equipment and unfilled doctor vacancies.
1.It is imperative for the government to recognise the limitations of a market-led mechanism, as the NITI Aayog has pointed out in its action agenda for 2020, in providing for a pure public good such as health.
2.There is a need to move to a single- payer system with cost controls that make efficient strategic purchase of health care from private and public facilities possible.
- Bringing equity in access to doctors, diagnostics and medicines for the rural population has to be a priority for the National Health Mission.
4.We need to invest in training and deploying professionals in public health management at different levels of the system.
5.Based on a core combination of public health expertise and management skills, further specialisation can be customised for public health programme management and hospital management.
6.The disease surveillance system needs to be strengthened in both community and hospital settings, to provide reliable real-time data.
7The primary healthcare system must be well resourced and adequately staffed, to be capable of early detection and care, appropriate referral for advanced care when needed, and post-recovery counselling and follow-up.
8.Fully functioning health and wellness sub-centres and primary health centres must speedily spring and serve close to the communities rather than rest and rust as undelivered plans in the proposals of health programmes.
The private route: (The Hindu, Editorial)
- NITI Aayog’s recent proposal for the partial privatization of district-level government hospitals has been criticized for commercializing health care.
- Under the proposal, private hospitals will be allowed to bid for 30-year leases that give them control over portions of government hospitals dedicated to treating non-communicable diseases.
- Critics maintain that private hospitals focused on gains will be of no good to the poor who can’t pay for their services, so the government must step in to provide free health care.
- Affordability is indeed an issue preventing poor Indians from getting proper health care.
- Free health care provided by the government does not solve the problem.
- Governments often have very little incentive to provide quality health care to many citizens.
- Reason being, in politics, it is the benefits of powerful groups that get the most leverage.
- The poor, for various reasons related to electoral politics, often get left out of the race to influence their governments.
- In the marketplace, private hospitals have huge monetary incentives to proactively cater to the demands of their customers.
- Each consumer’s currency note holds equal weight to a private hospital that seeks profit. This makes market-based health care a fundamentally superior way to deliver health services to the poor.
How to make market-based health care more affordable?
- The standard notion in this regard is that for-profit health care works against the interests of the poor by making health-care more expensive.
- Various regulations are aimed mostly at reducing the profits of health-care investors and lowering the costs to consumers are imposed on investors.
- Unfortunately, these regulations, by denying investors the opportunity to make profits by providing health care, actually end up making health-care more unaffordable.
- This, in fact, works against the interests of the poor by reducing the supply of health care and increasing its price.
- The perfect way to make health-care affordable then is to increase its supply sufficiently, which in turn will lead to lower prices.
- It can only be achieved when health care is deregulated and investors are allowed to seek profits in an honest manner.
- This is how any good or service gets cheaper over time. As more investments are made into a sector in search of profits, the increased supply leads to lower prices for consumers and lower returns for investors.
- Sadly, it’s the thinking t that health care is too essential to be left to the market has prevented the health-care market from working like any other.
- It is no wonder then that luxury goods such as cell phones and cars have become affordable to a larger population over time. At the same time, health care has largely remained unaffordable to the vast majority of people.
Naming a right: (The Hindu, Editorial)
- The nine-judge Bench determining whether a fundamental right to privacy exists will definitively shape the evolution of our Constitution.
- What is at stake is nothing less than the terms of a fundamental relationship between citizens of a constitutional democracy and the state.
- A right to privacy embraces a wide range of things i.e. from preventing the state from watching the citizens without cause, to affirming that citizens can form and choose their identities, to deciding what information about citizens is collected by the state using the force of the law and how that information is processed and made available to whom.
- Each of these underpinnings of privacy raises different concerns and places different burdens on the state to justify intrusions.
- Thus, considering everything as ‘personal liberty’ flips the relationship between individuals and the state on its head.
- Also various fundamental rights share with the right to privacy, the characteristic of being specific forms of liberty.
- Rights are declared because they protect a value acknowledged as important and distinctive enough to merit constitutional force.
- And privacy follows the same logic.
- Irrespective of the outcome by nine judges, what is far more important is that they have the opportunity to empower each and every person in India with a right that lies at the very core of personal liberty.
‘Enact data protection law soon’: (The Hindu)
- India’s tech community, including technology billionaire Nandan Nilekani, who fronted Aadhaar, say India quickly needs a “data protection law.”
India’s requirement of data protection law
- The country needs a tactical position on data which represented risks such as colonization, privacy issues and a “winner-takes-all market,” in which the best players are able to seize a very big portion of the rewards, and the remaining contenders are left with very little.
- Data is being vacuumed out of the country and going into unaccountable systems that don’t come under Indian law, which probably share data with foreign governments, according to Mr. Nilekani.
- The law also has to make it incumbent on the data collector to immediately notify if there is any data breach.
- Due to the rapid adoption of smartphones, digital payments, social media platforms and Aadhaar authentications, India is going to become data rich very quickly, but there is a need to strategically think about data in a way that people of the country benefit from it.
Indian Economy. Planning, Growth and Employment
Ministerial group to oversee disinvestment: (The Hindu)
The Union Cabinet has mandated a panel led by finance minister Arun Jaitley to oversee, accelerate strategic disinvestments in CPSEs
- The Cabinet on Wednesday empowered a ministerial group led by Finance Minister Arun Jaitley to decide on details of strategic disinvestment of public sector firms.
- The Cabinet Committee on Economic Affairs (CCEA) has approved the proposal of the Department of Investment and Public Asset Management (DIPAM) for setting up an Alternative Mechanism (AM) consisting of the Finance Minister, Minister for Road Transport and Highways and Minister of Administrative Department.
- The panel will help the government raise more revenue from asset sales.
- It will decide on the matters relating to terms and conditions of the sale from the stage of investing of Express of Interest (Eols) till inviting the financial bid.
- The panel will decide on matters relating to terms and conditions of the strategic sale from calling for expressions of interest from potential buyers to inviting financial bids.
- The new mechanism will empower the core Group of Secretaries (CGD) to take policy decisions regarding procedural issues and to decide on deviations as and when necessary for the effective implementation of the decision taken by the CCEA.
- This will speed up the process of strategic disinvestment.
- The government has so far shortlisted BEML Ltd, Scooters India Ltd and Pawan Hans Ltd and three units of the Steel Authority of India Ltd for strategic disinvestment this year.
- The government has set an ambitious target of raising Rs72,500 crore from disinvestment in 2017-18, including Rs15,000 crore from strategic asset sales.
- Earlier this year, the government asked Niti Aayog to identify CPSEs for strategic disinvestment and advise it on the mode of sale, percentage of stake to be sold and the method for valuation.
- The CGD has been set up to consider the recommendations of the Niti Aayog to facilitate a decision by the CCEA on strategic disinvestment and to supervise the implementation process.
- The government has set up an alternative mechanism with the same composition to decide on minority stake sales in CPSEs.
Meaning of strategic disinvestment:
- Strategic disinvestment implies the sale of a substantial portion of government stake in a CPSE with transfer of management control.
- Strategic disinvestments have in the past been controversial and often become entangled in legal tussles.
Government should opt for competitive bidding in the most transparent manner so that allegations of favouritism could be avoided.
Infrastructure and investment models
AI shows interest in overhauling defence planes: (The Hindu)
The Civil Aviation Ministry has written to the Defence Ministry asking them to facilitate the servicing of defence aircraft at Air India’s Maintenance, Repair and Overhaul(MRO) facilities.
- Air India’s MRO unit, Air India Engineering Services Limited (AIESL) presently carries out MRO activities for commercial aircraft of various Boeing and Airbus.
- These facilities are based in Delhi, Mumbai, Hyderabad, Thiruvananthapuram, Nagpur, and Kolkata.
- In the beginning of this year, AIESL had applied for a bid to service Indian Air Force’s IL-78 mid-air refueller aircraft and four Embraer-135 aircraft.
- However, the bids were rejected because AIESL does not possess mandatory authorization certification required to be obtained for servicing these planes from the Russian-based OEMs.
- AIESL chief executive officer H.R. Jagannath said “under the Make-in India scheme, these aircraft should be maintained in India and by doing so, India can save a lot of foreign exchange”.
- Getting the maintenance manual details from OEMs was essential for maintaining any aircraft.
- The Comptroller and Auditor General(CAG), in its report in last month, had pointed out to “several loopholes in infrastructure facilities and maintenance and repair of the existing IL fleet”
- The audit report highlighted that India had only one hangar for 14 IL-76 aircraft and one for six IL-78 planes, which are due for overhaul in 2018-19.
- The report pointed out that due to non-availability of hangars, the costly air assets remained in the open which seriously affected their serviceability and life.