SECURE SYNOPSIS: 25 JUNE 2018
NOTE: Please remember that following ‘answers’ are NOT ‘model answers’. They are NOT synopsis too if we go by definition of the term. What we are providing is content that both meets demand of the question and at the same time gives you extra points in the form of background information.
General Studies – 1
Topic – Salient features of Indian Society, Diversity of India
Why this question
With the deadline for final draft of the Supreme Court-monitored National Register of Citizens (NRC) nears, it is prudent to understand the issue of migration in Assam and how far NRC can resolve the issues.
Key demand of the question
In the first part of the question, we have to throw light on the history of migration, the communities who migrated and the issues it has created. In the subsequent part, we need to examine whether NRC will resolve issues or create new ones.
Directive word
Examine – When you are asked to examine, you have to probe deeper into the topic, get into details, and find out the causes or implications if any .
Structure of the answer
Introduction – Give an overview of the current situation to explain why this question.
Body – In the first part, examine the nature of migration. Mention the history of migration – in 8th century Turks and Arab traders and sailors came to the Brahmaputra Valley and settled in the Darrang region, during British time, how tea plantation workers from other parts were taken to Assam pre independence, migration from Bangladesh etc. Highlight the issues arising out of migration – demography change, resource crunch, struggle for political power etc
In the subsequent part, explain the need for NRC, and the pros and cons of its implementation.
Conclusion – present your view on NRC and way forward.
Nature of migration in assam :-
- Migration into Assam is not a new phenomenon. Tribes from different parts of the world belonging to different races came to Assam throughout history.
- The Mongoloid race from West China, The Austric race, the Drabian race, and finally the Aryan race from the Gangetic plains have all immigrated to Assam before 1st century A D.
- In 8th century Turks and Arab traders and sailors came to the Brahmaputra Valley and settled in the Darrang region.
- Successive Mongoloid rulers invited Brahmin priests to Assam and got converted to Hinduism. Around 12th century, the Ahom rulers from Burma established their long lasting rule (till the advent of British).
- The Ahom rulers also converted to Hinduism but encouraged the co-existence of all other religions.
- British conquered entire region of Assam and brought together the various tribes in Assam under the administrative umbrella of Assam province. The British, soon after their occupation of the region found the soil and climate highly conducive to the cultivation of tea. So they brought large number of labourers from Bihar, Madhya Pradesh and Orissa to work in tea gardens.
- The British also imported large numbers of tillers from East Bengal, who were Muslims. The influx of Muslims into the region was constant and thorough.
- There is also immigration from different parts of India for commercial purposes .
- The large volume of influx of migrants have modified the population structure of Assam in respect of ethno-religious composition, literacy and education pattern, occupation structure, age-sex composition, economy, work force etc. and host of associated population problems in changing socio-political disturbance like ethnic clash etc.
National register of citizens:-
- The National Register of Citizens (NRC) is the register containing names of Indian citizens.
- It is a part of a much-awaited list that aims to separate the genuine residents of border state Assam and illegal Bangladeshi immigrants
- Nearly 32 years after the Assam Accord was signed, the first draft of an updated National Register of Citizens (NRC) for the State listed 1.90 crore names out of the 3.29 crore applicants.
- Assam is the only State in the country that prepared an NRC in 1951 following the census of that year and has become the first State to get the first draft of its own updated NRC.
- The NRC, 1951, is updated in Assam with the names of applicants whose names appear in NRC, 1951, or any electoral rolls of the State up to midnight of March 24, 1971, and their descendants and all Indian citizens, including their children and descendants who have moved to Assam post March 24, 1971.
Concerns and Challenges:-
- The initial publication of the register has caused confusion as many legal residents of Assam have found their names missing.
- The sudden appearance of a separate category of “original inhabitants” in the list. It is governed by the Citizenship Rules of 2003, which does not define “original inhabitants”. Even though the category has reportedly been withdrawn, it is not clear what criteria had been used in the first place.
- The possible disqualification of lakhs of applicants who had submitted panchayat documentsas proof of identity. The Guwahati High Court said they had no statutory sanctity. This left about 48 lakh people who had submitted such documents in the lurch.
- There is a renewed conviction that the exercise of counting Assam’s citizens is a political one, and the new register will be a document of exclusion, not inclusion.
- The issue has become much larger than a cut-and-dried question of who is an Indian citizen and who is not. There are important humanitarian concerns at play, concerns that go beyond identification and numbers.
- Nearly five decades have elapsed since the cut-off date of March 25, 1971, and individuals who have sneaked in illegally have children and grandchildren by now.
- Muslim fears:
- Compounded older fears of discrimination that haunt Muslims in the state, which has never quite recovered from the Nellie massacres of 1983.
- The concerns of the Bengali speaking Muslims have peaked due to the proposed amendment to the Citizenship Act, 1955. The amendment would allow illegal migrants who are Hindus, Sikhs, Buddhists, Jains, Parsis and Christians from Afghanistan, Bangladesh and Pakistan, eligible for citizenship.
- It embodies the paranoia of a volatile state.
- Paper issues:
- The process depended on countless fragile, fading documents, where entire family histories may be wiped out by a spelling mistake, a name misheard by surveying officials decades ago, a page missing from an old electoral roll.
- The bureaucratic ledgers are permeated by memory and hearsay, the document flickers between the official and the personal. It may have been this subjectivity in the counting process that laid it open to charges of political manipulation.
- In all least 10 districts the records are incomplete or unavailable.
- The concern for many in India is that a number of people may be deprived of citizenship through this process.
- Forged documents:
- Authorities detected a sizeable number of cases of persons trying to use forged documents to establish their Indian citizenship. Most of the persons who submitted forged documents are suspected to be illegal migrants
- Delay in process:-
- Most of the documents sent to authorities outside Assam are taking a lot of time. For instance around 65000 documents were sent to different authorities in West Bengal, only 30 have been sent back after verification so far.
There are some positives as well:-
- These are misplaced fears. The number of people who might get left out would be 50,000 at most. Even then, they will get an opportunity to prove their citizenship through claims and objections
- Despite concerns the initiative is praised by many experts as a necessity to reduce the migrant issue in Assam.
- NRC is the long awaited process for the people of Assam AASU and many other students’ organisation as well as social organisation wants it is the part of historical Assam accord.
- The publication of the updated NRC is indeed a positive step in so far as it puts to rest wild speculations about the extent of the illegal migrant population in Assam and the resulting polarisation that political parties have been exploiting to make electoral gains.
Conclusion:-
- The need of the hour therefore is for the Union Government to allay apprehensions presently in the minds of the people of Assam and take steps to contain any adverse fallout after the publication of the final draft of the NRC. At the same time, it also needs to spell out what it intends to do with the persons whose names do not figure in the final NRC.
Topic: part of Static series under the heading “Freedom of Speech and Expression and Censorship”
Key demand of the question
The question expects us to examine the situation related to freedom of press in India, the causes why it is under threat and the impact that it would have. In the second part, we need to bring out the press reforms required for media to regain the lost trust and function effectively as the fourth pillar of democracy.
Directive word
Examine – When you are asked to examine, you have to probe deeper into the topic, get into details, and find out the causes or implications if any .
Structure of the answer
Introduction – Highlight that India has fallen on the press freedom index with its position only slightly above Pakistan, which does not portend well with respect to press freedom in India.
Body – Bring out the status quo of press freedom in India. Examine the reasons why it is under threat. Discuss the impact that new forms of technology like social media has had on press freedom. Highlight the impact lack of freedom of press would have on democracy.
In the next part, discuss the reforms such as Leveson committee reforms etc which would help strengthen freedom of press by imparting greater credibility to media.
Conclusion – Discuss the importance of press freedom for democracy and the necessity of undertaking press reform asap.
Background:-
- Press Freedom is the indicator of Democracy. Balanced, free and fair press can take the country forward. The recently released Press Freedom Index, in which India slipped two places to rank 138th among 180 countries. It measures the level of freedomavailable to journalists and not the quality of journalism.
Growing threat to freedom of press:-
- India slipped two points on the World Press Freedom Index ranking and India’s ranking reflects growing bitterness towards journalists.
- The antagonism towards the media which is openly encouraged by political leaders poses a great threat to democracy.
- Government’s pressure on the name of Regulation, bombardment of fake news and over influence of Social media is dangerous for the occupation. Security of journalists is the biggest issue. Killings and Assaults on the Journalists covering sensitive issues are very common.
- Section 124a of IPC under which sedition is punishable by life imprisonment
- Although no journalist has been imprisoned under Section 124a of IPC for ‘sedition’, the law encourages self-censorship. Also, the coverage of regions regarded as sensitive by the authority like Kashmir is quite difficult in India.
- Foreign reporters are barred from the region and the Internet is often disconnected there.
- Kashmiri journalists working for local media outlets are often the targets of violence by soldiers acting with the central government’s tacit consent
- The killing of journalists in connection with their work
- One of the reasons India’s rating was downgraded were the incidents of murder of journalists.
- Hate speech targeting journalists shared and amplified on social networks
- It suggests scary picture especially in democratic countries where political leaders are openly threatening journalists, even incarcerating them if they refuse to offer their loyalty.
- India fared poorly on indicators such as hate speeches attacks on journalists on social media, trolling them and targeting their reputation. It also mentions that at least 4 journalists were gunned down in India in 2017.
Fourth pillar of democracy is not working well:-
- Survey conducted by Edelman, Indian media has been losing its credibility and trust among the people.
- The study has noticed a sharp drop in trust over the past two years in television news in India.
- Study indicates a bright future of the Indian newspaper industry. According to the Trust Barometer Survey, people trusted newspapers more than any other medium.
- Corruption-paid news, advertorials and fake news
- Competition for instant and quick news and reporting without first checking the facts. For example ,reporting of GPS nano chips in new 500 and 2000 notes.
- Corporate interest:-
- Corporate and political power has overwhelmed large sections of the media, both print and visual
- Corporates have financial stakes in either print or visual media leading to biased reporting.
- Overemphasis on TRP’s because they determine advertising revenue.
- Role of social media:-
- Social media enables antisocial people to become social.It helps lone wolves find the pack. More than a means to perform socially deviant roles collectively, social media offers a platform to do it anonymously. The Spreading of fake news further degraded the condition.
- Credibility issue:–
- Biasness of reporters, editors etc have dented the image of news channels and newspapers.
- Weak regulation:-
- Only a self regulating body like PCI (press council of India) has little power or legislative backup to regulate the press.
- Media Sensationalism, Lack of Media Ethics, Profit/Self-Interests v/s Public Interest, Senior Journalists are not stepping up/not taking initiatives to correct the wrongdoings in their respective media houses [silent/mute spectators] are other issues.
Reforms needed:-
- Workplace Harassment, Insecurity of Jobs, Gaps in Pay are the other areas which needs improvement.
- Ownership restrictions on holdings have to be legislated.
- Senior print and television journalists must speak write and expose very clearly the issues plaguing the press in India.
- Implementing the recommendations of TRAI with regard to media ownership and investment disclosure norms would help in maintaining transparency required for the news media sector.
- Basic regulation for digital media outlets like compulsory and online registration of details need to be implemented strictly.
- Robust surveillance and compliance mechanism need to be implemented effectively so that source of news is verified before
- Journalists must resist the urge to sensationalise matters. They must keep a global perspective, and pay attention to the words they use,
the examples they cite, and the images they display. - They must avoid speculation and finger-pointing in the immediate confusion following an attack when nothing is known, yet the demand for information is perhaps the strongest of all.
- They must consider carefully the fact that there is something inherent in terrorism as a violent act that provokes a fear in many that is far disproportionate to the actual level of risk.
- And most of all, they must avoid fostering division and hatred and radicalisation at both margins of society.
Conclusion:-
- In the interest of democracy it is essential that the exchange of ideas take place in an uninhibited manner where all citizens can access information free of bias and prejudice.
General Studies – 2
Topic: Development processes and the development industry- the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders.
Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Why this question
The question is related to GS-2 syllabus under the following headings-
Development processes and the development industry- the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders.
Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Key demand of the question.
The question wants us to write at length about the role of CBHI in strengthening the health information system in India. We have to discuss all the related aspects of the question (CBHI) and be as exhaustive as possible ( of course within the word limit).
Directive word
Discuss- This is an all-encompassing directive and here we have to write about the nature of CBHI, its vision and important activities it performs.
Structure of the answer
Introduction – Mention that CBHI was established in 1961 by an Act of Parliament on the recommendation of Mudaliar committee. It is the Health Intelligence Wing under Directorate General of Health Services (Dte.GHS), Ministry of Health & Family Welfare (MoHFW).
Body-
- Briefly discuss the vision of the CBHI and relate it to the importance of the work. We have to discuss why having a robust Health Management Information System (HMIS) is important.
- Discuss in points the important activities undertaken by CBHI. e.g National Health Profile, information on reform initiatives for Health Sector Policy Reform Option Database, National Health Resource Repository, Training and education, Collaboration with international bodies etc.
Conclusion- Reiterate the need for a strong HMIS in the country and suggest (if possible) how CBHI can be made more effective. Else, just conclude with a fair and a balanced opinion on the CBHI.
Background:-
- Health Management Information Systems is one of the six building blocks essential for health system strengthening. HMIS is a data collection system specifically designed to support planning, management, and decision making in health facilities and organizations.
- The health information system provides the underpinnings for decision-making and has four key functions: data generation, compilation, analysis and synthesis, and communication and use.
- The health information system collects data from the health sector and other relevant sectors, analyses the data and ensures their overall quality, relevance and timeliness, and converts data into information for health-related decision-making.
Central Bureau of Health Intelligence:-
- CBHI, established in 1961, is the health intelligence wing of the Director General of Health Services in the Ministry of Health & FW, GOI with the vision to have a strong Health Management Information System in entire country.
- This national institution is headed by a SAG level medical officer with specialization in public health administration of Central Health Services (CHS), supported by officers from Indian Statistical Services as well as CHS through its field survey and training units.
- The Mission of CBHI is to strengthen Health Information system in each of the district in the country up to facility level for evidence based decision making in the Health Sector.
Central bureau of health intelligence:
- The objective of CBHI is to
- To collect, analyze & disseminate Health Sector related data of the country for evidence based policy decisions, planning and research activities
- To identify & disseminate innovative practices for Health Sector Reforms
- To develop Human resource for scientifically maintaining medical records in both Government & private medical Institutes in India
- To carry out Need Based Operational Research for Efficient implementation of Health Information System & Implementation of Family of International Classifications in India
- To sensitize & create a pool of Master Trainers in Health sector for implementation of Family of International Classification in India
- To collaborate with National & International Institutes for imparting knowledge & skill development
- To function as collaborating centre for WHO FIC in India & SEARO countries.
Major Activities of CBHI
- CBHI collects primary as well as secondary data on various communicable and non-communicable diseases, human resource in health sector and health infrastructure from various Government organizations/ departments to maintain and disseminate Heath Statistics through its annual publication “National Health Profile” .
- CBHI collects the information on reform initiatives for Health Sector Policy Reform Option Database (HS-PROD).
- CBHI solicits information on such reforms from State/UT governments, health program managers, researchers, teachers and institutions in order to regularly update this national database.
- National Level Man-power Development Training Programs:-
- For capacity building and human resources development in health sector, CBHI conducts in-service training programme for the officers and the staff working in various Medical Record Department & health institutions of the Central/State governments, ESI, Defense and Railways and well as private health institutions through its various training centres.
- CBHI Provides Internship and Health Management Programmes for the students of National Universities and Institutes and also collaborates with international bodies etc.
- Understanding the need of timely and accurate health resources data from both public and private sector, CBHI conceptualized the framework of making a National Health Resources Repository (NHRR), where both public and private sector data resides.
Topic – Role of civil services in a democracy
Why this question
With the recent news of lateral entry in government service capturing headlines, the focus shifts to performance of IAS officers and whether they have dutifully performed the role that was envisaged of them – becoming the iron frame. Answer to this question would automatically help us do a critical analysis of lateral entry in civil services.
Key demand of the question
The question expects us to critically comment on whether several of India’s developmental challenges like malnutrition, poor learning levels etc are a result of the faults within the IAS system.
Directive word
Critically comment – When you are asked to comment, you have to pick main points and give your ‘opinion’ on them based on evidences or arguments stemming from your wide reading. Critically comment is also forming opinion on main points but in the end you have to provide a fair judgement.
Structure of the answer
Introduction – You can start with explaining the vision of sardar Patel regarding the role of civil services in democracy.
Body – Focus should be on examining how far the IAS have helped the country in carrying out projects and running administration so that the fruits of development are enjoyed by everyone. We should also bring out the failures of IAS system such as myopic understanding of their role, bend under political pressure etc which have led to sub-optimal results in several critical challenges like malnutrition etc.
Conclusion – give a fair and balanced view along with the way forward which is unleashing civil services reforms.
India’s developmental challenges are due to failure of IAS system:-
- Loss of innovation:-
- Despite initial competence and enthusiasm, the hard reality is that many civil servants in the course of the 30 years of their career lose much of their dynamism and innovativeness, with no faith in their own contribution to public welfare.
- The fatal failing of the Indian bureaucracy has been its low level of professional competence.
- The IAS officer spends more than half of their tenure on policy desks where domain knowledge is a vital prerequisite. However, quick transfers from one post to the other in many states dampens the desire to learn.
- In Uttar Pradesh (UP) the average tenure of an IAS officer in the last 10 years is said to be as low as six months.
- Experts criticize that this service has been primarily responsible for India’s failure to achieve Millennium Development Goals (MDGs) in hunger, health, malnutrition, sanitation, and gender, as most IAS officers could neither design effective programmes nor can they implement them with accountability.
- At present, officials at all levels spend a great deal of time in collecting and submitting information, but these are not used for taking corrective and remedial action or for analysis, but only for forwarding to a higher level, or for answering Parliament/assembly questions
- Due to the control that the IAS lobby exerts on the system, a large number of redundant posts in the super-time and superior scales have been created to ensure them quick promotions. Often a senior post has been split, thus diluting and diminishing the scale of responsibilities attached with the post.
- Corruption and politicisation of the civil services have become more entrenched in the Indian Administrative Service (IAS).
- Unfortunately, the IAS faces a number of serious challenges from diminishing human capital to political interference that, if left unaddressed, will lead to further institutional decline. While a competent, functional IAS may not be a sufficient condition for improving key development and governance outcomes, it is likely a necessary one.
- A Hong Kong-based organisation, in its study in 2012, rated Indian bureaucrats high on the index of red tape among other bureaucracies of Asian countries . It revealed that working with the civil servants in India is a slow and painful process
- Older officers who enter the service as part of larger cadres face limited career prospects and are less effective at improving economic outcomes.
- Nearly seven decades following independence, India’s steel frame is exhibiting considerable signs of strain. Even insiders agree that the apex civil service is not functioning anywhere close to its highest capacity.
IAS has contributed a lot for development of the country:-
- Historically, the IAS was needed because India is a union of states, has a federal system, with all essential subjects with which the people are concerned, such as education, health, agriculture, water, housing, and police, being dealt with at the state level, but largely supervised and funded by the centre.
- A common civil service not only facilitates coordination, but also helps in national integration as almost half the IAS cadre in each state consists of outsiders. A rigorous process of recruitment for the higher civil services ensures that the best talent available in society joins the civil service in India.
- It has played a crucial and storied role in managing natural disasters, preserving law and order during episodes of political instability, and conducting free and fair elections.
- District magistrates oversee revenue collection, law enforcement, and crisis administration, making them among the most powerful bureaucrats in the country.
- They also are responsible for supervising all infrastructure development projects and working with district-level agencies to implement centrally sponsored schemes like the Pradhan Mantri Gram Sadak Yojana, an all-India rural roads program, or the National Rural Employment Guarantee Scheme, a federal workfare program and the largest social-sector scheme in the world
Reforms needed:-
- Lateral entry:-
- Internal specialisation must be promoted by insisting on stable tenure in the states so that there is incentive for the Indian Administrative Service officers to acquire expertise in their chosen sectors.
- Also, the IAS officers should take the entry of the outsiders as a challenge, because if they do not improve their performance, there could be repetition of such recruitment every year.
- After the first 10 years of service, each IAS officer should be encouraged to specialise in one or two chosen sectors by not only giving them long tenures, but even permitting them to join academic or research organisations where they could improve their intellectual skills.
- Developing a new administrative culture is the need of the hour. To ensure a flexible and simplified structure and procedure we need to imbibe the spirit of development administration.
- Immediate reforms should be brought about by the Government to reshape recruitment and promotion processes, improve performance-based assessment of individual officers, and adopt safeguards that promote accountability while protecting bureaucrats from political meddling.
Topic: Development processes and the development industry- the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders.
Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Why this question
CBHI has recently released the annual National Health Profile for the year 2018. The report throws light on the state of health infrastructure in the country. The issue is related to GS-2 syllabus under the following heading –
Development processes and the development industry- the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders.
Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Key demand of the question.
The question wants us to bring out the overall importance of a robust and efficient health infrastructure for a country/ society. It wants us to highlight the status of health infrastructure in India as revealed by the NHP-2018. Thus we have to correlate both the aspects and discuss what should be done in this regard.
Directive word
Critically analyze- we have to dig deep into the question, identify and deliberate upon its key demands. Based on our discussion, we have to form a personal opinion in the form of a way-forward.
Structure of the answer
Introduction– Briefly discuss the performance of India globally, in terms of various health/ socio-economic parameters like HDI, Hunger index, TB, Malnourishment, IMR, MMR etc. Also mention that poor health infrastructure is one of the most critical factor hampering India’s development and constitutional goals.
Body-
- Bring out the overall status of health infrastructure in the country as depicted by NHP-2018. E.g Educational infrastructure vs service infrastructure; increase in no. of medical and dental colleges, lack of hospitals including mental hospitals and blood banks in the country, south vs north difference in infrastructure etc.
- Discuss what should be done in this regard; e.g increasing health spending by the govt, increase private sector participation and investment, proper insurance policies, improve basic infrastructure to make it attractive for private sector participation, medical tourism, open date etc.
Conclusion– mention the Ayushman Bharat scheme and other such schemes, which need to be consolidated, backed by adequate resources and periodically revised in order to achieve the SDGs.
Background:-
- Health plays an important role in the development of any society. Unfortunately, health infrastructure and health scenario in India is very poor.
- Across the country, the bed-to-people ratio is 1:422.The existing record of Government hospitals is worse. Thirty five per cent of patients in private hospitals belong to lower income groups with many of them not having any insurance cover.
- According to studies conducted by FICCI, about 7-8 per cent of households are pushed below the poverty line due to expenses incurred on health care. These facts point to critical gaps in infrastructure, especially with respect to the availability of healthcare centres and well-trained staff.
National health profile 2018 findings:-
- The National Health Profile covers demographic, socio-economic, health status and health finance indicators, along with comprehensive information on health infrastructure and human resources in health.
- There are noteworthy improvements in health indicators such as life expectancy, infant mortality rate (IMR) and maternal mortality rate (MMR) due to increasing penetration of healthcare services across the country, extensive health campaigns, sanitation drives, increase in the number of government and private hospitals in India, improved immunisation, growing literacy etc. Initiatives such as Janani Shishu Suraksha Karyakarm, Janani Suraksha Yojana, Reproductive, Maternal, New-borns, Child and Adolescent Health Services and national programmes to curb incidences of diseases such as polio, HIV, TB, leprosy etc have played pivotal roles in improving India’s health indicators.
- It has divided health Infrastructure indicators is subdivided into two categories viz. educational infrastructure and service in
- Educational infrastructure:-
- Medical education infrastructures in the country have shown rapid growth during the last 26 years.
- There has been a marked improvement in the Dentist to population Ratio.
- Medical education infrastructure in the country has shown rapid growth during the last 20 years. The country has 476 medical colleges, 313 Colleges for BDS courses and 249 colleges which conduct MDS courses. There has been a total admission of 52,646 in 476 Medical Colleges & 27060 in BDS and 6233 in MDS during 2017-18.
- Ayush:-
- India, with its kaleidoscopic variety and rich cultural heritage, is proud of some unique medicinal forms that look at health, disease and causes of disease in completely different ways.
- Best known as the AYUSH, its main focus is on holistic health and well-being of humans. Over the years with gaining popularity, there is a steady rise in total number of registered AYUSH Doctors in India
- Health finance:-
- The North Eastern states had the highest public health expenditure as a percentage of GSDP in 2015- 16 (2.76%).
- With the government sparing just 1.3 per cent of the GDP for public healthcare, way less than the global average of 6 per cent, there remains a severe scarcity of doctors in the country and people continue to incur heavy medical expenditure across rural and urban hospitals.
- Insurance:-
- Around 43 crore individuals were covered under any health insurance in the year 2016-17. This amounts to 34% of the total population of India. 79% of them were covered by public insurance companies
- Non communicable diseases:-
- After completion of 70 years of independence, India has witnessed remarkable progress in the health status of its population.
- Changes have been seen in economic development, nutritional status, fertility and mortality rates and consequently, the disease profile has changed considerably.
- Though there have been substantial achievements in controlling communicable diseases, still they contribute significantly to disease burden of the country.
- Decline in morbidity and mortality from communicable diseases have been accompanied by a gradual shift to, and accelerated rise in the prevalence of, chronic non-communicable diseases (NCDs) such as cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD), cancers, mental health disorders and injuries.
- According to the report, one allopathic government doctor in India, on an average, attends to a population of 11,082, which is 10 times more than the WHO recommended a doctor-population ratio of 1:1,000.
- Infant and maternal mortality
- Along with the life expectancy rate, there is noteworthy progress in health indicators such as the infant mortality rate and maternal mortality rate (MMR) in the country.
- NHP mentions that as per the SRS Statistical Report of 2016 by the Registrar General of India, the TFR in 12 India states has fallen below two children per woman.
- Regional disparities:-
- Huge disparity in the availability of healthcare resources continues to exist in India. The rural urban divide is considerable when it comes to healthcare access. Fairly-developed states like Kerala, Maharashtra and Tamil Nadu have brought down their IMR, TFR and MMR rates and states like Assam, Jharkhand continue to grapple with these issues even today.
Way forward:-
- To tackle the above mentioned challenges, private hospital chains should set base in emerging cities to provide health-related infrastructure.
- The Government should come up with investment-friendly policies in the health sector. Tax holidays, land bank to support builders of hospitals, special interest rates and loans from banks, benefits for setting up of private practices, hospitals, diagnostic centres and pharmaceuticals, can change the face of healthcare infrastructure in India.
- The revenue earned from Medical Tourism could help subsidise medical costs for poorer patients.
- Easing of regulations in opening and governing of medical colleges is another policy change warranted in this sector.
- Better compilation of per capita expenditure data of patients and availability of beds at the regional or local levels within states can help investors set up hospitals for the needy. The Government should demarcate health circles and priority areas for intervention, based on available information, indexed with health standards of each particular area.
Conclusion:-
- Universal access to health care is a well-articulated goal for both global institutions and national governments. India’s National Health Policy, 2017 envisions the goal of attaining highest possible level of health and well-being for all at for all ages through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without financial hardship to the citizens.
- Ayushman Bharat Mission, world’s largest health scheme announced in the Union Budget 2018-19, is the latest initiative for expanding the health insurance net and targets 10 crore poor and deprived rural families. These need to be efficiently implemented to achieve sustainable development goals.
Topic: Issues relating to development and management of Social Sector/Services relating to Health
Why this question
With several crucial health reforms on the anvil, benchmarking against global best practice in healthcare can only give is better ideas to make our reforms more effective.
Key demand of the question
The question expects us to analyze how the indian design of healthcare system is closely related to the national health service of UK, the shortcomings in our implementation which have obstructed us from achieving the same result as NHS in UK and lessons we can learn from the same. We also need to bring out the other viewpoint that comparing the results of the two would be as different as comparing apples and oranges.
Directive word
Analyze – When asked to analyze, you have to examine methodically the structure or nature of the topic by separating it into component parts and present them as a whole in a summary.You need to conclude with a fair judgement, after analyzing the nature of each component part and interrelationship between them.
Structure of the answer
Introduction – Explain what NHS is and the principles on which indian healthcare system was designed.
Body – Bring out the point of similarities in vision of NHS and Indian healthcare system. Highlight the reality of both these systems in present times. Explain that NHS has made healthcare affordable, universal etc which we have failed to do. Examine the reasons why – multiplicity of regulatory agencies, poor spending on healthcare, rise of private players etc. Also discuss the alternate viewpoint that challenges of UK and India differ significantly in terms of resources available, complexity in terms of burden of diseases, economic strata of patients, paucity of infrastructure etc and hence like to like comparison can not be done.
Conclusion – present a fair and balanced view, discuss the lessons learnt and way forward.
Background:-
- The deaths of more than 70 children in Uttar Pradesh last year reflect the appalling state of public health in India. According to the latest Global Burden of Disease Study, which ranks countries on the basis of a range of health indicators, India has the 154th rank, much below China, Sri Lanka and Bangladesh.
National health service of UK:-
- NHS is a single powerful, organised system owned and driven smoothly by the government and works as the heart and brain of healthcare sector in the UK
- All the medical facilities are owned by the government and the people working in the NHS are employed directly by the government.
- One of the best part of NHS is that it is totally financed out of taxation. Every health service is provided free of cost to all the permanent UK residents.
- The major player in healthcare sector of UK is the NHS, even though the private agencies exists. The cost of healthcare services provided by the private agencies is met by the private health insurance schemes.
How Indian healthcare system resembles National health service of UK:-
- The founding principles of health care for India were established through the Bhore Committee. Here, health care was envisaged as comprehensive, universal and free at the point of delivery, based on a government-led service, and to be paid from tax-funded revenues. These policies were adopted from the National Health Service (NHS).
They are not similar due to issues in implementation:-
- The UK health systems provide universal coverage for the population. Relative to other countries, the NHS provides highly equitable care. It also performs well internationally on a number of reported measures of experience and access. Indian health care system performance is abysmal.
- Public health care failure in India:-
- India’s health model has declined because of chaotic, mismanaged, unregulated and discriminatory policies and the priorities of successive governments.
- The complex and multiple levels of healthcare authorities each with different set of goal and programmes makes the Indian healthcare system a complete mess.
- Lack of proper regulation and name-sake public hospitals are indirectly helping the private corporate hospitals.
- The common man has to either be satisfied with the poor quality health service that is available at the public hospitals or else he has to spend money from his own pocket to get good quality services from the private hospitals.
- Without providing good facilities like safe drinking water, proper waste disposal system, ensuring quality nutrition, healthy environment etc, India is looking at development from a wrong perspective.
- Private sector domination in India:-
- Due to regressive policies India has created a system in the form of the urban private sector, which is responsible for most health care in India. The private sector over-medicalises and overcharges the patients to meet management targets,
- There has been a paradigm shift from a ‘service’ to a fee-for-service model of health care. All this disorganisation has led to a trust deficit between patient and doctor.
- Health care in India is changing from a conservative, clinical, affordable, accountable, patient-centric British model to a more investigative, aggressive, expensive, commercial and insurance-driven American system, without the safety mechanisms of either.
- Financing:-
- India has one of the highest (86%) out-of-pocket (private) expenditures on health care in the world. With little or no health insurance, this leads to approximately 40 million people falling below the poverty line every year.
- States have been reducing their health-care spending efforts in relation to total government spending. In 2013-14, the per capita public expenditure on health in U.P. was Rs.452.
- General physician:-
- In UK, every person has to consult the General Practitioner (GP) doctor with whom he/she has registered. No patient can go directly to a specialist doctor.
- This is unlike the case in India where the patient decides which specialist he wants for specific diseases. The GP doctors in UK act as both a guide and a filter to the appropriate specialist.
- By giving more importance to the concept of family doctors and GPs, NHS has moved far away from the consumer driven healthcare market.
- Basic investigation:-
- A patient might need to wait for weeks or even months to get a basic investigation done in UK. But here in India, investigations ranging from routine blood tests to MRI scans can be done at patient’s will anytime he wants. Most of such investigations done by the patients in India are in fact a waste of time and money.
- Medicines:-
- Pharmacies in UK do not sell medications unless there is registered doctor’s prescription. The number of private pharmacies working outside the NHS hospitals have a contract with the NHS to issue drugs only in a systematic and well organised manner.
- On the other hand, the vast majority of pharmacies in India are owned privately. Any person can get any sort of medicine for “over the counter” purchase and the worst part is that prescriptions are not even required.
- Healthcare provider’s revenue is just the premium, and no other costs are paid. The NHS does not pay for any excess diagnostic tests/or treatment administered. There is, thus, no incentive to provide excessive treatment which is the case in India.
Even UK health system suffers from the following issues:-
- When the UK is compared to other Western European economies, UK also has fewer doctors per thousand population and fewer hospital beds per thousand population. Again these are problems India faces and to a greater degree. The UK also struggles with rising demand as the population demographic becomes older and more people survive but with long-term diseases.
- The root of the crisis inadequate funding . Funding has failed to keep up with the needs of a system pressurised by an expanding and ageing population, and advancing medical technology.
- Adding to this are the cuts that have been made to social care budgets across the country.
However challenges of UK and India differ significantly in terms of :-
- Resources available
- Extremely high disease burden for India:-
- India still faces many communicable diseases (malaria, dengue and tuberculosis) which require a robust public health system. Along with non-communicable diseases (diabetes, heart disease and cancer) also on the rise, this is a double burden.
- Economic strata of patients, paucity of infrastructure etc and hence like to like comparison can not be done between UK and Indian healthcare systems.
Way forward:-
- International lessons:-
- For instance, Thailand has enacted a law to make quality health care a constitutionally guaranteed right. Unlike in India, Thailand has undertaken structural reforms in the health sector to achieve the goals stated in the Health Act. Even before it started reforms to attain universal health coverage, it began massive investments to build public health facilities in rural areas.
- Both countries need to invest in prevention as well as cure, both need to recognise the huge benefits of primary care in the community as well as hi-tech hospitals and they both need to disinvest in treatments which don’t work.
- Both countries need to ensure that the private sector supplements the government sector, rather than being a substitute for it.
General Studies – 3
Topic – Indian Economy and issues relating to planning, mobilization of resources, growth, development and employment.
Major crops cropping patterns in various parts of the country, different types of irrigation and irrigation systems storage, transport and marketing of agricultural produce and issues and related constraints; e-technology in the aid of farmers etc….
Why this question
Agriculture is the main occupation of almost half of the Indian population and the sector is today at crossroads facing various challenges. Although it is a general question, it will help you in framing answers for other questions and also for your essay. The issue is related to GS- 3 syllabus under the following heading –
Indian Economy and issues relating to planning, mobilization of resources, growth, development and employment.
Major crops cropping patterns in various parts of the country, different types of irrigation and irrigation systems storage, transport and marketing of agricultural produce and issues and related constraints; e-technology in the aid of farmers etc….
Key demand of the question.
The question wants us to express our understanding and knowledge of the issue. We have to bring out the problems of Indian agriculture in relation to viability, profitability and sustainability and how they could be solved.
Directive word
Comment- We have to present our knowledge and understanding of the issue and present our opinion on the causes of these problems and how they should be handled.
Structure of the answer
Introduction – Mention that agriculture contributes just about 16% to India’s GDP but employs about half of its population etc.
Body–
- Discuss in detail the problems of viability and profitability in agriculture, and also the issue of sustainability. Discuss these problems vis a vis their underlying factors e.g shrinking land-holdings and farm sizes, increasing competition internationally, high prices of inputs, entry of multinational corporations, climate change, land degradation, problem of plenty followed by period of scarcity etc.
- Discuss what should be done in this regard- e.g Irrigation, Infrastructure, Investment and Insurance sectors – need to be strengthened for an integrated development of farm sector, training of latest know-how and trained in the do-how in order to improve farm productivity; diversification of crops, efficient distribution of food grains, better weather information and advisory services etc.
Conclusion– based on your above discussion, form a fair, balanced and a concise opinion on the given issue.
Background:-
- Although agriculture contributes only around 17% to the country’s GDP, nearly half of India’s labour force (47%) works in the agrarian sector. With a predominantly rural backbone of the agrarian economy, efforts to improve agricultural labour productivity are needed to raise the living conditions of the majority of the population.
Issues plaguing Indian agriculture:-
- Farm incomes are unattractive for a variety of reasons:-
- The overriding objective of price stability, over time, has tilted farm policy in favour of the consumer, the numerically larger vote bank.
- Trade and price controls are highly restrictive, and mostly anti-farmer.
- Protection afforded to the inefficient fertilizer industry ensures that input costs are high.
- The farmer is forced to sell in the domestic market where prices tend to be lower than global agricultural prices.
- In the absence of state intervention, prices soar in bad weather years and plunge in good weather years, hurting consumers and farmers.
- Shrinking land-holdings and farm sizes, increasing competition internationally, entry of multinational corporations, climate change, land degradation etc are other issues.
- Lack of funding:-
- Despite efforts by the government to improve labour productivity, as per 2014-15 levels the total amount spent on AgRE&XT is only 0.7% of the GDP derived from agriculture (GDPA). This is against the minimum level of 2% as proposed by the World Bank.
- Eastern states, which are also some of the poorest in the country, spend the least on Agricultural research.
- Inefficient use:
- Of the total amount devoted to Agricultural research, about 70% is utilised for crop husbandry purposes, and only 10% is used for animal husbandry and dairy development. This is despite the growing importance of animal husbandry and dairy to the Indian masses.
- No communication:-
- AgRE &XT sector is plagued by disparate and disjointed entities and players (NGOs, public and private enterprises, and institutional bodies), without any channel of communication or synergy between them.
- Lack of awareness leading to:-
- In remote and disadvantaged areas, farmers are rarely contacted by extension agents
- Several farmers have committed suicide especially in the states of Andhra Pradesh and Maharashtra because of indebtedness and repeated crop failures.
- Though contract farming performed by agri-business companies do provide some kind of integrated support, they don’t focus on farmer organizational development.
- ICAR initiatives failure:-
- Though ICAR’s extension initiatives have been important to transformations in Indian agriculture, their capacity and reach has always been limited compared to those of first-line extension systems run by State-level departments of agriculture.
- Further, since agriculture is a State subject, the mode of organisation and operation of public extension systems vary widely across States.
Way forward:-
- India should have to develop a Human Resource Management Plan at the state levelto figure out capacity gaps, bringing new expertise and enhancing capacities of existing human resources.
- Extension still operates in the Research-Extension-Farmer paradigm that restricts its linkages to only research and farmers. Extension needs to embrace systems frameworks such as innovation systems framework, which accommodates more number of actors, their interactions, role of institutions and learning to reinvent its future.
- Effectively capitalising the global competitive advantage, Indian agricultural instituteshave to work out policy with regards to technology, more market access opportunities, and more transparency.
- Foremost requirement is investment in activities which create productive assets. The agriculture sector needs huge investment to transform and become more attractive and remunerative.
- There are three possible options to supplement government investment:
- Converge various region-wise government schemes into one umbrella programme. This will check duplication of efforts and reduce administrative costs.
- More incentives may be given to corporate social responsibility (CSR) initiatives for agricultural development schemes.
- Pilot public-private partnerships (PPPs) in developing agri-infrastructure.
- Role of start-ups offers huge potential in the agriculture sector that is yet to be harnessed.There are opportunities for start-ups for agri-packers and movers, door delivery of inputs, services and agro-advisory. A small farmers agribusiness consortia (SFAC) can take the lead in developing appropriate institutional arrangements to attract agribusiness start-ups for such initiatives, which will help smallholders to take advantage of government programmes.
- The holistic plan should encompass technology, risk, institutions, policy and skills
- Technology incubation: outcome-based technology policy encouraging research, innovation and incubation
- Risk institutions and financing: Banks and financial institutions to help promote technology infusion, insurance and mechanization
- Institutions of governance: Promote farmer-producer organizations to be agri micro, small and medium enterprises
- Policy for farming: Focus on improving human and farm productivity
- Skilling: Agricultural technical training institutes
- Pradhan Mantri Kisan Bima Yojanaand other schemes must be followed up with steps in the national budget. This will bring a new focus to agriculture.
- Irrigation, Infrastructure, Investment and Insurance sectors need to be strengthened for an integrated development of farm sector
- Diversification of crops, efficient distribution of food grains, better weather information and advisory services etc are also needed.
