TOPIC: General Studies 2
- Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.
- Issues relating to development and management of Social Sector or Services relating to Health, Education, Human Resources
Why not a right to primary healthcare?
- According to liberal economists, the markets have to power to ultimately allow for a ‘perfect’, symmetric allocation of resources.
- This is assumed to lead an optimal or equilibrium price in case of all goods and services, thereby maximising the welfare of all stakeholders.
- However, development economists like Kenneth Arrow, Angus Deaton, Gerard Debreu have debated if privatisation in primary education and healthcare in developing societies lead to economically efficient outcomes.
India’s health scenario
- OECD study: there were 253 deaths per 100,000 persons in India. It is higher than global average of 178
- Reason: Communicable diseases
- Poorest health among emerging economies: India faces higher disease burden than China, Indonesia, Brazil, Mexico and Sri Lanka. Even, poor neighbours such as Nepal and Bangladesh have better health.
- Life expectancy comparisons: India (68), China (76), Bangladesh (72), Nepal (70), Sri Lanka (75)
Where lies the problem?
India’s poor health average can be attributed to
- Low public investments in preventive health facilities such as sanitation and waste management
- There is minimal focus to upgrade PHCs (primary health clinics) and accessibility to health professionals.
- The quality of public health services has deteriorated. As a result of which, Indians are compelled to spend heavily on private care. This increased the average out-of-pocket health expenditures.
- The unviable health insurance model has forced to visit the private healthcare centres during health shocks.
- Unexpected health emergencies + lack of public care centers + financial burden + insufficient medical insurance has pushed people on brink of poverty line to below poverty again.
- A worrisome stat: India’s out of pocket expenditure on health is a sixth of India’s poverty burden.
New National Health Policy (2015)
A Brief background
- Comes after almost 13 years since the last health policy in 2002
- It was conceived to address the basic but pressing health issues.
- Suggests making health a fundamental right whose denial will be justiciable vide a National Health Rights Act
- Proposed funding: General taxation, health cess, taxes on commodities like tobacco and alcohol etc.
- Role of private sector also included in services like ambulance, imaging and diagnostic, tertiary care etc.
- Focus: improving MMR, controlling infectious diseases, tackling non-communicable diseases as well as reducing medical expenditure.
- However, Parliament is yet to debate on it.
- Its vision is:
- Public health spending should touch 5 per cent of the Gross Domestic Product by 2020 (Current= 1.04%). Out of it, 70% should be on primary healthcare alone
- Per capital public spending on healthcare to be 3,800 at 2015 prices.
- Centre government shall contribute around 40% of the resources instead of present 20%
- States would allocate at least 8% of their total budget on health
NITI Ayog’s views
- Contrary to what New National Health Policy envisages, NITI Ayog has been against increasing public investments on health
- It is in favour of increase in private sector financing and insurance as a substitute to public health expenditure.
- According to it, States should increase their allocation in public healthcare sector vis- a-vis the Centre’s outlay on health.
- However, the primary source of funding must come from private financial sources.
- For this, CSR and PPP models can be used to address financial and operational challenges relating to health system.
Right to primary healthcare
- The free and compulsory education for all children (6-14 years) is a constitutionally recognised right under Right of Children to Free and Compulsory Education (RTE) Act at a State level
- This is not cited as a financial cost to national treasury.
- Instead, it is looked upon as an investment to brighter and better future
- Thus, primary healthcare can be treated as a fundamental right in a same way for the dependents, i.e. children below 15 years and senior citizens above 60 years.
- It is futile to compute and state the financial burden on national economy due to poor health.
- Good health makes a country capable to fulfil its national goals.
- A fundamental right to good health can be a first step towards enhancing primary health facilities in rural and urban areas.
- Rwanda and Thailand have proved that primary healthcare facilities throughout the state is a possibility
- Rwanda basics: a low income country, lower GDP than India but has an appreciable universal health coverage covering 7.8 million of its 11.8 million population
- The Chinese government is also pushing for significant reforms since last five yearsà to cover the primary health care service cost for all its people at a provincial level by 2020
- The Immediate Healthcare reform package includes 5 major programmes in its implementation plan. It includes establishing a national essential drug system and providing equal access to basic public healthcare services for all dependents.
State dedication to healthcare
- To say that a malnourished primary healthcare system imposes huge, implicit economic costs is to emphasise the obvious.
- Key is to implement right to healthcare at state level.
- A ray of hope: Tamil Nadu and Kerala have shown that well-funded and well-designed public health system can produce satisfactory health outcomes.
- The public health care can reduce out of pocket expenditure for those lacking the means to increase their real income.
- Instruments of development and liberty areà preventive health services and access to quality, primary education
Connecting the dots:
- Can increase in scope of private financing to fund public health care be a rational option? Evaluate.
TOPIC: General studies 2
- India and its foreign policy, its International relations
- Bilateral, regional and global groupings and agreements involving India and/or affecting India’s interests.
- What India has to do to become a ‘great power’
- Challenges concerned with Indian Foreign Service and its personnel
Reforming India’s foreign policy apparatus
India’s current status
- Celebrating its seventh decade of Independence
- World’s biggest democracy
- World’s seventh largest economy
- Member of the G-20 and BRICS (Without these countries, global growth would be below 4%)
- India’s influence of power is increasing in global arena, such as – in international financial institutions, growing acceptance as a nuclear-armed state etc.
- India has an impressive UN peacekeeping credentials
We can conclude India’s present status as “a global power which is not just recognized but increasingly institutionalized”.
India, particularly under the Narendra Modi government, has sought to influence global developments through a series of initiatives such as
- Neighbourhood First
- Act East
- Think West
- India-Africa Forum
India’s foreign policy apparatus, particularly the Indian Foreign Service (IFS), has so far shown courage and determination following up these initiatives.
However there are certain challenges that loom large for India.
- India is facing a defining period and its future is increasingly intertwined with developments in the international arena.
- Additionally, geopolitical and geo-economic shifts have created simultaneous opportunities and challenges.
- India has sought to influence global developments through a series of initiatives.
But for all this to be achieved India’s foreign policy apparatus, particularly the Indian Foreign Service, should be fit to serve India’s interests for the next decade and beyond. But can IFS do the needful?
Let us briefly look into this aspect
India’s future is increasingly intertwined with developments in the international arena, especially the geopolitical and geo-economic shifts such as –
- The opening with the US
- The rise of China and Beijing’s efforts to block India’s global accommodation
- The so-called Arab Spring and its aftermath
- The growing international tussles over climate, cyber, energy, food, the oceans and outer space
However, there are number of concerns facing Indian Foreign Service and its personnel.
- The numbers and skill sets of India’s foreign service personnel is very poor and is woefully out of sync with the global role that the political leadership envisage for the country
- India’s Foreign Service has the smallest number of diplomats among the G-20 and BRICS countries.
(According to the latest report of the parliamentary standing committee on external affairs chaired by Shashi Tharoor, the total number of IFS officers is 772—140 short of the sanctioned strength of 912 officers, making it one of the smallest.)
- There is a serious disconnect between the foreign policy requirements of the country and the language skills of India’s diplomatic corps.
(For instance, of the 772 IFS officers, only 569 have proficiency in any non-Indian language, leaving 203 diplomats with no foreign language ability whatsoever, the report says.)
The report cites “anecdotal evidence of Indian Ambassadors in Arabic-speaking countries being handicapped by their lack of knowledge of Arabic, and similar examples in a variety of countries”.
- Worse, there is an even greater disconnect between the foreign policy priorities and language skills.
- While the government has prioritized its Neighbourhood First policy, there is not a single diplomat with proficiency in either Bhutanese, Dari or Nepalese and a mere two with knowledge of Pushtu and only three diplomats with ability in Sinhalese.
- Similarly, both the Act East and Think West initiatives are poorly served by the lack of local language proficiency.
These will, doubtless, adversely impact India’s ability to advance its interests.
- The lack of numbers and inadequate language is most evident in Africa (a continent of increasing import for India), where over two dozen embassies remain headless for want of diplomats and most of the diplomats serving there have no knowledge of the local language.
Clearly, the numbers and skill sets of India’s Foreign Service is woefully out of sync with the global role that the political leadership envisage for the country.
The MEA is juggling multiple strategies to improve its manpower, including the possibility of non-resident Indians joining its ranks.
The way ahead
The committee’s report offers a series of practical and evolutionary steps to remedy the existing situation.
For instance –
- The quality of new recruits and their linguistic expertise should be taken well care of.
- MEA is now saying that it is ready to welcome non-resident Indians to join its ranks, with a recommendation to the UPSC to waive the Indian language provision if such applicants have done half of their schooling abroad.
- Create lateral entries into IFS.
- In the appointment of Indian ambassadors, there are plans to give more weightage to language expertise.
- The report also recommends for reforms in recruitment, structure and capacity-building of IFS Cadre, including need for a separate UPSC examination for cadre, mid-career entry and in-service training and orientation.
The Ministry of External Affairs ministry (MEA) is currently drawing up a blueprint for increasing the strength of India’s diplomatic bench – “Expansion Plan 2.0” – even as it faces questions from a parliamentary panel about the quality of new recruits and their linguistic expertise.
Until the recommendations are implemented and the situation is rectified, India—and the Foreign Service—will keep punching well below its weight.
Connecting the dots:
- India has sought to influence global developments through a series of initiatives such as Neighbourhood First, Act East, Think West, SAGAR and India-Africa Forum. However, a latest report of the parliamentary standing committee on external affairs criticizes the Indian Foreign Service (IFS) personnel. Critically analyze what are the challenges faced by the India’s foreign policy apparatus, particularly IFS and suggest suitable strategies.
- Discuss what stratagems India should adopt to achieve its external objectives and finally become a great power?
- Can India become a ‘great power’ with its Indian Foreign service personnel numbers and skill sets being very poor and woefully out of sync with the global role that the political leadership envisage for the country? Critically analyze.
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