TOPIC: General Studies 2
- Bilateral, regional and global groupings and agreements involving India and/or affecting India’s interests
- Effect of policies and politics of developed and developing countries on India’s interests, Indian diaspora.
India-China and the Changing World Order
Evolution of the world order
- The control of nations on the global geopolitics has shifted hands from Asian powers till the late 18th Century to the Western nations such as United Kingdom and United States of America.
- The late 19th century and the 20th century have witnessed the Western powers using imperialism and colonialism to dictate trade and even production and consumption.
- The contemporary events now hint at history repeating itself and the power returning in the hands of the Asian powers once again.
Changes that have occurred
- The relative decline of the U.S. that has occurred both economically and strategically. However, focus is also needed on Asia’s re-emergence.
- Declining supremacy and might of the global institutions such as World Bank, International Monetary Fund (IMF) and World Trade Organisation (WTO) and emergence of institutions such as BRICS Bank and Asian Infrastructure and Investment Bank.
- Increase in the limits to trade liberalisation in the West also.
- Containment, as adopted during the Cold War, is not effective in Asia since China is emerging as the largest global economy and has no close competition.
- Alliances, as formed during the World War, are also losing significance in Asia as economic influence is attaining greater importance than military influence.
- Emergence of the New U.S. President Elect, Donald Trump who intends to focus on “America First” approach with focus on resetting ties with Russia and build a very strong relationship with China based with focus on trade.
- Emergence of Right wing leaders across various nations.
- Exit of the UK from European Union.
- Annexation of Crimea by Russia and its impact on the power equation between USA and Russia.
Emergence of Asia
- Asia will be restored as the economic centre of global politics
- Asia will also be the main centre of commercial transactions and trade rules will be limited to standardisation and dispute settlement only unlike the prevailing trade regime under the WTO framework.
India and China – Common Values
China and India have had much in common in terms of physiography and strategic ideology.
- Both countries have major snow fed rivers as boundaries.
- Strategically, both the nations have not been believers of conquering nations outside their territories of influence.
- Contrary to western belief, both these nations focus on building partnerships based on common values.
- In terms of political ideology as well, both China and India give due importance to secularism, human rights and welfare of all.
- They have had a common agenda at the United Nations (UN) as well. Both the nations have not been favouring the international relations based on the global strategy of shared natural resources, technology and prosperity.
- The great positive of the India-China relationship in the recent years has been the increased business-to-business and people-to-people contacts between citizens of the two countries.
Scope of Cooperation
- China’s One Belt, One Road (OBOR) initiative is an opportunity for both nations to collaborate and take a lead in connectivity-led trade in Eurasia.
- Both the nations should give recognition to each other’s special interests in the South China Sea and the Indian Ocean and enhance the strategic advantage from it.
- There is a need to come to a mutual understanding on the issues of membership of the Nuclear Suppliers Group (NSG), global terrorism, and China’s role in Gwadar.
- China has also suggested a free trade agreement and both countries aspire towards creating an ‘Asian Century’.
- India’s advantage in terms of knowledge industry complements those of China in infrastructure and investment.
- China is the world’s largest producer of goods and India is the largest producer of services. India will have an advantage in this since the future growth in Asia will be service sector oriented.
- India has the potential to be the world leader in terms new knowledge-based order through its pharmaceutical sector, information technology and crop varieties.
- It is the only country with both extensive endemic biodiversity and world-class endogenous biotechnology industry.
- India is also developing low cost and indigenous solutions for urbanisation, governance, health and education problems.
- Institutional and professional interaction must also increase.
- India can do more to facilitate the travel of Chinese to India to enhance the people to people ties further.
Back Office to shape the 21st Century as an Asian Century. The same can be achieved by sharing solutions to common problems. Such an approach will provide legitimacy to reshape the global order based on sustainability.
India should revisit its stand on the OBOR and work towards ‘Digital Sustainable Asia’, and better Eurasian connectivity. China will also be keen to see India come forward because despite all its weaknesses, the Indian economy has shown its capacity to sustain higher rates of economic growth.
If China rejects an imperialist view of history and believes in the creation of a multipolar world based on common values, then it can work with India and ensure that the bilateral relationship to move beyond official government-to-government relations.
Connecting the dots
- India and China have the potential to shape the global geopolitics in the times to come. Comment. Also highlight how the same can be achieved by both the nations.
- The 21st century is witnessing a changing world order. Analyse. Also, discuss how India and China can make the best of these changes and define the 21st Century as the “Asian Century”.
TOPIC: General Studies 2
- Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
- Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Promoting medical education as public good
In news: Recently, the National Medical Commission draft bill and NITI Ayog report on medical education seems to further accelerate privatisation and commercialisation of medical education in the country rather than keeping it in check. It has also raised concern about lack of priority to protection of patients and need for strong clampdown on widespread unethical practices.
Salient features of National Medical Commission Bill, 2016
- The NITI Aayog committee has proposed to replace the Medical Council of India (MCI) with a National Medical Commission.
- The current electoral process of appointing regulators for medical education should be replaced by a broad-based search-cum-selection committee.
- The for-profit organizations be permitted to establish medical colleges as against the present norm where only not-for-profit organizations are permitted to do so.
- Suggestion to create Medical Advisory Council by the central government, with one nominated member from every state government and two members to represent Union territories, to be nominated by the home ministry.
- NMC should not engage in fee regulation of private colleges because micro-management can encourage rent-seeking behaviour in the NMC.
Medical education status in India
- The doctor- population ratio is 1:1,500 in India, which cries for dire need of doctors.
- The new bill which proposes commercialisation of medical education justifies its relevance as it will incentivise investors to set up medical colleges, increase the supply of doctors, induce competition and reduce the cost of tuition fees and services.
- However, currently, USA is facing the downside of such a policy
The US crisis
- The logic of ‘market knows best’ brought banks, hedge funds, private equity and venture capital for establishing colleges in USA.
- The loan markets thrived by making student incomes as the one that “produces a fat and stable return in the form of tuition fees”.
- Post 2002, student debt has climbed to $1.2 trillion. Here, 44% of loan defaults were among the working-class students who either couldn’t afford to graduate or, if once they did, they found their degrees largely useless in the marketplace and thus unable to return loan.
- In this, the quality of education became the casualty.
- A 2009 review showed that in 30 leading for-profit universities, 17% of their budget was spent on instruction and 42% on marketing and paying out existing investors.
- The free markets also widened inequality. The for-profit institutions are behind students who fully pay their fees so as to get 30% profit margin. On the other hand, the not-for profit institutions also feel compelled to increase fees when public funding is reduced or withdrawn.
- When these situation arise, the families, particularly with stagnant incomes and reduced capacity to repay loans, have problems in having access to good institutions.
- Hence, these factors are reportedly compelling USA to revert to the pre-neo-liberal era of the 1960s of making higher education a public good.
What is public good?
- Public good is a good which if one individual consumes, it does not reduce its availability for another individual. In larger sense, it is something which is used by society.
- Economists refer to public goods as “nonrivalrous” and “nonexcludable.” Few examples are National defense, sewer systems, public parks etc.
India not learning from the experiences
- According to NITI Ayog, its recommendations are expected to trigger healthy competition, reduce prices and assure quality.
- Allowing private investors to establish medical colleges untrammelled by regulations.
- Freedom to levy fees for 60% of the students to recoup their money.
- Making the exit examination the marker for quality and for crowding out substandard institutions.
- However, NITI Ayog recommendations for reforming medical education need to be viewed in USA’s backdrop.
Trained faculty not guaranteed
- India has 422 medical colleges with 58,000 annual admissions. But establishment of new colleges will not alone solve the issue of lack of doctors.
- India is short by 30 lakh doctors. The rate at which India is producing doctors, it will take 50 years to clear the backlog — a terrible, unacceptable sacrifice of two generations.
- But the major concern is non-availability of teachers which has constrained further expansion and thus over half of the colleges give poor quality doctors.
- Skilled teachers form the basis of quality medical education, hence there is a need of a comprehensive policy framework consisting of innovative approaches such as use of technology, faculty training in pedagogical skills, permitting foreign faculty to teach etc.
Inequities in availability
- The health sector crisis in India is not only about insufficient availability of doctors but also their geographical spread and quality.
- Privatising education or opening foreign universities will not address these issues. It is important to ask questions like- if any investor will be willing to set up colleges in Bundelkhand or Raipur? Or why surplus doctors from Tamil Nadu and Karnataka do no go to Odisha or Chhattisgarh where there is desperate need for them?
- The reason is that language, culture, payment systems, social conditions act as barriers to free movement of doctors.
- In areas that have few doctors, there are three-quarters of the maternal, infant mortality and morbidity due to infectious diseases.
Multiple fee structure
- Tamil Nadu private colleges enhanced their fees in response to imposing restrictions on admission policies.
- Also, due to the lack of transparency in fee fixations, there are multiple fee structures for students taking admission in government quota, full paying domestic students and NRI students. In such complications, the government ends up paying more than required.
- Besides, high fees do not guarantee quality. For example, in undivided Andhra Pradesh, the government had spent around Rs. 6,000 crore per annum towards fee reimbursements to private engineering colleges and out of them, the industry found less than a fifth of the graduates employable.
Less doctors in primary care and low remuneration
- It has been observed that now over half to three-quarters of the students want to pursue specialisation, go abroad, work in tertiary hospitals or city hospitals, or set up private practice.
- Hardly 15000 doctors are available to work in rural areas, in the public sector or in public health and primary care as family physicians.
- To reverse this trend, drastic change will be required in curriculum.
- For this, the government will have to make interventions in public heath and primary care which are financially remunerative.
- Thus, the demand-supply equations in imperfect markets like health do not get smoothened by open door policies.
- A one day examination to judge the quality of a skill-based profession like medical care is not apt.
- Quality is also about attitudes towards patient care, knowledge, values and competencies that are imparted by good teachers in classrooms and by bedside training.
- If the profits become focus in this sector, investments in such quality care will be secondary.
Today, public health and primary care require critical attention as there has been growing evidences of rise in infectious disease like dengue, chikungunya and drug-resistant HIV/AIDS and tuberculosis. To contain the spread of these diseases, high quality primary care will be required. For this, substantial investment is needed to create well trained and aptly skilled doctors to reduce country’s disease burden.
US example of such market led health care education needs to be studied and reflected in India’s context. As a critic has put it, “Quality education and higher earnings are two masters. You can’t serve both.” Hence, India has to look after its national interest in a pragmatic way to determine a progressive public policy on medical education.
Connecting the dots:
- What is MCI and why is it being replaced? Critically examine the status of medical education in India.
- India has a dismal doctor-population ratio, yet government is not taking concrete steps to make this field more attractive as health of people determine health of nation. According to you, what steps should government take to organise health sector in India, especially critically starved primary sector?
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