Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Issues relating to development and management of Social Sector/Services relating to Health
Giving priority to health services over medical services:
The tragedy of children with encephalitis dying in a Gorakhpur hospital has caused much outrage about hospital mismanagement. Far more outrageous is the fact that encephalitis threatens many thousands of lives every year in Gorakhpur alone, and this in the 21st century.
Neglecting health services at the cost of health services:
“Focusing on clinical services while neglecting services that reduce exposure to disease is like mopping up the floor continuously while leaving the tap running.”
Health services in India have prioritized medical services, neglecting public health services that seek to reduce the population’s exposure to disease.
This neglect is evidenced in many ways, such as the explosive growth of an array of mosquito-borne diseases. Faecally transmitted diseases, which include infections from a whole cafeteria of parasites, viruses and bacteria, cause widespread debility and can be fatal.
Treatment for such diseases is sought on a huge scale across the country, while faecal waste continues to be poorly managed. Studies show that major Indian rivers now contain antibiotic-resistant matter, supplying water that can threaten immunity to available drugs.
Reducing exposure to communicable diseases:
This should be at the highest priority in public health services, as their spread causes severe negative spillovers.
These services save incalculable medical costs.
An indirect indicator of the gains from communicable disease control is the small gap in life expectancy between the richest and the poorest in the US, despite their vast differences in living conditions and access to healthcare.
Indian public funds could improve health outcomes far more if spent on public health instead of subsidizing health insurance.
What needs to be done?
Streamlining MGNREGA: India’s employment guarantee schemes could use lessons from the US’ Depression-era public works programme.
Case: In areas badly affected by malaria in US, the labour was used for large-scale drainage and other works to control malaria, with technical inputs from public health personnel and sanitary engineers.
The Swachh Bharat campaign could also use such technical expertise to maximize its impact in reducing exposure to diseases.
Charitable foundations can emulate the Rockefeller Foundation’s efforts to improve public health and sanitation.
Case: In the early 20th century, the foundation found that 40% of school-aged children in the southern US had hookworm, an aggressive faecally transmitted parasite that can cause listlessness and stunting. They sponsored demonstration projects combining deworming treatment, campaigns to raise people’s awareness of the problem, and technical assistance in building latrines in homes and public buildings. The state health authorities learnt from this approach and applied it widely. A study finds that programme beneficiaries gained in school attainment and earnings.
Strengthen public health service delivery:
The Central government can do much in this regard.
Case: Tamil Nadu offers some basic organizational principles whereby other states can strengthen their public health systems within their existing administrative and fiscal resources.
The Central government could link its fiscal support to states with phased progress in:
(1) The establishment within the state health departments of separate public health directorates with their own budgets and staff, managed by medical doctors trained in public health administration.
(2) The enactment of public health Acts to provide the basic legislative underpinning for public health action.
(3) The revitalization of public health cadres.
These measures can help use public funds more effectively for protecting people’s health.
The government can do much else with more innovative and better-focused use of other programmes such as the employment guarantee programme and the Swachh Bharat campaign.
The state must improve sanitation and public health services to reduce the prevalence of the communicable diseases, despite lack of public demand for such services. Most countries around the world have made this a priority, viewing it as essential to building development infrastructure, improving human capital and labour productivity, and reducing poverty.
Connecting the dots:
The state must improve sanitation and public health services to reduce the prevalence of the communicable diseases, despite lack of public demand for such services. Critically analyze.
The government is focusing on clinical services while neglecting services that reduce exposure to disease. Do you agree. Discuss the implications of it.
TOPIC: General Studies 2
India and its neighborhood- relations.
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.
Important International institutions, agencies and fora- their structure, mandate.
Challenges for India at BRICS
As Prime Minister Narendra Modi prepares to travel to Xiamen for the September 3-5 summit of BRICS, it is important to see how the bilateral relationship and several other changes in geopolitics are now going to change the course of the BRICS engagement as well.
The power of five:
BRICS (BASIC was later disbanded) went from a modest 16-paragraph joint statement at Yekaterinburg in June 2009 to the more substantive 110 paragraphs that the five countries agreed upon in the Goa Declaration of October 2016, developing common positions not just on climate change but also on terrorism, energy, and world politics.
The valuation of the BRICS grouping, that represents 40% of the world’s population and a quarter of its growth at $17 trillion did well with more and more investment being driven into the five economies, mainly led by India and China.
Not only did the BRICS countries better their positions in the World Bank and International Monetary Fund, they also struck a small blow against Bretton Woods institutions, and the BRICS New Development Bank set up in 2015 has already given out about $6 billion in loans for 23 projects across BRICS countries. This is no mean feat given the vast differences in size and political systems, and internal turmoil in BRICS countries.
Above all, BRICS has furthered the cause of a multipolar world.
Xiamen Summit: The most challenging one
BRICS now faces its most challenging summit, not because of the West or the developed world, but because of growing differences between its two biggest members, India and China.
The Xiamen summit follows a gruelling two and a half months during which the rhetoric between India and China — especially the latter’s — has been quite sharp. While diplomats smoothed out a victory over more hawkish elements by disengaging the troops at Doklam and obtaining a Chinese assurance that it would not continue its road construction at the tri-junction area, more needs to be done to restore the situation to pre-June terms.
The bilateral tensions will no doubt spill over to the multilateral negotiations at Xiamen.
Beyond the bilateral issues over the boundary, Nuclear Suppliers Group membership for India, terrorism, the Dalai Lama and others, the rift over China’s Belt and Road Initiative (BRI) is also likely to dominate discussions at BRICS.
India’s refusal to be a part of the BRI over sovereignty issues, coupled with its broader objections to the transparency and agenda of the project, was a cause for tensions before the Doklam stand-off.
There is little doubt that China will aim to bring the BRI on the table for negotiations at BRICS, to win a statement of endorsement as it did at the Shanghai Cooperation Organisation last year.
India will have to use considerable leverage with other members to ensure that its concerns prevail.
Also Russia and South Africa are important parts of BRI, and while Brazil is not, it is no less a recipient of Chinese investment, with a $20 billion Brazil-China infrastructure fund inaugurated this May.
Another challenge for India is likely to arise from China’s plan for a “BRICS-Plus” or “Friends of BRICS” grouping, with Foreign Minister Wang Yi’s plan to include Pakistan, Sri Lanka and Mexico to an expanded version of BRICS.
Meanwhile Russia, which was the prime mover for the grouping, has moved closer to China and away from India; this could affect the language of the joint statement, especially on issues like Afghanistan, on which BRICS members had previously been on the same page. Russia’s estrangement from the U.S. and Europe post-2014 and the Ukraine crisis in particular have increased its dependence on its east and south, mainly in the direction of the $300 billion Russia-China oil pipeline that China is funding. At both the BRICS conference in Goa last October, as well as the Heart of Asia summit in December, Russian officials cavilled at backing India’s strong language on terrorism emanating from Pakistan.
The road ahead:
The Modi government must be credited for ensuring that it won peace at Doklam without building the outcome up as a defeat of China, which would have made their rivalry at BRICS that much more intense. BRICS has fared better than two other groupings, SAARC and the Non-Aligned Movement, whose last summits India skipped, and appears to have abandoned.
The two countries must chart a road map to repair ties. This could provide a realistic understanding of where the road ahead leads for BRICS as well, and whether post-Xiamen it can still bear out the potential that was promised a decade ago in Yekaterinburg and Copenhagen. How India and China repair ties at the Xiamen summit will determine the future of BRICS itself.
Connecting the dots:
The growing difference between India and China may put one of the most important grouping’s (BRICS) future at stake. The bilateral tensions will no doubt spill over to the multilateral negotiations. Discuss.
The challenges for India at BRICS has only increased with time. Critically analyze.