IASbaba’s Daily Current Affairs (Prelims + Mains Focus)- 12th April 2018
Part of: Mains GS Paper II- Government interventions in key sectors
- The Food Safety and Standards Authority of India (FSSAI) has launched ‘Project Dhoop’.
- An initiative aimed at shifting the school assembly time to noon to ensure maximum absorption of Vitamin D in students through natural sunlight.
- The schools across the country have been sent advisories asking them to hold daily assembly between 11 a.m. and 1 p.m.
- “Project Dhoop’s Noon Assembly is an innovative and effective concept to ensure that school students get adequate Vitamin D through sunlight, while also opting to choose food products like milk and edible oils that are fortified with Vitamins A and D.
Studies have shown that over 90 per cent of boys and girls across the country were deficient in Vitamin D while the number ranged between 90-97 per cent for school children in Delhi.
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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.
- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes.
The Ayushman Bharat Programme: Challenges
A nation’s development and growth is gauged by the health of its population.
The fact that even after 70 years of independence, 80 per cent of the Indian population is not covered under any health insurance scheme and the average cost of in-patient treatment is almost half of their annual household expenditure is bound to affect India’s growth.
The announcement of the National Health Protection Scheme (NHPS) under the Ayushman Bharat Programme, in the Union Budget 2018-19, is timely and can be a trigger to achieving the country’s growth aspirations.
The programme will cover 40 per cent of the population — 50 crore people in the first phase.
- A FICCI-EY study in 2012 estimated that to implement UHC in India by 2022, the government would need to allocate health expenditure between 3.7-4.5 per cent of the GDP, as against 1.4 per cent in 2017-18.
- The bed-to-population ratio needs to be raised to 1.7 beds per 1,000 population from the current 0.9 beds.
- The country needs another 9 lakh graduate doctors for primary care and around 1.2 lakh specialist doctors for secondary and tertiary care services.
- The hospital business, particularly the multi-speciality tertiary care business, is capital-intensive with a long gestation period.
Financing options along with incentives and tax benefits need to be provided to the private sector to aid development of healthcare infrastructure in Tier II and Tier III cities.
- Since health is a State subject and States are expected to contribute 40 per cent funding for the scheme, it will be critical to streamline and harmonise the existing State health insurance schemes and RSBY to NHPS.
- The choice of purchasing model and empanelling providers would be critical to the success of NHPS.
Countries with both public and private health infrastructure, such as France, Germany, China and Indonesia, have opted for dual mechanism — “provision by government and contract in from private providers”
- Reimbursement slabs should be objective, transparent and linked to accreditation according to the hospital categories.
National Costing Guidelines and a standard costing template should be used for calculating reimbursement packages.
Improving clinical and operational efficiencies in the supply side:
Standardisation in clinical practice and other processes needs to be implemented through:
- Adoption of standard treatment guidelines, electronic health record standards, clinical audits etc. across public and private hospitals,
- Framing of referral protocols and implementing effective mechanisms for supervision leveraging technology.
- Integration of technology at each level of the healthcare continuum such as tele-medicine for remote locations, health call-centres, tele-radiology, app based emergency response etc.
Addressing workforce woes:
In addition to strengthening the number of healthcare professionals, we need focused skilling, re-skilling and up-skilling programmes for existing as well as additional workforce. Three key steps in this direction would be:
- Providing technical as well as soft skill training to Ayushman Mitras, with adequate incentives and provisions for periodic re-training and upgradation of skills,
- Making General Practitioners (GPs) responsible for overseeing the primary health network and and incentivising them to prevent the number of hospitalisations
- Introducing a nurse practitioner system in strict compliance with established clinical protocols, where they are authorised to handle several clinical responsibilities.
- NHPS must use biometric enrolment process, mobile and app based technologies for claim processes and payment wallets for real-time payments to streamline claim management.
A robust fraud and abuse control mechanism should be implemented through use of digital technologies, business intelligence frameworks and standards for de-empanelment.
- A Grievance Redressal Forum should be created to ensure timely resolution of complaints without intervention of civil or consumer courts.
- The government must encourage and recognise transparency, self-regulation and third party ratings and reward clinical outcomes to help bridge the widening trustdeficit in the sector.
Connecting the dots:
- Described as “the world’s largest government-funded healthcare programme”, the sheer scale of this programme magnifies many its systemic challenges. Highlight the major challenges involved and also ways to address them.
General Studies 2:
- Indian Constitution- historical underpinnings, evolution, features, amendments, significant provisions and basic structure.
- Functions and responsibilities of the Union and the States, issues and challenges pertaining to the federal structure, devolution of powers and finances up to local levels and challenges therein.
General Studies 3:
- Indian Economy and issues relating to planning, mobilization of resources, growth, development and employment.
Terms of reference of the 15th Finance Commission: Issues
Most federations in the world have arrangements for the mobilisation and devolution of resources.
In India, the Constitution provides for the appointment of a Finance Commission every five years to recommend methodology to share resources such that the fiscal space of the constituents, especially the States, is well protected.
The terms of reference of the 15th Finance Commission are thus a matter of utmost importance to the resources available to the States of India.
The terms of reference of this Commission have created apprehension among States about principles of fairness and equity in the distribution of public resources for development.
Vital for unity:
The foremost objective of the Finance Commission is an equitable distribution of financial resources between the two units of the Union.
In the allocation of duties (7th schedule of the constitution) between the Centre and the States, fundamental tasks of enhancing human development, income growth, livelihoods, and protecting and sustaining the environment are entrusted to the States.
However, although these major tasks of nation-building are the duty of the States, the resources to finance them are substantially controlled by the Centre.
Asymmetry in the federal system:
The States in India today neither have the resources to fulfil their tasks as laid down in the Constitution, nor do they have the right to raise such resources. There is thus a great asymmetry in India’s federal system.
The Centre’s capacity to mobilise resources is far greater than that of the States, but the latter are required to undertake development expenditures that far exceed their revenue generating capabilities.
The Constitution of India entrusts the Finance Commission with the responsibility of addressing this anomaly.
In the wake of demonetisation and GST:
The devolution of resources by the 15th Finance Commission assumes further significance in the current environment, in which the finances of States have received a double blow in the form of demonetisation and the Goods and Services Tax (GST).
The freedom of States to raise resources has been restricted by the introduction of the GST. They now have hardly any major tax left with them to make a difference to State resources.
Using the population data of 2011 as the base for tax devolution should not reduce the allocation of resources to States that have successfully reduced their rate of population growth. These States have incurred huge fiscal costs in order to achieve a lower population growth and healthy demographic indicators. They have made substantial investments on education, health and directly on family welfare programmes.
Many States of India today have achieved a replacement rate of growth of population or have gone below that rate in a short span of time. An immediate effect of this is a sharp rise in the proportion of elderly in the population. The care of the elderly is the responsibility of State governments.
The enhanced costs of such care must be considered by the Commission in making its awards and in deciding the population criterion to be used.
Beyond the constitutional mandate:
The current terms of reference go far beyond the constitutional mandate of the Finance Commission.
- They intensify efforts to use the Finance Commission as an instrument of fiscal consolidation and to impose the ideological and economic agenda of the Central government on the States.
- It is not the task of a Finance Commission to recommend “road maps for fiscal management” or to impose its perception of what policies are good for the people of the States.
That is for democratically elected State governments to decide.
- The terms of reference explicitly privilege the “committed expenditures” of the Centre.
The terms of reference are unprecedented in asking the 15th Finance Commission to consider proposing performance-based incentives beyond those relating to fiscal responsibility, population and devolution to local bodies.
This reflects the viewpoint and ideological inclinations of the Central government and is an attempt to micro-manage the fiscal domain of the State governments.
For the Finance Commission to propose “measurable performance-based-incentives” is an attack on the federal structure mandated by the Constitution.
It is not the duty of the Finance Commission to venture into the realm of day-to-day governance. The elected governments of States will decide what policies are appropriate for our people.
India’s great wealth rests in its diversity. To recognise this diversity is also to recognise that States will follow diverse paths of development.
The Finance Commission must facilitate diversity and a democratic path of development by respecting principles of equity and fairness in allocating resources between the Centre and States in India.
Connecting the dots:
- Various concerns have been raised regarding the Terms of Reference of the 15th Finance Commission. Discuss these concerns.
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