1. How does failure of governance create challenges for the health sector? Illustrate.
Approach:
Since the question is asking you to illustrate it mean you have to ‘explain’ whereby you are asked to show the workings of something, making use of definite examples and statistics if appropriate to add weight to your explanation.
Introduction
The healthcare industry is facing many changes that pose new challenges to medical organizations big and small. The COVID-19 pandemic has produced mass market and governance failure in global private health, particularly in tertiary care. In particular, the fast-evolving government regulations, technological innovations, and patient expectations create a new environment in which running a medical practice isn’t just about treating patients anymore.
Body
HOW DOES FAILURE OF GOVERNANCE CREATE CHALLENGES FOR THE HEALTH SECTOR
The COVID-19 pandemic very quickly witnessed numerous and catastrophic instances of governance failure in health. Be it failing supply of personal protective equipment (PPE), medical masks, gloves and surgical gowns, as well as medical oxygen or the lack of vaccine production capacity.
Indian states have moved through their own trajectories of responses to the service and pricing crisis, with even pro-market ruling BJP administrations becoming increasingly aggressive toward private providers.
Despite multiple states capping prices for treatment of patients, and despite sequestration of beds and capacities by legal means and emergency powers, the situation has been anarchic, with tensions and real divisions emerging between state governments and private providers.
Firms are still routinely breaching price caps and gouging, turning away COVID patients and hoarding beds, with reports of unseemly black markets for beds emerging.
States have reacted with the sequestration of hospitals, enforced openings, prosecution, and other measures, but circumvention of law and emergency measures have continued through nonetheless.
The startling chaos in India reveals that governments have not factored in reliance of profit-seeking and market-driven providers into national pandemic preparedness, and the mismatch between private sector reliance in LMICs’ national health systems and pandemic emergency needs.
Conclusion
The pandemic has sharply reminded us once again how health policies and increasing privately-focused health systems fail to meet both national needs and those of the most marginalized and vulnerable.
Amid widespread national governance failures—either crisis bound or historic—with regards to poorly resourced public health services and burgeoning private health—governments have responded with increasing legal and financial interventions into national health markets. In contrast, multilateral governance has been path dependent with regard to ongoing commitments to privately provided health.
2. What are the issues pertaining to the autonomy of institutes of higher education in India? Discuss.
Approach
A simple and straightforward question where in the candidate needs to discuss the issues with respect to the autonomy of institutes of higher education in India.
Introduction
UNESCO defines institutional autonomy as, “a degree of self-governance, necessary for effective decision making by institutes of higher education regarding their academic work standards, management, and related activities”. Here, Academic autonomy is a generic concept, implying self-governance of a university and not limited to a narrow sense of designing the academic curriculum.
Body
Higher education in India is highly centralised and institutions have very limited autonomy, regardless of their public or private status. This is especially true with colleges.
The Gajendragadkar Committee Report (UGC, 1971) states “The concept of University autonomy is often misunderstood. The concept of university autonomy means that it would be appropriate on the part of democratic legislatures not to interfere with the administration of university life, both academic and non-academic.”
Presently, Higher education in India is highly centralised and institutions have very limited autonomy, regardless of their public or private status. This is especially true with colleges. Universities have some substantive autonomy in theory while private institutions have more leeway in terms of procedural autonomy.
In India, there is a skewed allocation of limited funds to central universities while state universities face a paucity of funds. Moreover, the existing system of governance and regulation needs to be re-examined.
Under the affiliation system, most parent universities are responsible for regulating admission, setting curricula, and conducting examinations for the affiliated colleges under the general oversight of the UGC.
The system of command and control does not promote accountability. The institutions are constantly subjected to governmental pressures and decisions are often made based on non-academic considerations. This intervention starts at the highest level with the appointment of the Vice Chancellor.
Academic curricula of professional courses are subject to oversight by their professional councils. Both public and private universities can modify curriculum and propose new programmes with UGC approval but have no or limited autonomy over areas like fees.
Private universities also have their fees determined by state committees headed by prominent public figures who ensure that these institutions are not profiteering. Neither public nor private universities can determine faculty or staffing salaries.
The current systems of regulation-based autonomy have ignored the recent demographic and compositional shifts in education. Currently, the number of private institutions is almost twice that of government institutions. Yet, the model of governance has been relatively slow to change.
Finally, most of the existing regulations are based on the affiliating model which does not seek to address the aspirational value of Indian institutions in quality and diversity. In short, institutions of higher education (IHEs) in India need to be looked through a different lens to conceive the reality of autonomy.
National Education Policy 2020, a blueprint for the development of education over the next 10 years, proposes a departure from the current top-down system to allow considerable autonomy to institutions. Its measures can be seen from the following points –
Under graded autonomy, academic, administrative and financial autonomy will be given to colleges on the basis of their accreditation status under the three categories, with top research universities having the highest levels of autonomy.
A National Research Foundation or NRF will be set up as a top body for promoting a strong research culture and building research capacity across higher education.
The NRF will identify research-focused universities and help to develop their state-of-the-art research facilities to enable researchers to undertake highly advanced, innovative and pioneering research.
Universities and colleges restructured in the other two categories will focus more on teaching and granting degrees, with the affiliation of colleges to degree-granting universities phased out in 15 years and a stage-by-stage mechanism established for granting graded autonomy.
Rather than the overarching University Grants Commission, the current regulatory body which will be scrapped under the NEP 2020 proposals, boards of governors would supervise the day-to-day operations of individual universities.
Conclusion
The post-Covid-19 time is ripe to act and seize the opportunity to set things right in the higher educational sector where a data-driven approach can help in providing a new measure of institutional autonomy and academic freedom in India where introducing an Indian Index of Institutional Autonomy (i3A) can be a good start.
3. What measures have been taken to improve the employability of graduates in India? Why haven’t we achieved much success on this front? Examine.
Approach
The candidate needs to highlight the measures taken in India to improve the employability of graduates in the first part of the answer while the second part should examine the reasons for limited success on this front of employability of graduates.
Introduction
Employability and education have been two of the top issues for the citizens of the country. Here, employability skills are defined as a range of competencies or abilities that are necessary for graduates to gain success in the labour market at all employment levels which benefits themselves, the community and the economy.
Body
How Government is Increasing Employability of Engineers in India –
AICTE in association with various organisations carries out an employability Skill Test of pre-final and final year graduate students of AICTE approved institutions annually.
To increase the employability of graduates in the country, Ministry of Human Resource Development is working along with Sector Skill Councils (SSCs) under National Skill Development Corporation (NSDC) to undertake Apprenticeship/Internship embedded degree programmes with the core focus on the development of knowledge, skills, aptitude and on-job training.
Furthermore, the government has also recommended that courses on nine emerging technologies like AI, data science, IoT, cyber security, robotics, design, quantum computing, AR/VR, Block chain and 3D printing and should be introduced in UG engineering courses.
In order to revamp the engineering curriculum and to impart the requisite skill set to the students to enhance the employability of engineering students, AICTE has approved an action plan with the following objectives: Induction Training, Revision of Curriculum, Mandatory Internships, Industry Readiness and Mandatory Accreditation.
Further, AICTE is implementing schemes namely National Employment Enhancement Mission (NEEM) and Employability Enhancement Training Program (EETP) to enhance the employability of the students.
In addition, AICTE has also partnered with Ministry of Micro, Small and Medium Enterprises (MSME), Govt of India, Internshala, NETiit and LinkedIn to provide internship opportunities and industry exposure to students for aligning their technical knowhow with industry requirements.
Apart from that, the All India Council for Technical Education (AICTE) is taking the following measures to increase the employability of graduates in the country, particularly engineering graduates:
Preparation of outcome-based model curriculum for Diploma, Undergraduate (UG) and Post Graduate (PG) courses in Engineering and PGDM/MBA Courses.
Exam reforms and formulation of comprehensive teacher’s training. 8 modules are proposed for the incumbent as well as in-service teachers.
Mandatory internship, Revision of model curriculum, and Industry readiness accreditation.
The employability of the fresh graduates has risen as a result of different measures taken by Government. As per the data maintained by All India Council for Technical Education (AICTE), the overall employability has increased from 34% to more than 45% in the last five years. This showcases the success of governmental initiatives, but these have been limited in nature. The reasons for the same include –
Uncertainty among graduates: Lack of focus and definite career path among graduates. As per a latest report, around 40% of the engineering graduates is preparing for various competitive exams in government sector which his not even relate to engineering.
Sanction of new institutes: The ease of securing approval from the All India Council for Technical Education (AICTE) to set up engineering colleges and other higher education regulators has led to the mushrooming of institutes. These are understaffed and lack in qualified, competent and suitable faculty members. E.g. the number of approved institutes in Maharashtra alone is around 650.
Teaching methods: Most of the institutions still follow traditional way of teaching without realizing that the information is available over the internet and the need of the hour is the application level teaching for practical purposes.
There is no policy framework for participation of foreign universities in higher education. Also, there is no overarching funding body to promote and encourage research and innovation. Public funding in the sector remains inadequate.
Conclusion
In today’s era, staying updated with technological advancements and rapid changes in surrounding are of prime importance for both success and growth of Individual and employability where to effectively skill, up-skill and re-skill India’s workforce, all stakeholders must coordinate upon improving the larger economic prospects as well as new end employment prospects.
4. Do a critical assessment of India’s performance on the sustainable development goals (SDGs).
Approach
Candidates are expected first to write about the sustainable development goals and then do critical assessment of India performance to achieve the SDG.
Introduction
Development which meets the needs of the present without compromising the ability of future generations to meet their own needs’. This most widely accepted definition of Sustainable Development was given by the Brundtland Commission in its report Our Common Future (1987). Sustainable development (SD) calls for concerted efforts towards building an inclusive, sustainable and resilient future for people and planet.
Body
India, got committed to the 17 Sustainable Development Goals India played a significant role in making the declaration and its progress in achieving these goals are crucial such as:
There is notable progress on SDGs 6, 7, 9 and 11. While, a decline in the Maternal Mortality Ratio has contributed to our improved performance in the area of ‘Good Health and Well-Being’, ramping up toilet coverage under Swachh Bharat Abhiyaan has raised the country’s score on ‘Clean Water and Sanitation’.
The commendable performance on Goal 7 is due to expanded access to clean cooking fuel and the government’s massive electrification drive. Similarly, on Goal 9, the progress can be attributed largely to a significant improvement in rural road connectivity and increased mobile phone penetration.
Our performance on Goal 11 has been boosted by better access to housing through the Pradhan Mantri Aawas Yojana as well as more widespread adoption of door-to-door waste collection and processing.
NITI Aayog has undertaken a mapping of schemes as they relate to the SDGs and their targets, and has identified lead and supporting ministries for each target. They have adopted a government-wide approach to sustainable development, emphasising the interconnected nature of the SDGs across economic, social and environmental pillars.
The reforms have included fiscal consolidation, inflation targeting, improved governance all around, accelerated infrastructure development (SDG 9), curbing of corruption (SDG 16), Aadhaar Act for providing unique identity.
The MGNREGA provides a legal guarantee of a minimum of 100 days of wage employment programme generated over 2 billion person-days of employment (SDG 8) during the last year. Women and disadvantaged groups have been the largest beneficiaries (SDG 5 and SDG 10) of the programme accounting for 56% and 39% of person-days of work generated during last year.
There is now compelling evidence that rapid growth India has achieved following the economic reforms initiated in 1991 has led to significant reduction in poverty. The evidence shows that poverty fell across all economic, social and religious groups nationally and in all states in the post-reform era.
Kerala’s top rank is attributed to its superior performance in providing good health, reducing hunger, achieving gender equality and providing quality education. Himachal Pradesh ranks high in providing clean water and sanitation, in reducing inequalities and preserving mountain ecosystem.
Still there is need to strengthen institutional arrangements by identifying support departments and defining roles and responsibilities let us assess conditions:
As per Sustainable Development Report 2020 India has been ranked 117th in the index with overall score of 61.92. The score can be depicted as the percentage of SDG achievement.
While this progress is heartening, there are certain indicators where focussed attention is required. For instance, India’s tuberculosis notification rate is still high, thus limiting our overall progress on Goal 3.
The CAG found deficiencies regarding the adaption of the 2030 Agenda and stressed upon the need to develop a roadmap to be aligned with defined milestones to be achieved in year 2020, 2025 and 2030, which it found has not been attempted yet. The auditor was concerned that the vision document was still under preparation and states did not complete the exercise to prepare policy documents.
The agency squarely blamed the Union Ministry of Statistics and Program Implementation for its failure to finalise the National Indictor Framework (NIF). The delay in approval of NIF held up finalisation of monitoring and reporting framework on implementation of SDG.
The audit highlighted that three crucial ministries of AYUSH, tribal affairs and home affairs were not involved in the national consultation on transitioning from Millenium Development Goals to SDGs.
In states, the health spending as a percentage of total expenditure, ranged from 3.29 to 5.32 per cent, which shows that there is a need for considerable augmentation.
COVID-19 pandemic hit at a time when the SDGs were gaining traction and a significant number of steps have been taken and were making good progress. The COVID-19 pandemic has caused disruptions to plans and timelines.
Conclusion
India will continue to pursue the implementation of the SDG agenda through close collaboration between the national and sub-national governments as well as active participation of all other relevant stakeholders. Localisation of SDGs is crucial to any strategy, essentially we need better adapting, planning, implementing and monitoring the SDGs from national to local levels by relevant institutions to achieve goals.
5. What are the components of social security? Discuss. How is India performing on the key indicators of social security? Examine.
Approach- Question is straight forward, candidate can define social security and give account of India’s performance with the help of suitable government schemes.
Introduction
According to International Labour Organisation,” Social security is the protection that a society provides to individuals and households to ensure access to health care and to guarantee income security, particularly in cases of old age, unemployment, sickness, invalidity, work injury, maternity or loss of a breadwinner”.
Body
What constitutes social security?
The principle of Universality of social security is enshrined in various goals related to the 2030 Agenda for Sustainable Development.
Right to a Standard of Living- adequate for the health and well-being, including food, clothing, housing and medical care and necessary social services.
Right to Income Security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond any person’s control.
In the ILO conventions and UN instruments, it is considered to be a basic human right. The Universal Declaration of Human Rights (UDHR) recognises the right to social security for all. It helps the recipients to ensure their rights to family protection and assistance, an adequate standard of living and adequate access to healthcare.
Social security acts as an umbrella for people during adverse situations. Social welfare is not possible without social security. It acts as a buffer against all odds in the time of need. It helps in lifting millions of people out of poverty and thus, raises people’s standard of living.
Types of social security in India
Gratuity, Old-age pension
Health and medical insurance
Maternity benefits
Disability benefits, Minimum Wages Act
Need of social security in India
Majority of Work Force is in Unorganised Sector: The organised sector workers constitute less than 10% of all workers in India.
The lockdown necessitated by the Covid-19 pandemic has caused misery to almost all sections of society, but the vulnerable section viz. people below the poverty line, migrant workers have been affected the most.
Too Expensive Private Healthcare Expense: Out-of-pocket health expenses, which create barriers to seeking healthcare and can push marginal households into poverty, form as much as nearly 90% of private expenditure on health.
Also, in a dynamic market-economy, workers will lose jobs at a faster pace with technological changes. Thus, workers need to keep learning to stay productively employed.
Covid-19 has highlighted the urgency for providing universal free health care. It has demonstrated that private health care can be afforded only by the wealthy.
Performance of India in social security
India has a broad aim of social protection programs, but the overall public expenditure on social protection (excluding public healthcare) is only approx. 1.5% of the GDP, lower than many middle-income countries across the world.
However, in spite of great attention given to skills development in the last 15 years, the results are not very encouraging.
What can be done?
Skill Development via ‘Learning while Earning’ Model-The principle of “learning while earning” should be more vigorously applied to improve India’s skill development systems.
MGNREGA has proved its utility by providing employment to millions of workers who have reverse migrated. Thus, there is a case for extending this programme to urban areas with municipal bodies
Providing Universal Health Coverage-There is a need to establish the Ayushman Bharat-National Health Agency at all levels of governance for management of the Pradhan Mantri Jan Aarogya Yojana (PM-JAY).
Atal pension yojana- The APY will be focussed on all natives in the unorganized sector, who join the National Pension System (NPS) managed by the Pension Fund Regulatory and Development Authority (PFRDA)
Pradhan Mantri Suraksha Bima Yojana (PMSBY) and Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) would give protection cover in the terrible occasion of death by any reason/demise or inability because of a mishap.
The target of raising the share of expenditure on health care to 2.5% of the GDP, as envisaged by the National health policy 2017, in the next two years would be a good beginning.
Conclusion
Covid-19 pandemic exposed our vulnerabilities of social securities. The poor healthcare and social infrastructure needs immediate revamping to provide BASIC right to life to the marginalised and vulnerable.
