Is the Rajya Sabha essential?

The Upper House of the Indian Parliament traces its direct history to the first bicameral legislature introduced in British India in 1919 as a consequence of the Montagu-Chelmsford reforms. The Council of State, as it was called then, was made up of 60 members, 34 of whom were Indian and elected by a narrow and elite group. There were no women in the council and the direct election was conducted under a framework of communal franchise that the Indian National Congress opposed vehemently.

Immediately before and after Independence, the bicameral question was raised in the Constituent Assembly debates. Professor Shibban Lal Saksena represented the position against a bicameral legislature thus: “In this motion, we have been asked to vote for two Houses, the Lower House and the Upper House. I wish to point out that our experience has been that the Upper House acts as a clog in the wheel of progress. I think that everywhere in the world the experience about Upper Houses has been the same. It has always acted as a sort of hindrance to quick progress.”

Many years later, Sarvepalli Radhakrishnan, speaking as the first chairman of the Rajya Sabha, said, “There is a general impression that this House cannot make or unmake governments and, therefore, it is a superfluous body. But there are functions, which a revising chamber can fulfil fruitfully. Parliament is not only a legislative but a deliberative body. So far as its deliberative functions are concerned, it will be open to us to make very valuable contributions, and it will depend on our work whether we justify this two chamber system, which is now an integral part of our Constitution.”

Even though some ancient civilizations had a bicameral legislature, the modern version can be traced to estates of the realm in medieval Europe: think of it as a European caste system with the clergy, nobility and commoners representing the three estates. During the French Revolution, many arguments for and against a bicameral system were made. Most modern democracies that have a bicameral legislature do so on the grounds of a federal polity. The role of the Upper House is to be a deliberative body that would balance what James Madison, the author of the Federalist Papers, called “fickleness and passion” of an elected Lower House. The relative size, scope and power of the two Houses are different in different countries. The US Senate has two senators from each state with the Senate holding equal power to the House of Representatives. A (very large) House of Lords in the UK has an advisory role to the House of Commons.

India’s Rajya Sabha has equal powers to the Lok Sabha except for money bills, where it has no jurisdiction. It is a 250-member body, 12 of whom are appointed from the field of art, literature, science and social services. Other members are elected by an electoral college made up of state legislators.

Is the Rajya Sabha necessary today?

The contemporary argument against it comes from two primary angles. The first one suggests that a Lok Sabha that has representation from several regional parties more than adequately represents a federal country. The recent reversal on the land acquisition ordinance is an example of this federal character of the Lok Sabha in practice. The second argument charges that the Rajya Sabha has become a haven for losers in elections, crony capitalists, compromised journalists and party fundraisers. Far from being deliberative, the Rajya Sabha appears to have descended into the same fickleness and passion as the Lok Sabha and has shown a disconcerting trend away from the decorum expected from it.

Now for the reality check. It is virtually impossible to abolish the Rajya Sabha without adopting a new Indian Constitution. The bicameral nature of the Indian Parliament is likely to be interpreted as a “basic structure” of the Indian Constitution, rendering it incapable of being amended. Even if this were to be tested, it would be ensnared in a judicial process for a very long time. It is much more practical to try and reform the Rajya Sabha than seeking to abolish it.

One useful reform step would be to have members of the Rajya Sabha be directly elected by the citizens of a state. This will reduce cronyism and patronage appointments. This step should be combined with equal representation for each state (say, five members) so that large states do not dominate the proceedings in the House. This streamlined Rajya Sabha should remain deliberative, but there should be deadlines set for responding to bills initiated in the Lok Sabha.

The Rajya Sabha is here to stay. It is our responsibility to make it an effective and time-bound contributor to India’s parliamentary system.

Only then will India be able to make (progress) haste, slowly.

P.S. “Men are mortal. So are ideas. An idea needs propagation as much as a plant needs watering. Otherwise both will wither and die,” said B.R. Ambedkar, the principal author of India’s constitution.

Narayan Ramachandran is chairman, InKlude Labs.

Microfinance Institutions

Microfinance Institutions (MFIs) dominated the second set of differentiated and small finance banks announced by Reserve Bank of India (RBI) on Wednesday. Eight of the ten companies that received the in-principle nod from the central bank are MFIs.

Surprisingly, some of the big names among the 72 applicants for small finance bank permits were dropped from the final list. These include India’s only listed microlender, SKS Microfinance, Dewan Housing, IIFL Holdings and former chief financial officer of Infosys, V Balakrishnan.Of the other two that received approvals, one is a Rajasthan-based non-banking finance company (NBFC) and the other is a local area bank.

Here's the full list

Why it matters

Considering the dominance of MFIs in the final list, the RBI clearly wants microlenders to take up a bigger role in taking banking to the rural poor, who aren't yet covered by the existing full-service banks. By having small banks, India now will have a network of small, focused lenders, specifically targeting the low-income segment. This is something on the lines of community banks in US.

By definition, small finance banks can undertake almost all operations of a normal commercial bank, albeit on a smaller scale. The RBI clearly restricts these banks to operate in low-income segment, by stipulating that 75 per cent of the total credit extended by these banks should be given to borrowers who qualify to be in the priority sector as defined by the central bank.

Also, the maximum loan size and investment limit exposure to a single and group obligor would be restricted to 10 per cent and 15 per cent of its capital funds, respectively. Further, in order to ensure that the bank extends loans primarily to small borrowers, at least 50 per cent of its loan portfolio should constitute loans and advances of upto Rs 25 lakh.

Thus the new set of banks will be forced to operate among low-income segments and not chase big borrowers. Logically, they have to work out viable models to stay in the competition. This can give a major boost to financial inclusion and credit-expansion to unbanked areas given that in this case financial inclusion wouldn’t be a charity forced by regulation like the existing commercial banks. In this case it would be the mainstay of the business. That’s good news for the Indian poor.

In August, the RBI had given another 11 licences to payments banks, which will undertake basic banking functions, except lending. The whole process is part of advancing country’s financial system to a differentiated banking regime, where each set of banks focusses on certain specific segments in which they understand the business and have expertise. The RBI has made it clear that it intends to make bank licencing on-tap (on a continuous basis) in the future which could mean we might see more banks operating in specialised areas.

The idea of floating several small private banks were mooted by Raghuram Rajan long before he took over the governor of Indian central bank. At the time the high-level financial sector reforms committee headed by him proposed a ‘A hundred small steps’ to reform India’s financial sector. By paving the way for payments and small banks, Rajan has taken the country’s banking industry to its biggest stage of reform since the nationalization of banks that began in 1969.

How this helps MFIs and people

As Firstpost noted earlier, the entry of MFIs in the small finance bank segment is a revolutionary step since these entities are well-familiar with the nuances of banking with the poor borrowers. MFIs were so far not allowed to accept deposits and engaged in extending credit after sourcing money from commercial banks.

Now, by getting access to banking, these entities can tap public deposits, which will significantly lower their cost of borrowing and enable them bring down their rate of interest on loans from the current 24-26 per cent to a level decided by the market competition, possibly lower double digit figures.

In fact, this is a golden opportunity to microlenders to reinvent themselves after facing a major crisis in 2010 in the aftermath of a controversial law promulgated by the erstwhile Andhra Pradesh state government. These companies went through a correction phase in the following years.

The crisis had forced MFIs to change the way they conduct business. Some stability returned to the sector after the RBI came out with guidelines to govern such companies. In the aftermath of the crisis, many smaller micro-lenders had to shut shop, while even some of the big NBFC-MFIs based in Andhra Pradesh had to carry out massive loan recasts to stay afloat. Since then, these entities haven’t fully recovered from the impact of the crisis.

Becoming small banks will help them significantly lower their borrowing costs, and engage in businesses focused on small and medium enterprises and the lower end of the retail customer base.

Once these firms enter the banking industry, logically, the bigger commercial banks will face intensified competition in the cheaper deposit and small-value loan market. State-run banks, which used to have dominance in rural areas of the country with their reach, will find competition tougher if the new set of banks hit the market with competitive rates of interest to poach customers. Public banks will have to work harder.

The bottomline of the RBI decision is this: The entry of small and payments banks mark the biggest banking revolution India has witnessed after the nationalization of banks. This will create positive disruptions in the country’s banking sector, intensifying competition, thus making banking more affordable for the common man.

Pradhan Mantri Khanij Kshetra Kalyan Yojana

Mining companies with leases under the 1957 law in this regard will be paying an additional amount, equivalent to 30 per cent of the royalty, for benefit sharing with locals.

This is under the Pradhan Mantri Khanij Kshetra Kalyan Yojana (Prime Minister's mining Areas Welfare Scheme), launched on Thursday.

Where leases were granted under the 2015 law, which has replaced the one of 1957, the companies would pay an additional 10 per cent of the royalty for this purpose.

ALSO READ: DMF committees may exclude miners

With the amended law, state governments must set up a District Mineral Foundation (DMF) in each district, which will use these funds for locals’ benefit sharing. It is estimated that Rs 6,000 crore will be available for DMFs in the first year.

The scheme's aim is to minimise or mitigate the adverse impacts, during and after mining, on the environment, health and socio-economics of people in affected districts, beside ensuring sustainable livelihoods.

The central government has laid down guidelines for implementation and directed states to incorporate these in the rules framed by the latter for DMFs.“High prority areas like drinking water supply, health care, sanitation, education, skill development, women and child care, welfare of aged and disabled people, and environment conservation will get at least 60 per cent of the funds,” went the official statement.

The rest of the money will be spent on roads, bridges, railways, waterways, irrigation and alternative energy sources.

अमरीका का फेडरल रिज़र्व रेट कट करेगा तो क्या होगा | रवीश कुमार

हिन्दी के युवा पत्रकारों से मेरा अनुरोध है कि वे अपना पेशेवर जीवन यूपी और बिहार की साधना में न गंवा दें। राजनीति की जो पारंपरिक समझ हम सबसे के भीतर बन गई है और जिसे हम सब बनाते भी रहते हैं उससे निकलने का वक्त आ गया है। नई आवाज़ों को पहचानिये और नए मुद्दों को खोजिये जिसे आप राजनीतिक बहस का हिस्सा बना सकें। वर्ना जैसा जीवन मुझसे पहले के पत्रकारों का बीता, जैसा मेरा बीत रहा है वैसा ही आपका बीतेगा। छोड़ दीजिए मोकामा इटावा की पोलिटिक्स में पीएचडी पाने की लालसा।

आज मैं इंडियन एक्सप्रेस में ही छपे जहांगीर अज़ीज़ के लेख का सार बताने जा रहा हूं। जगांहीर अज़ीज़ का लिखा मुझे पसंद आता है। इन दिनों पूरी दुनिया में अमरीका के फेडरल रिज़र्व की चर्चा हो रही है। फेडरल रिज़र्व भारतीय रिज़र्व बैंक टाइप ही है। फेडरल रिज़र्व शुक्रवार के रोज़ ब्याज़ दर में बढ़ोत्तरी का फैसला कर सकता है। इस एक फैसले को लेकर वित्तीय बाज़ार में खलबली मची है।

फेड रिज़र्व कई सालों से ब्याज़ दर को शून्य के करीब बनाए हुए है। पहली बार यह उम्मीद की जा रही है कि फेड रेट बढ़ सकता है। जहांगीर का मानना है कि अगर ऐसा हुआ तो लंबे समय के लिए दुनिया के वित्तीय बाज़ार में एक बदलाव आएगा। उभरते हुए बाज़ारों पर इसका असर नहीं पड़ेगा यह सोचना सही नहीं होगा।

ग्लोबल बाज़ार चाहता है कि फेडरल रिज़र्व रेट न बढ़ाये और लंबे समय के लिए टाल दे। जहांगीर मानते हैं कि यह एक टालने वाला कदम होगा। फेड का मानना है कि अमरीका का संभावित ग्रोथ रेट 2.2 प्रतिशत हो सकता है। जहांगीर कहते हैं कि इसे हासिल करने के लिए उत्पादकता बढ़ानी होगी। मामूली बढ़ोत्तरी के लिए भी जो तकनीकी बदलाव और ढांचागत सुधार चाहिए उसकी संभावना नज़र नहीं आती है। हो सकता है कि ग्रोथ रेट 2.2 प्रतिशत के नीचे ही रह जाए। अमरीकी अर्थव्यवस्था में अभी जो भी सुधार दिख रहा है वो रेट कट के बाद की स्थिति में मज़दूरी या पगार के बढ़ते ही गुम हो जाएगा। इससे दुनिया के वित्तीय बाज़ारों को झटके लग सकते हैं।

क्या भारत इस तरह के झटके से बचा रह सकता है, जहांगीर ये सवाल उठाते हैं।

भारत के पास 355 बिलियन डालर का विदेशी रिज़र्व है। चीन के पास कई गुना ज़्यादा है। 3.5 खरब डालर का विदेशी रिजर्व है। ये आंकड़ा देते हुए जहांगीर बताते हैं कि विदेशी मुद्रा भंडार में पैसे का लबालब होना संकट से बचने की कोई गारंटी नहीं है। इसके बाद भी चीनी अर्थव्यवस्था ढलान की तरफ़ है। ढलान रूका नहीं है। अगर अमरीका के फेडरल रिज़र्व ने रेट बढ़ा दिये तो भारत के विदेशी मुद्रा भंडार पर व्यापक असर पड़ेगा। निवेशक अपना पैसा यहां से हटाकर अमरीका में लगा देंगे। भारत अगर अपने रुपये को बचाने के लिए डालर खरीदने लगा तो यह भंडार और भी खाली होता चला जाएगा। विकल्प यह है कि अमरीका में रेट बढ़ता है तो भारत भी घरेलु ब्याज़ दरों को बढ़ा दे।

आप जानते हैं कि इस वक्त रिज़र्व बैंक पर दबाव पड़ रहा है कि वह ब्याज़ दरों को कम करे। जहांगीर एक दूसरी बात कर रहे हैं। चीन में अर्थव्यस्था के सुस्त पड़ने से बाज़ार में अनिश्चितता बनी हुई है। दुनिया के बाज़ारों में मांग घटती जा रही है। इसके कारण भारत का निर्यात कमता जा रहा है। मंगलवार को ही एक खबर छपी है कि भारत का निर्यात कैसे लगातार घट रहा है। आप पत्रकार इसे चेक कर सकते हैं। हमारे निर्यात का 25 फीसदी हिस्सा पश्चिम एशिया, रूस और लैटिक अमरीका जैसे चीली, मैक्सिको या अर्जेंटीना जैसे मुल्कों को जाता है। इन हिस्सों में मांग घटती जा रही है। अगर दुनिया की दूसरी सबसे बड़ी अर्थव्यवस्था यानी चीन सुस्त है तो यह मानना ग़लत होगा कि इसका भारत पर असर नहीं पड़ेगा।

जहांगीर कहते हैं कि तेल की कीमतें कम होने से भारत पर दबाव कम है लेकिन मुद्रा स्फीति कम होने से लोगों के बाच खर्च करने के लिए ज़्यादा पैसे आने चाहिए थे। वो क्यों नहीं हैं। आंकड़े बताते हैं कि उपभोक्ता वस्तुओं की मांग में कोई उछाल नहीं है। जहांगीर कहते हैं कि वर्तमान अनिश्चितता के कारण लोग बचत पर ध्यान दे रहे हैं। कारपोरेट के पास पैसे नहीं है इसलिए वे नया पैसा लगा नहीं पा रहे हैं।

इसलिए भारत में नीति बनाने वालों को संभल कर चलना चाहिए। जोखिम भरे कदम उठाने की बजाए जैसा चल रहा है वैसा चलने देना चाहिए। जब स्थिति साफ होगी तब कोई बड़ा कदम उठाना चाहिए। जहांगीर की एक और दलील ख़तरनाक लगती है। इनका कहना है कि महंगाई कम होने से ब्याज़ दरों में कटौती को लेकर दबाव नहीं बनाना चाहिए। बल्कि ब्याज़ दर बढ़ाने चाहिए। इसकी जगह पर तेल की कीमतों में कमी करनी चाहिए जिससे लोगों के पास खर्च करने के लिए अतिरिक्त पैसा आए। यह एक सुरक्षित रास्ता होगा। लेकिन मेरी समझ से जहांगीर रियालिटी सेक्टर और इंफ्रा सेक्टर में आ रही सुस्ती को नहीं देख रहे हैं या क्या पता देख भी रहे हों। जैसा  मैंने कहा कि मैं भी आर्थिक खबरों को सीखने समझने का प्रयास ही कर रहा हूं।

जहांगीर का कहना है कि ग्लोबल अर्थव्यव्था में कई स्तर पर सुधार चल रहे हैं। 2008 से ही। इनमें से कई बदलावों ने बीच रास्ते में ही दम तोड़ दिया। अब कोई नीतिगत ग़लतियां हुईं तो बाद में भारी कीमत चुकानी पड़ सकती है।

Severe Acute Malnutrition | Severe Chronic Malnutrition

SAM is typical of African countries and is a medical emergency where children are not only hungry but are also sick
with high levels of mortality. It is because of drought, civil wars, crop failure etc. Hence both medical care and quality feeding is required.

SCM is typical of India where children are only hungry but not sick therefore it is not a medical emergency. It is because of poor feeding practices, chronic food insecurity, poverty and protracted illness. Thus it is less severe than SAM but is continual form of malnutrition.

Indian children face SCM due to which 30% of under 5 years of age are underweight, 1 in 5 is wasted and 2 in every 5 is stunted. Also Indian children are prone to micronutrient deficiency where 60% pre schoolers suffer from deficiency of vitamin A. These are higher than poorest of African country due which south asian enigma is termed as Indian enigma.

Reasons:
1. Poverty
2. Illiteracy and ignorance about nutrition and government schemes
3. Improper implementation of TPDS
4. Non empowered mothers 
5. Lack of health facilities(doctors, nurses, medicines etc)
6. Denial of reproductive rights to women
7. Early marriage of girls as child born at young age is severely malnourished
8. Lack of sanitation and drinking water facilities which causes gastrointestinal problems due to which nutrients do not get absorbed in body
9. Junk food eaten by children which are low in nutrients causing micronutrient deficiency
10. Poor breastfeeding habits

Tackling malnutrition:
1. To tackle micronutrient deficiency food fortification or bio fortification of good option. These food grains should be distributed via TPDS, MDMS, ICDS etc.
2. Hiring more staff to be placed at PHC, CHC and district hospital
3. Weekly iron and folic acid supplementation, JSSK, NSSK should be effectively implemented to ensure than pregnant women should not give birth to malnourished child and for providing post natal care
4. Expenditure on health should be increased from current 1% to atleast 6% of GDP
5. Swachh Bharat Abhiyan, National Nutrition Mission, National rural drinking water Programme be implemented in letter and spirit
6. Education of mothers on nutrition be aggressively pursued with help of ASHAs, ANMs, Anganwadi workers
7. Promoting healthy eating habits in children. Banning selling of junk food around school premises.
8. Countering poverty via providing more days of employment under MGNREGA in drought areas
9. Providing reproductive rights to women and discouraging early marriage.

What India today need is holistic approach then only we can be able to garner fruits of demographic dividend and our
younger generation is able to contribute towards economic growth.

Medical infrastructure

The recent findings by World Bank that the number of hospital beds per thousand people in India is much lower than the world average has revealed the creaking medical infrastructure status.

Importance of Medical infrastructure:

1. India is prone to seasonal diseases (Eg: Dengue). Robust medical infrastructure is utmost importance to shift essential drugs on emergency basis.

2. The diversified demographic profile of India needs readiness to cater to the needs of all sections of people. Eg: Gender sensitive medicine, Geriatrics and Mental health care for youth.

3. Vaccination programmes-Mission Indradhanush and Universal Immunization program- need well trained medical human resources to achieve success.

4. Changing consumption patterns and lifestyles would lead to more chronic diseases. They should be handled to maintain healthy workforce.

Measures:

1. Right-sizing public health expenditure to 2.5% of GDP in accordance with the population size.

2. Harmony of purpose between the public and the private healthcare delivery systems to achieve public health goals.

3. Empowering ASHAs role by training and pay revision.

4. Robust Medical human resource management policy to train and manage staff to serve on Pan-India basis.

5. Restructure and revise the draft of National Health Policy to suit the demographic needs.

6. Special emphasis on primary care and child health care that integrates state, district and local governments with national health policy goals.

The demographic dividend of India can be harnessed not just with skill development alone but by complementing with sound health care policies to keep the workforce strong.

ख़बर लहरिया

https://ruralindiaonline.org/articles/khabar-lahariya/

short term and long term measures to fix India’s agriculture failures

India’s agriculture success story in ensuring food security and self-sufficiency is phenomenal and inspiring for many poor and emerging nations of the world.

At the same time, it is, probably, the only sector that has uncountable issues and structural weaknesses. The ever increasing population, climate change, and dependence on it make agricultural reforms imminent.

Short-term measures:

1. “Lab-to-Land” initiative must educate the farmers of the use of latest technology that is production cost cutting.EG: Tamil Nadu Model

2. “Priority sector lending” of banks must be Aadhar (or robust identity) based to eliminate duplication and targeted lending. Eg:Andhra Pradesh Model.

3. “Wrong crops” that are not suitable to the local climate and irrigation capacity must be discouraged. They demand heavy fertilizers application. Eg: Cotton in Telangana and Sugarcane in Vidharba region.

4. “Decentralized panchayat initiatives” like pond management, canal maintenance, improving local water use efficiency, traditional water harvesting methods and agri-produce storage facilities promotion must be encouraged.Eg: Punjab initiatives.

5. Gram Sabha based authenticated data collection to computerize and identify beneficiaries for various government policies. Eg:Malkangiri of Odisha

Long-term measures:

1. Expansion of formal credit financing through banks to the village level.

2. Building robust network of forward and backward linkages that benefit agriculture and agri-based industries too.

3. National Agricultural Market creation to better market the produce.

4. Devising crop insurance policies that are region and climatic specific (specifically for Vidharba, Telangana,Northern Karnataka).

5. Implementing Shanta Kumar Committee suggestions related to FCI procurement.

6. Following MS Swaminathan MSP+50% formula and “Ever Green Revolution” with “per drop more crop”.

Strong growth driven agriculture sector complements the government’s efforts towards manufacturing too by contributing quality agro-based industries inputs.

National Health Policy 2015

The draft National Health Policy (NHP) 2015 admits that while India’s population growth rate has significantly dropped (Section 2.2) and the gross domestic product (GDP) has grown (Section 1.1), the country’s health equity has not merely stayed the same but moved in the reverse direction (Section 2.3). The document stresses the “two way linkage between economic growth and health status” (Section 1.2) but this linkage has evidently not just failed to work in the Indian context, it has actually boomeranged. It is important to examine if the document offers insights about addressing this issue. Is it equipped to make amends before it is too late?

The objective of this article is to map some of the blind spots and the contradictions and gaps in the NHP 2015 in order to keep the debate on it alive.

Diluting the Positive Shifts

Urban Poor Health: The draft distinctly focuses on urban (poor) health and underlines the need to step up the pace of the National Urban Health Mission (NUHM). The volume of the population of the urban poor has been growing exponentially especially in the metropolitan and high-end cities. It has also been shown that this voluminous population often ends up suffering the worst of both the rural and the urban settings. The document mentions that “A technical resource group has examined the urban health situation at length and suggested measures needed to address the most vulnerable and marginalised sections of the urban poor and the way forward in convergence.” Yet, it remains strangely silent on what the “suggested measures” are, accounting for one of its several blind spots, and diluting the seriousness of the concern to engage with urban health.

ASHAs: The imperative to develop a cadre of urban accredited social health activists (ASHA) seems to be a proactive step. In fact, there is a significant stress on the role of ASHAs and the duties they have been discharging, but the blind spot lies in the document not revealing any indication of having taken into cognisance the volume of criticism (made by several health rights groups) pertaining to the way they have been exploited and under-recognised in terms of payment, access to facilities, etc. ASHAs have credibly established themselves as “activists” in only rare circumstances. Certification of skills is essential, but not a substitute for compensation and social security. It is almost criminal to keep thinking of female labour as “voluntary” while increasingly investing more responsibility onto this segment of the health system. We could take our cue from how Iran has scaled up and supported the behvarz (Iran’s community health activists) by creating posts and institutional structures for their activities. Greater synergy and cooperation between ASHAs and auxiliary nurse midwives (ANM), therefore, is urgently called for.

Health Research: Section 10 (“Knowledge for Health”) of the document is important because it underscores the importance of health research. It refers to the Department of Health Research but refrains from making any observation on its rather little known existence and insubstantial style of functioning. Interestingly, it talks about the need for India to contribute to global health research, and develop its own policy in international health and health diplomacy, besides stating that India should reposition itself as an equal partner in international technical cooperation rather than remain a mere recipient of aid and technical assistance. The suggestion that India, in collaboration with the other BRIC (Brazil, Russia, India and China) nations, must explore building multilateral institutions like the World Health Organization (WHO) is not just radical but too ambitious at present. This is so especially against the backdrop of India’s own poor health status and tottering public healthcare system, the escalating out-of-pocket expenditure and an acknowledged link between the country’s poverty and unregulated healthcare costs. While it can be inspirational to project such visions, concrete and realistic steps to go about it should be drawn up especially when planning national documents (Bandewar 2015).

Self-Contradictions

Attitude towards the Private Healthcare Sector: The draft policy acknowledges that “catastrophic expenditure due to healthcare costs is growing and is now being estimated to be one of the major contributors to poverty” (Section 1.3) after acknowledging that there is a “two way linkage between economic growth and health status.” Yet, when discussing the private healthcare sector, the document engages primarily with its not-for-profit version and leaves the issue of regulation of the already-vast-in-size-and-further-growing for-profit private sector to the margins, despite this being the sector which is overwhelmingly instigating the said catastrophic healthcare expenditures.

Regulatory Role of the Government: The document mentions that the government has a regulatory role in managing healthcare: “…clearly as private industry grows at a massive pace, and as this is an area touching upon the lives and health of its population the Government has to find ways to move forward on these responsibilities” (Section 2.17). However, it is rather curious that the draft, representing the agency and voice of the Ministry of Health and Family Welfare (MoHFW), does not discuss the possible “ways to move forward” in this serious, overwhelming and complex issue, but simply leaves it to the “government.” Who is the concerned government apparatus in this case one wonders, if not the MoHFW itself!

Unrealistic Budgetary Allocation: Inadequate budgetary allocation to health has been a concern for more than five decades and continues to be so in this 2015 document. The NHP 2002 had promised an increase in public health expenditure from 0.9% of GDP to 2% in 2010 (though it was still far short of the 5% of GDP recommended by WHO and also demanded by the health movement in India). In comparison the document proposes only 2.5% of GDP on grounds of inadequate financial capacity of the country and institutions for effective utilisation of funds. It also adds that “most expert groups have estimated 2.5% as being more realistic” (Section 2.18), but does not elaborate on the supposed inherent realism in the figure even when this seems to (financially) sabotage several of the goals the document sets for itself. Thus, while it assures us of investment in the idea of a Health Care Act, it refrains from substantially increasing the budgetary allocations which would make the idea seem practicable.

Harmful, Hazardous Industries: The draft states that it will levy a “health cess” along the lines of an “education cess.” The supposed cess will come from industries that are unhealthy and toxic: “Extractive industries and development projects that result in displacement or those that have negative impacts on natural habitats or the resource base can be considered for special taxation extractive” (Section 4.1.2). This is very disturbing since it implies that the government accepts evidently unhealthy development—even that which it distinctly identifies as causing displacement and having a negative impact on natural resources and people’s lives. The only “action” the government will take is by imposing special taxes on these industries—which hardly sounds like a punitive measure. This stand of the government severely undermines and violates a sustainable and eco-preserving development model. The overt conceding of unhealthy industry and unhealthy development also contradicts the “preventive and promotive health” component (Section 4.2) the document itself stresses.

The 2010 Clinical Establishments Act: The discussion on the “failure” of the implementation of the Clinical Establishments Act (CEA) tends to suggest that the government can do nothing much to deal with the terms of the insurance companies: the language of the draft at this point seems to be one of “giving in” to the demands of the private insurance industry. There is no mention of how to fix the purported gaps in the CEA, but instead, in Section 12.1 it is listed amongst other acts which are deemed to require a legal makeover.

Omissions and Gaps

Women’s Health: The draft subsumes the topic of women’s health under the Millennium Development Goals (MDG) and “Population Stabilisation,” and later women’s health crops up in the discussion on the reproductive and child health (RCH) services. While improvements in maternal health indicators (such as the maternal mortality rate (MMR) and under-five mortality rate—U5MR) are expected to find mention in such a document, it is a huge disappointment to realise that the State continues to perceive women and their healthcare needs only in terms of reproductive needs. Conflating women’s health and gender mainstreaming under the RCH clearly indicates (a) misplaced emphasis on population stabilisation, ignoring evidence from around the world contrary to the idea that reduced fertility rates contribute to enhancing socio-economic opportunities; (b) that the responsibility for population stabilisation is to be shouldered by women, defying even the very modest expectation of the progressive health and women’s movements; and (c) the government has once more let down the women’s health movement. The document fails to respond to women’s health needs in compliance with the gender justice commitment.

There is mention of the need to increase the targets for male sterilisation and contraception utilisation as well, but a number of questions arise at this point: why does the government want to continue with the target-oriented approach? Should population stabilisation be the agenda even in 2015? What stops us from accepting the evidence that supports the view that moving away from target-oriented approach to population stablisation serves people better by focusing on enhancing their socio-economic well-being?

Relation with the For-Profit Private Sector: The draft document points out that the private healthcare industry will receive a substantial variety of exemptions and benefits (“higher depreciation in medical equipment,” “custom duty exemptions for imported equipment that are lifesaving,” “preferential and subsidised allocation of land that has been acquired under the public acquisitions Act,” etc). However, while several private hospitals are forgoing their part of the memoranda of understanding (MoU) to offer 10% free beds and treatment to the underprivileged, the document says nothing about regulation, monitoring or accountability. And through this stark silence, it ignores the activities of the civil society groups which have been fighting long and hard to foreground and curb such corruptions.

More Medical Colleges: Having acknowledged that there has been a significant increase in the number “of medical colleges” and “seats for both undergraduate and postgraduate [medical] education,” the document adds that “...even further expansion is needed and planned for.” But no rationale is provided for simply adding to the number of medical colleges, without interrogating the quality of medical education. It is common knowledge that a lot of medical colleges that have come up after 1990 are privately funded, often abysmally equipped, and arguably churning out inadequately trained professionals, while receiving accreditation through equally dubious means; there are accosting issues of seat auctionings as well (Seethalakshmi 2013; Nagarajan 2014). So, without even addressing these factors which are eating away at the existing healthcare system, a simple glorification of numbers of quality is naïve at best and criminal at worst.

The Wait Continues for Right to Healthcare: The document refers to the need to enact the right to healthcare legislation in the coming times (Section 12.2), and this is a reason to both rejoice and despair about. It seems that it would be a long wait before a Right to Health (RTH) Act could be legislated, since it is said to follow the CEA 2010, that is, it will be enacted only on the request of at least three or more states (with a per capita public health expenditure of Rs 3,800). The proposal to enact the RTH is also prefaced by several questions, including whether the level of economic and health systems’ development allows us to make the denial of health rights an offence; and whether such a law should focus on the enforcement of public health standards related to conditions for health, or on access to healthcare and quality of healthcare.

State Medical Councils: Yet another omission is the absence of discussion on the role and achievements of the state medical councils: the state medical councils have a strong and powerful role to play in regulating medical practice, service and delivery in the state; while it is known that the performance of most state councils have not been satisfactory (George 2011), as a national level policy document, the NHP 2015 should have emphasised the role of the councils, invested them with responsibility and made them accountable in more possible ways.

Possible Interfaces: The document does not explicate how it will interface with the other existing allied policies, such as, the health research policy of 2010, the drugs policy, the palliative care policy of 2012, the occupational health policy, and the changing terrain on patent regime in relation to ensuring availability of generic medicine.

Conclusions

Health is a priority area and the NHP 2015 should have been able to provide a more concrete road map with doable timelines and practicable end-points. The document does contain interesting and much-awaited interventions and shifts, yet falters—primarily—in offering a realistic support structure for that. That is, with all the much appreciated plans and end-points, the NHP 2015 suffers from a meagre budget. From implementing the urban health mission to training a new cadre of urban ASHAs to facilitating the RTH, a health budget of 2.5% is far too less. The paradox of this third national health policy is that it is self-defeating.

http://www.epw.in/commentary/national-health-policy-2015.html-0

Landscape of the individual | Anand Gandhi

At the risk of reductionism, I am tempted to engage with an irony — we are now simultaneously a state that awards death to an individual keen on living, and forces life upon an individual keen on dying. We are one of the few civilised states still practising capital punishment, and one of the many still shirking the right to die. We have been negotiating the decriminalisation of attempt to suicide since 2013. In February, the ministry of home affairs decided to accept the recommendation of the Law Commission of India to delete Section 309 from the IPC, and drafted a proposal. We are still waiting. We now remain one of the last countries in the world where, if you don’t die successfully, you’ll go to jail for trying. My partner tells me that can make for a good film. The fundamental function of the state is to guarantee sustenance, equality and complete civil liberty, while balancing it with checks to ensure one individual’s liberty does not violate another’s rights. It is to negotiate social contracts, warn against violation and compensate for a breach. The state builds infrastructure and systems to fulfil its fundamental promises, and protects property, owned individually, commonly or collectively. So how do we resolve a conflict between the state’s guarantee of the citizen’s wellbeing and a citizen’s demand for self-annihilation? By establishing a simple inviolable boundary — the landscape of the individual. The individual (an informed, sound-minded consenting adult) is the sole owner of the self, entirely responsible for the self, and not state property. The state’s duty is limited to protecting the citizen from external threats. The state, in its traditional paternalism, should not forget it has limited powers and responsibilities in individuals’ choices affecting their own selves. The state must educate, inform and caution the citizen, but it must not mistake pedagogy for paternity. For example, smoking. The state directs cigarette companies to warn consumers, without ambiguity, against the risks smoking poses to their health. The state is even free to carry out educational campaigns enlightening citizens of such risks. Warned against potential fatality, the individual is still free to smoke. Not everywhere though — the state has to now step in to prevent the individual’s action from harming others, and may do so by banning smoking in public spaces, even creating smoking booths where smokers are welcome to injure and pleasure themselves. Now, when the law fines a citizen for not wearing a seatbelt or a helmet, the only ethical explanation for such punishment is that it’s a deterrent created to lessen the public health burden caused by the incidence of accident-related fatalities. (There have been arguments about smokers having to register themselves, which will limit their healthcare rights if they develop lung cancer, but such a recommendation is bound to conflict with the other fundamental rights of the citizen). I will engage in some self-labelling here — I am an atheist and I am assertively irreligious to the extent that I am convinced that most religious and ancient philosophical systems of the world are well intended, but under-updated, vestigial, stagnant and flawed, inspired at times, yet misinformed. I am not an advocate of freedom of religious expression if it violates the fundamental rights of another individual (including of non-humans). In that, I like to think of myself as a humanist, a rationalist and a utilitarian. In furtive didacticism, the character of Maitreya in my film, Ship of Theseus, often mouths my personal beliefs. One such is, “All ethics should be arrived at in isolation of religious beliefs.” It was important to me that a monk say this. I wanted to make sure that the central philosophical debate about identity, self and violence didn’t get embroiled in religious politics, social practice and contemporary law. So, I hypothesised the situation within the framework of a fictitious religion, the basic principles of which were inspired by the two Sramana traditions, Jainism and Buddhism. Similarly, I suggest we step away from religion to examine the discourse around Sallekhana. At a time when we have decoded the human genome, plunged deep into the brain, deconstructed every emotion and instinct to its original evolutionary function, we have little need to fall back on ancient institutions to find moral solutions. We can do that using contemporary tools of enlightenment and inquiry. (We might however, in some cases, want to dust over usable parts of intuitions and ideas from ancient wisdom.) In building a case for the right to die and Santhara, I recommend that we do not let the defence get overpowered by a singular conversation around religious freedom. There is something bigger at stake here. Bodily integrity and individual sovereignty are inalienable rights of the modern citizen. These rights are even more fundamental than the right to religious expression, and it is primarily these rights that are being challenged by the Rajasthan High Court ban on Sallekhana, which has been stayed by the apex court. We have to accept and establish that the law has no moral right whatsoever to legally interfere with the lifestyle, sexual, reproductive, death choices of informed, consenting adults, even if they are beyond the understanding of presumably well-intentioned state representatives. The right to religious expression follows, and can be rephrased as the right to define and manifest the self, as an extension of the worldview that guides an individual’s life. How the individual sees the self — as a sum total of all past causes, as an evolving biochemical organism with an accumulated meaning and free will, as a wave in an ocean, as a meaningful creation of a hyper-intelligent entity, as a meaningless accident, as a notion, as a machine hosting a ghost, as a step towards ascension, as transient, as permanent or as an atom carrying the universe — will have to be allowed, however unacceptable it may seem to the rest of us. The individual has the right to construct their own meaning of life and interpret life and death in light of that meaning. This worldview can be negotiated with, argued with, transformed and informed, but not legally regulated. Not for a while, at least. However, it will be puerile to brush the nuances of the dilemma under the carpet. While there is greater unanimity over a terminally ill patient’s right to die, the debate is really within the space of a physically healthy individual’s choice to terminate their life, as it raises questions of mental wellbeing and informed consent. Is it a stable choice, achieved after due deliberation and profound consideration of the consequences, or is it an impulsive decision, made out of mental instability or a falsely perceived absence of choices? Can we establish coercion? Is it the concerned individual making the choice, or is it a guardian or caretaker? These questions will need more inquiry and deliberation. Meanwhile, as far as informed, sound-minded, consenting adults are concerned, it’s high time the state stops criminalising their sexual and aesthetic choices, their media consumption, their personal expression, how they live, and how they die. 

Gandhi, 34, is a filmmaker and director, most recently, of ‘Ship of Theseus’ - 

See more at: http://indianexpress.com/article/opinion/columns/landscape-of-the-individual/#sthash.vNJTeWkl.dpuf