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1.Forging the ‘New Delhi Consensus’ on health (Live Mint)

2.India at 70 (The Financial Express)

 

1.Forging the ‘New Delhi Consensus’ on health (Live Mint)

Synoptic line: It throws light on the issue in Health sector, how policy framed is not able to tackle challenges in the sector. (GS paper III)

Overview

  • The rampant spread of infectious diseases has contributed to India’s nutritional crisis, and imposes a heavy human and economic cost by raising health expenditure, and lowering productivity and earnings.
  • Recently the Gorakhpur tragedy shows that healthcare is not a political priority till the point there are large-scale deaths. There are systemic issues which plague the health sector, which often do not receive the importance they deserve.
  • Health policy documents of the Indian government typically emphasize a broad range of goals but they do not take into account the need for prioritization, or the efficacy scores of the suggested interventions.

Assessment of Health sector in India

  • There seems to have the conflict between the health ministry and the planning body, which is not new but it reflects at its core that there is a fundamental lack of consensus and clarity on the role of the state (and the role of the market) in healthcare.
  • The Nobel-winning economist ‘Kenneth Arrow’ stated that the market for healthcare is quite far from what those ideal conditions demanded, there is a stark information asymmetry between the buyer and the seller of medical care, the patient could not be expected to know either the cause or the treatment for his or her ailment. The buyer cannot even evaluate what he or she has been sold with any degree of certainty.
  • Healthcare is has certain aspects of it that are unlikely to be provided by the market because of what economists call ‘externalities’. If a person is vaccinated for instance, the benefits accrue not just to him but to the entire community.
  • Also there are certain aspects of healthcare, primarily relating to preventive health, which have public good characteristics, for example a well-functioning drainage and waste management system, which by lowering the chances of infectious diseases contributes to overall welfare and reduces health expenses.
  • After independence in India the biggest casualty was preventive public health. Given that the contribution of preventive public health services are measured primarily in negative terms (diseases or epidemics averted), it requires great political skill to make the case for such investments. Investments in curative care such as new hospitals have greater appeal in a democracy.
  • The setting up of missions to tackle specific diseases such as malaria also detracted from the larger goal of creating an over-arching public health infrastructure. As a result, the public health cadre of the colonial era withered away as scarce resources were directed towards curative care, and towards a few disease-specific donor-driven programmes.
  • While such disease control programmes met with sporadic successes as in the case of eradication of malaria in the 1950s, these gains proved to be unsustainable because of the overall weakness of the public health infrastructure and disease surveillance systems. Decades later, India still bears the legacy of that neglect.
  • According to the British Medical Journal although South Asia has emerged as a hotspot for zoonotic infections (those that are spread by humans and animals), the “Institutional capacity for epidemiological and laboratory response, especially at sub-national levels, remains limited”. High population density and inadequate public health systems in this region have resulted in an extraordinarily high disease burden in India even when compared to other developing countries.

Government initiatives

  • Recent months saw lots of moves in the health sector on the one hand, the government has shown a remarkable alacrity to micro-manage prices of drugs and surgical implements such as coronary stents and knee implants, while on the other hand, a section of the government wants a private-public-partnership model for district hospitals. But the contradictory nature of the policy moves suggests the lack of a coherent policy framework to deal with India’s health challenges.
  • The Swachh Bharat (Clean India) programme also marked a radical change when it was announced, with the top political leadership owning an aspect of sanitation. However, the narrow focus of the programme has meant that its impact will be far lesser than what it could have been if it were integrated within an overall thrust to rebuild India’s preventive public health apparatus.
  • The programme has progressed slower than planned, and not all of the toilets that have been built are being used. The two key reasons for this are the lack of attention to the ‘behavioural component’ of the programme, and lack of development of an entire ‘sanitation value chain’.
  • A research done in rural Odisha shows that toilets can be very effective in preventing diseases if they are universalized, and accompanied by complementary goods including water connections. Evidence from other parts of the world also lends support to the view that an integrated approach to public health is usually more effective in improving health outcomes.
  • We can learn from the Copenhagen Consensus Centre that has evolved into a US-based non-profit that shows the importance of preventive public health. Of the 10 most important priority projects identified by the panel for Copenhagen consensus, five related to water, sanitation, and nutrition.

Way ahead

  • We need a comprehensive framework for health and nutrition that takes into account complementarities and externalities in health investments, and ranks the different kinds of investments which will be most effective.
  • According to the World Bank data less than 2% of GDP, India’s overall spending on public health is much lower than that of its peers from the developing world, in order that the increase in spending is most effective, there has to be a clear prioritization of goals.
  • It is time the Indian government took a leaf out of that approach and identified a priority list of interventions in healthcare based on the desirability and cost-effectiveness of those interventions and come with a New Delhi Consensus.

Question– Explain the implication of low health standards on the targets that India had taken under SDG.

 

India at 70 (The Financial Express)

Synoptic line: It throws light on the still prevalent centuries old Caste system in society. (GS paper II)

Overview

  • Recently millions of Indians celebrated Independence Day, but ‘untouchables’, oppression and violence are still an everyday reality. All the Indians, whether Christian, Muslim, Parsi, Buddhist, Jain or Hindu, carry some vestiges of the caste system in them. Caste and casteism have been carried to every corner of the globe to which the Indian Diaspora migrated.
  • Our caste prejudices manifest themselves most clearly in the matrimonial newspaper columns, where prospective brides and grooms of all religions are sought for traditional marriage alliances.

Background

  • The origins of the Indian caste system lie in Varna system. Varna is the four-fold division among Hindus -Brahmin, Kshatriya, Vaishya and Sudra. The lines that divided them were horizontal, hierarchical and unbreachable, once you were born in a Brahmin or Kshatriya or Vaishya or Sudra family, you will remain there for your life and your progeny will remain there for the duration of their lives.
  • Within each Varna, there are divisions and sub-divisions and each one of them came to represent a caste (Jati) or a sub-caste. Each caste or sub-caste became a closed shop as it framed its own tyrannical rules and violations were punished by exclusion or expulsion. The worst form of caste oppression was untouchability. An ‘untouchable’ now called a Dalit was totally excluded from Hindu society.
  • By any standard Varna, caste and untouchability made Hindu society one of the most oppressive, exploitative and less productive social systems in the world. Some of these issues were brought to the fore during the freedom struggle.
  • The goal of freedom absorbed the nation’s attention but the social reform remained in the background. Babasaheb Ambedkar emerged as the authentic voice of the Dalits. EV Ramasamy (“Periyar”) took up the cause of the non-Brahmin castes in Tamil Nadu, the non-Brahmins constituted nearly 97% of the Hindu population. Sri Narayana Guru worked to liberate and unite the so-called lower castes, especially the Ezhava.

Centuries old puzzle

  • Still the prevalence of caste system through the centuries is a puzzle.  It raises many questions like why did the Kshatriyas and Vaishyas, who had power and money, accept the Brahmin as their superior? Why was the guru invariably a Brahmin? Is it because humans crave an associational life, that caste became a convenient association that gave a measure of physical and social security?
  • Caste is still the most dominant factor in politics, social relations and marriage. Caste has significant influence, in varying degrees, in government administration, private sector, trade and professions. There are deep caste divisions in the world of art, culture and literature. Though the education, urbanisation and migration is eroding caste from the edges of Hindu society, but caste still sits at the core of Hindu society, notwithstanding the Constitution of India or Articles 14, 15, 16, 17 and 21, caste and casteism survive to this day.

Question–  Caste System in India is a reality that has to be accepted, but the problem associated with it, is about the exploitation that caste system brings. Comment.