Mitras Analysis of News : 21-03-2017

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1.Framing the right prescription for health expenditure (The Hindu)

2.Behavioural solutions for road safety (Live mint)

3.Pakistan’s first census in 19 years

4.Bystander effect


1.Framing the right prescription for health expenditure (The Hindu)

 Synoptic line: It throws light on the suggestions to improve the status of healthcare in India by certain institutional measures.(GS paper III)


  • India fares poorly on various health indices. It poses great danger for India’s demographic dividend as it can lead to a demographic disaster.
  • The reasons for this state of affairs are both resource-related and systemic. Tackling the former requires, of course, an increase in the centre’s current health spending. However, it isn’t simply a matter of the centre throwing more money at the problem. A look at the systemic issues will show that the current situation could be improved even with the available resource allocations.

India’s Health expenditure

  • Cumulatively India’s spending on health sector is close to 5% of its GDP.
  • At a comparison in terms of Purchasing Power Parity (PPP), a measure that more accurately corresponds with our actual standard of living, India is the third largest economy in the world, at almost PPP $8 trillion.
  • Given the large size of our population, our 5% allocation to health translates to a mere $267 per individual, a number far lower than the OECD average of $4,698.
  • The biggest reason for the slow improvement in health parameters in the country, however, is the huge out-of-pocket (OOP) health expenditure incurred by Indian households. Private expenditure on health also includes insurance, donations and direct service payments by corporations. In India, 85.9% of private expenditure on health is OOP

India’s Performance

  • India as a part of lower middle income countries, does not spends too poorly when compared to its counterparts. However, on an index measuring country performance on the health-related Sustainable Development Goal (SDG) indicators, India ranks poorly at 143 out of 188 countries.
  • Even, countries with comparable or even lower per capita health expenditures, including Indonesia, Thailand, and Ghana, are ranked better on the SDG Index at 91, 112, and 141, respectively, out of 188, and offer us hope and a few lessons.
  • The World Health Report of 2016 shows that despite being placed roughly in the middle of the South-East Asian Region (SEAR) one of the worst performing regions in health after Africa in terms of gross national income per capita, India figures in the bottom slots for most health-related parameters within the group. For instance, among SEAR nations, it ranks the worst in the relative inequality score the ratio of mean coverage among the poorest populations to national average for reproductive, maternal, new-born and child health intervention.

Tackling the problem

  1. Increasing penetration                                                                                
  • First, India’s health services and health personnel, besides being grossly inadequate, are inequitably distributed across and within states. Rural-urban inequalities inevitably translate into differences in health outputs. For example, there is a 63% difference in infant mortality rates and 44% difference in total fertility rates of rural and urban areas in India.
  1. Expenditure Pooling
  • India has among the lowest pooled expenditure for health care; between 2004-2014, approximately 4-7% of households fell below the poverty line as a result of high out-of-pocket expense. Pre-payment and pooling of resources are critical to ensure financial protection against catastrophic health shocks.
  • The extent of pooling is determined by the government’s tax allocation to health and insurance coverage in the country. India’s low tax to GDP ratio and allocations of around 5% of general government expenditure to health impact the total quantum of funds available.
  • Countries such as Thailand which have a comparable tax to GDP ratio have prioritised health within their budgets and allocate 13% of it to health care. To increase pooled funds for health care, India needs to both provide a significantly higher level of allocation to health care in its annual Budgets, as in Thailand, as well as extend schemes such as the Employees’ State Insurance Scheme (ESIS) currently a mandatory insurance scheme only for low-wage earners in the formal sector in India to all employees.
  1. Professional Revamp
  • Third, the quality of our healthcare is in serious jeopardy due to a lack of regulation as well as well-trained medical professionals. The National Eligibility cum Entrance Test controversy shows that policymakers after due consultation with states, must seriously reconsider improving the field of medicine and health sciences.
  • There is also an urgent need to upgrade the curriculum in keeping with the changing disease spectrum and technological advances.
  1. Reimagining Government role
  • Successful health systems, the world over, including in entirely free market developed economies such as Germany, Switzerland, South Korea, and Japan, do not necessarily have the government as a provider.
  • Nevertheless, they all have a high degree of direct government control on the services that are offered; the pricing of health services, referral pathways, and treatment protocols that are followed.
  • Governments such as those of Japan and Switzerland exercise direct price controls on services like how much physicians and hospitals may charge.

Way ahead

  • India’s demographic dividend is expected to last for another 25 years. But if the youth are restrained from achieving their potential due to illnesses, old and new, the dividend will remain theoretical. The Indian health story needs a rewrite. A bigger budget that irons out creases such as regional inequalities and accounts for a shifting disease spectrum might be a good storyline to begin with.

Question: It is clear that significant, strategic shifts in the level of control that the government exerts on both the financing and provision of health are urgently required. How government can move in this direction?


2.Behavioural solutions for road safety (Live mint)

Synoptic line- it throws light on how an effective behavioural change is need of an hour for road safety, rather than rational and infrastructural development.(GS III)


  • Despite measures being taken by the government on improving roads, there has been a continuous increase in road crash deaths, with increasing road fatalities, there in need in authorities to shift from rational method to behavioral change in person to tackle road accidents.
  • Road safety is not just about creating infrastructure. It is about designing behavioural solutions that take human biases and irrational behaviour into consideration.

India’s figure

India is seeing opposite trend- increasing no. of road accident with improving roads infrastructure. According to the National Crime Records Bureau only 0.8% of the total death cases, were due to lack of road infrastructure. It means improve road infrastructure have no impact on person’s mindset leading to more fatalities.

  • Between 2010 and 2015, incidence of road accidental deaths increased by an annual average rate of 1.2%.
  • Regular speed limit signs are ineffective at getting drivers to slow down, because drivers don’t choose the speed based on speed limit signs. Rather drivers simply go with the flow depending upon the width and smoothness of the road and traffic conditions.

Taking lessons from different country’s initiatives

To get drivers to reduce speeding, there have been several effective behavioural design nudges implemented around the world. Some of them are following

  • In Chicago, a series of horizontal white stripes have been painted on the road which get progressively narrower as drivers approach the sharpest point of the curve, giving them the illusion of speeding up and nudging them to tap their brakes. As a result, there were around 36% of fewer crashes. Same pattern has been implemented in China and Israel.
  • In UK more than 200 trees planted closer and closer together to give the impression that the vehicle was moving faster. This encouraged the motorists to slow down.
  • In US zigzag white markings had been painted instead of the familiar straight dashed lines, to caution drivers approaching the road-crossing intersection used by pedestrians and bicyclists.
  • An experiment in Mumbai seen 61% reduction in honking by implying a “bleep” (a red button on the dashboard) of a car that beeps and flashes when the driver presses the horn. To switch off the red button, the driver has to press it. This behavioural design nudge breaks the habit of drivers’ honking because now each time drivers want to honk, “bleep” makes them deliberate whether they should honk or not.

Way ahead

  • Time has come for authorities to stop relying on ineffective money-draining campaigns, driver education and enforcement of laws. Instead, by implying simple, practical, scientific behavioural design nudges to improve road safety.
  • Human does not act rationally. Drivers honk even when there is no way that honking could clear a traffic jam, therefore rational ways of changing behaviour like educating people or creating awareness-based campaigns are ineffective.

Question: Nudging can be a powerful tool to change the behavior associated with any issue. Explain how nudging techniques can be employed in effective governance?

3. Explained 

Pakistan’s first census in 19 years

  • Pakistan has kicked off its first headcount and house-listing exercise in 19 years after partially recovering from a wave of terror attacks and an economic meltdown that plagued the country over the past decade. The 70-day exercise will be held in two phases.
  • This will be the biggest census in Pakistan’s history. The last census was conducted back in 1998.

Why such a delay?

  • The census that is supposed to be held in every 10 years was postponed following frequent terror attacks and the economic crisis in 2008.
  • In 2011, a separate house listing exercise failed after a three-day operation.
  • Government actually moved into action after a Supreme Court order set a March deadline to start the process

Certain key issues in the exercise

  1. The process is marred by court challenges over ethnicity and failure to include the transgender and disabled people in the form and details about fertility, migration, education, etc. Officials assured the Supreme Court that the anomalies will be covered in a follow-up exercise this year.
  1. There are concerns about how the entire exercise will be held. Critics say some provinces fear they will be under-reported which would put their gains from a rise in population at risk. In Pakistan census is important as several key allocations, from funds to quotas and seats in the National Assembly are made based on population.
  1. Nationalist parties in Balochistan wanted the Centre to delay the census till Afghan refugees are returned to Afghanistan. Officials admit that over a million Afghan refugees are living in the province out of which less than 30% are registered with UNHCR and the government. But their objection was overruled by the federal government.
  1. The census is significant for the Khyber Pakhtunkhwa (KPK) province as well, this province has suffered the most in terms of terrorism and migration. More than five million people have migrated from KPK to Punjab and Sindh, while there was an influx of refugees from Afghanistan and the Federally Administered Tribal Areas (FATA). This time, the Centre has decided to include seven FATA tribal agencies in KPK. The exercise would allow the authorities to take an actual count of people in a province that was hit by the war against terror and then stake a proportionate claim in power and federal resources.

Implications of Census

  • The census is not merely an exercise of counting heads. It provides information on key indicators such as population density, gender ratio, literacy rate, financial conditions and employment numbers.
  • As the data from 1998 census
  • are obsolete, it is crucial for the government to obtain an updated picture of the country’s socio-economic composition to make the right policy choices.

Question: How Census exercise in Pakistan holds the key to socio-economic prosperity in Pakistan and thereby controlling the influx of non-state actors in India?

4.Ethics Special: Apathy experiment

Bystander effect

  • The experimenters got their inspiration and motivation to conduct this experiment from the highly publicized murder.
  • The bystander effect occurs when the presence of others discourages an individual from intervening in an emergency situation.
  • Social psychologists Bibb Latané and John Darley popularized the concept following the infamous 1964 Kitty Genovese murder in New York City. Genovese was stabbed to death outside her apartment while bystanders who observed the crime did not step in to assist or call the police.

Two reasons were offered to explain the bystander apathy effect.

  • First is diffusion of responsibility. This occurs when other people think that another person will intervene and as a result, they feel less responsible.
  • The second explanation is pluralistic ignorance. This refers to the mentality that since everyone else is not reacting to the emergency; my personal help is not needed. Seeing the inaction of others will lead to the thought that the emergency is not that serious as compared to perception when he is alone.


  • Individuals may be lead to thinking that other observers are more qualified to help. In times of medical emergencies, people might think that maybe a doctor is present in the scene and the patient will be better off with the help of the doctor.
  • Some people may be too self-conscious that they don’t want to give off negative images to other bystanders. For them to avoid this occurrence, these individuals simply do not respond to the emergency.
  • Fears associated to perception can also be an explanation of bystander effect. Such fears include being outranked by a superior helper, or being rejected when offering one’s help, or having to deal with legal consequences of offering inferior or even worsening assistance.

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