1.The elephant in the room (The Indian Express)
2.What’s at stake in Hyderabad (The Hindu)
3.Public health, private players (The Hindu)
1.The elephant in the room (The Indian Express)
Synoptic line: It throws light on the need of creative learning to effective utilise demographic dividend. (GS paper III)
- Despite considerable economic growth and increasing self-confidence as a major global player, modern India is a disaster zone in which millions of lives are wrecked by hunger and by pitiable investment in health and education services.
- By 2030, India will have 590 million people nearly twice the current US population living in its cities. The youth segment of this population is expected to include 170 million workers. These are the preschoolers of today. These are very important constituent is practically overlooked in all our policy plans. India’s public and policymakers’ imagination ignores children and the young.
- In India 50 per cent of 300 million children in school can’t read, needs action and the call is more urgent, when we know that 150 million of those children are 5-10-year-olds.
Concern for India
- Demographic Dividend is a limited time window, in which all the appropriate policy framework has to put in, to be able to utilize the window. These policy frameworks related to job creation, education and health standards, skill development, quality of jobs, social security.
- The Right to Education Act, with great foresight, which focused on free and compulsory education till class VIII, does not prescribe preschools for the poor or education beyond class 8. Nor does it talk quality or equity.
- The pre-primary and primary school children of today are going to be the work force of the 2030s. But there are few programmes for early schools goers. The 21st century needs creativity, innovation, problem-solving, entrepreneurship and a drive to excel. But basic education seems to be less important in the grand scheme of things than the mission of skilling Indian youth by the lakhs.
- The new Child and Adolescent (Prohibition and Regulation) Amendment Act, 2016, passed recently in Parliament is touted as “progressive” for it covers adolescents (up to age 18.) But it lacks the national commitment to abolish child labour in all forms. As the clause in the law permits children to be employed in “family or family enterprises” or allows the child to be “an artist in an audio-visual entertainment industry”.
- The list of hazardous occupations and processes has been slashed from 83 to just three. Now, adolescents can be put to work in chemical mixing units, cotton farms, battery recycling units, brick kilns, among other places.
- Even the UNESCO report of September 2016 says India will be half a century late in achieving its universal education goals. Hence, we will achieve universal primary education only by 2050; universal lower secondary education only by 2060; and universal upper secondary education only by 2085.
- School readiness is a critical factor for lifelong learning and sustainable education. If schooling helps break stereotypes and reiterate ideas of equity and equality, while enabling children to move away from the debilitating forces of mass media to a more gently critical culture. Our children would go to create a nicer, more sustainable world for themselves, through reading supported learning, realising the importance of gender equality, global climate change, and sustainable consumption.
- When children understand they can bring sustainable change to themselves they begin to understand the emotional and the economic purpose of education, leading to sustainable lifelong learning.
- Creativity and critical thinking are the prerogatives of all children. Imagination is the most important requisite. The softer skills every leader needs are quality in thought and deed, an ability to contribute to society, make and belong to civil society; to be a responsive and responsible citizen who treats every life form with kindness.
- The government school system should be made more robust. Disruptive and collaborative innovation in primary education is possible only when we all join hands, when we together make children’s sustainable learning happen.
Question– What do you mean by creative learning? What are implications of these strategies for education aspects in India?
2.What’s at stake in Hyderabad (The Hindu)
Synoptic line: It throws light on the how RCEP stands on IP will adversely affect nearly half of the world’s population on areas like access to knowledge and access to medicines. (GS paper II)
- India is hosting the Regional Comprehensive Economic Partnership (RCEP) meeting among ASEAN members in Hyderabad; a group of farmers, trade unions, intellectuals and non-governmental organizations have gathered to discuss about resisting RCEP agreement.
- Unsurprisingly, all public discussions on the Regional Comprehensive Economic Partnership (RCEP) are centred around leaked documents. RCEP stands on IP issues, will adversely affect nearly half of the world’s population on areas like access to knowledge and access to medicines.
- The proposed provisions seek to extend pharmaceutical corporations’ patent terms beyond the usual 20 years and also would require data exclusivity that limits competition. Such provisions are a cause for great concern among public health groups over their potential adverse impact on access to affordable medicines.
- As India negotiates the RCEP a free trade agreement that looks remarkably similar to the now failed Trans-Pacific Partnership (TPP) but for the absence of the chief protagonist and dissenter, the United States , Japan now appears to be playing the role that the United States is known for, policing the intellectual property (IP) regimes of its trading partners.
- Unlike the TPP, where India and China were not parties, the RCEP will open two of the world’s fastest-growing economies to new standards of IP protection with some unforeseen consequences.
- The Regional Comprehensive Economic Partnership (RCEP) is a so-called mega-regional economic agreement, is a proposed free-trade agreement (FTA) between the 10 countries of the Association of Southeast Asian Nations (ASEAN) and six others with which this bloc has foreign trade agreements (FTAs) — Australia, China, India, Japan, South Korea, and New Zealand.
- The stated goal of the negotiations is “To boost economic growth and equitable economic development, advance economic cooperation and broaden and deepen integration in the region through the RCEP.”
- RCEP covers trade in agricultural goods, industrial goods, services, investment, competition & dispute settlement, economic & technical co-operation and intellectual property.
IP and RCEP
- Over the years, global IP standards have steadily expanded beyond World Trade Organisation (WTO) requirements, because of some free trade agreements such as the Regional Comprehensive Economic Partnership (RCEP) which India is currently negotiating with its trading partners.
- Data exclusivity prevents drug regulators from referring to or relying on data submitted by an originator company relating to a drug’s safety and efficacy while approving bioequivalent versions of the same drug, i.e. therapeutically equivalent generics and biosimilars for a fixed period of time.
- One of the conditions that have been put forth both in the TPP as well as the RCEP is the formation of an Investor State Dispute Settlement mechanism and to include IP as an investment. Treating IP as an investment would allow private companies to raise investment disputes against the host country whenever they feel that the legal regime does not favour them.
- Japan’s insistence on the inclusion of this clause comes as no surprise as it is the third-largest RCEP investor country. Countries like India and China, which will be the destinations for the investments, should include safeguards against these measures.
- The few IP reforms discussed in the RCEP include data exclusivity, patent term extension, and much more lenient criteria for patentability.
- The IP chapter in RCEP is at risk of including provisions far stricter than those mandated by the World Trade Organisation (WTO) and the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).
- This will lead to delay in the entry of generic versions of medicines, extension of patent monopoly for a longer time, and exclusivity for drugs that should not be patented if strict patentability criteria were to be applied.
- The RCEP negotiations by Japan appear to be an extension of the arm-twisting that developing countries like India have been repeatedly subject to by the U.S. as reflected in the most recent Special 301 Report released by the U.S. Trade Representative. The strong MNC lobby growing in Japan, especially on the pharmaceutical side, is a reason for its insistence on stricter IP rules.
- If a provision of data exclusivity is passed, the millions of TB patients in India would have to buy the high-priced drugs, which would have no cheaper generic alternative. Otsuka, Japans’ MNC, which make drug for the treatment of extensively drug-resistant tuberculosis (TB), has been strategically withholding the registration of the patent in India, thereby preventing a generic version of the drug from being manufactured.
MOST FAVOURED NATIONS (MFN) CLAUSE OF WTO
- Under the WTO agreements, countries cannot normally discriminate between their trading partners. Grant someone a special favour (such as a lower customs duty rate for one of their products) and then the countries have to do the same for all other WTO members. This principle is known as most-favoured-nation (MFN) treatment.
- For example if India has an agreement with Japan (through the RCEP), India will be obliged to offer the same concessions to the U.S. as well as the other members of the WTO.
- Most-favoured nation (MFN) status did not always mean equal treatment. In general, MFN means that every time a country lowers a trade barrier or opens up a market, it has to do so for the same goods or services from all its trading partners whether rich or poor, weak or strong.
- On the ongoing 19th round of RCEP meet, India must resist Japan’s U.S.-style pressure. Developing countries like India which have taken the leadership in instituting and using balanced intellectual property protection for pharmaceuticals should not only proudly protect their laws in the RCEP negotiations, they should also encourage other countries to adopt and use similar measures that ensure generic competition.
Question– What does RCEP entails on IP grounds? What are its prospects for India?
3.Public health, private players (The Hindu)
Synoptic line: It throws light on the proposal to increase the role of private players in the health sector. (GS paper III)
- Concerned over the rise in non-communicable diseases in urban India, the Centre is working on a policy that will increase the role of private players in the health sector. India emerged as a front runner in the medical tourism space as early as the 1990s. Today, the sector is valued at $3 billion and has been witnessing a steady 22-25% growth year on year. Recent reports indicate that it is expected to grow to $6 billion by 2018 and $8 billion by 2020.
- The NITI Aayog has recently unveiled a grand plan to effectively privatise district hospitals in Tier-I and Tier-II towns. It has developed what it calls a “model concessionaire agreement” for provision of healthcare services for cardiac and pulmonary (lung) diseases and cancers.
- It is proposed that public facilities in district hospitals would be outsourced to private providers. They would be free to charge full treatment costs from patients not covered by government schemes (such as the Rashtriya Swasthya Bima Yojana) and the providers would be reimbursed by the government for treating patients referred by the government
- According to the leftist view, the scheme provides for an escrow account that would offset the risk to private providers posed by possible delays in reimbursement by the government. Providers would also secure access to public facilities such as ambulance services, blood banks and mortuaries. Clearly no effort has been spared to ensure that private companies are able to freeload on public assets.
Implications for accessible healthcare services-
- Most patients would have to pay for care even in public facilities. The promise that patients covered by government health insurance schemes would access care free of cost needs to be seen in the context of recent surveys which show that just 12-13% of people are covered by public-funded insurance.
- The proposal will further worsen inequity in access to healthcare services. Private providers will concentrate on better-off districts, leaving the poor and remote districts for the public sector to manage. This will further weaken the ability of public hospitals to attract and retain trained doctors and other health workers.
- The scheme will expose thousands of patients to unethical practices by private providers, compromises in quality and rationality of services and additional ‘top-up services’.
- Outsourcing of hospital care to private providers inevitably becomes increasingly unsustainable over time as they ratchet up demands on reimbursements and fees.
- Leftist believe that as health care is primarily a State subject and State governments must first question the legitimacy of a supposed think tank to pronounce public policy. The proposal represents a clear abdication of duty by the government.
- There is need to significantly enhance investment in public healthcare services, including in the training of health workers.
- The National Health Policy (NHP) 2017 clearly prioritises strengthening of public health systems as a key approach. However, it also recognises a critical gap-filling through strategic purchasing to be directed “towards those areas and those services for which currently there are no providers or few providers”.
- Recent policy decisions and funding support to States to undertake universal screening and management for common NCDs, provide comprehensive primary health care through health and wellness centres, strengthen district hospitals (DH) to provide multi-speciality care, upgrade DHs to medical colleges, and ensure access to free essential drugs and diagnostics in government health facilities indicate purposive actions to strengthen public health systems.
- Despite recent efforts, current capacities in public facilities to manage disease conditions in cardiology, pulmonology and oncology are practically non-existent in Tier-II and Tier-III towns in most States, even in the private sector. It leads to overcrowding in tertiary-level facilities in big cities, compromising quality of care and leading to high out-of-pocket expenditures.
- A 2014 study by Harvard University for the World Economic Forum shows that India stands to incur a cost of $2.17 trillion between 2012 and 2030 due to cardiovascular diseases alone. The proposal, developed in broad consultation with the Ministry of Health and Family Welfare, will expand access to care for key NCDs to such populations that have not hitherto had access.
- There will be a significant improvement over the status quo. The proposal envisages that care will be provided free for BPL families and those covered by government insurance schemes; the rates will be negotiated at Central government health scheme/State government insurance rates for others so that even the non-poor will receive care at a rate much lower than market rates.
- States have the liberty to adopt the PPP or modify the document based on their needs and context. It is too early to speculate on whether such an arrangement will work or not.
- The proposed PPP model in district hospitals will improve access but may not deliver appropriate and equitable care. However The proposal to invite private sector investment in district hospitals is based on following premises-
- District hospitals need upgrading to provide good-quality secondary care and some elements of tertiary care to reduce dependence on and overcrowding of medical college hospitals and corporate hospitals;
- Non-communicable diseases (NCDs) are affecting increasing numbers of people;
- Most government-run district hospitals are presently unable to provide this care;
- Incentivised private sector investment and participation in care delivery in such hospitals can fill this gap; and
- The proposed PPP model can function smoothly with shared facilities and a dual payment system.
- PPP proponents argue that it will take time, resources and management skills to reach an acceptable level of public sector capacity and the rising tide of NCDs can brook no delay. If this model of ‘one hospital, two systems’ is envisaged as a permanent feature, the risks and returns of such cohabitation require serious scrutiny.
- In a mixed health system, it could be efficient to engage the services of the private sector to supplement the capacity of the public sector. However, cost and quality must be controlled for delivering appropriate and affordable care with accountability.
- There are gaps in the proposal for example the less expensive thrombolytic treatment for heart attacks is not listed, listing of angioplasty as the only treatment in the cardiology segment is an open invitation to unnecessary procedures.
- It is proposed that the nested private facility will provide NCD care to two categories of patients — those referred and paid for by government schemes and self-referred patients who will pay from pocket. How will financial protection be provided to the near-poor who have to self-pay? Even if package costs for the latter are transparently displayed, who will negotiate those costs and prevent add-ons during hospitalisation?
- The proposed PPP model will improve access but may not deliver appropriate and equitable care. NCD care is welcome but has to be accommodated within a well-designed framework of Universal Health Coverage that integrates pre-paid primary, secondary and tertiary care through a combination of tax funding and social insurance.
- The failure of the PPP model in Karnataka raises a pertinent question that has anyone been held accountable for the damage caused to the public health system and people’s health? There is need of measurable improvements in quality of care focusing on patient safety, comfort, satisfaction, and clinical outcomes.
- Although it has been that the private sector utilises publicly funded insurance schemes to expand its market in the rural areas at the cost of patient care, rights and lives. Several primary and secondary level public facilities across the state are largely dysfunctional, without doctors, and essential medicines and equipment, leading to unnecessary maternal/neonatal complications and deaths.
- The logical solution to enact a change would be to invest in public sector infrastructure and human resources instead of pushing the entire population towards the private sector.
Question– Health care is a public good but the strategy to achieve it may lie in private channels. Comment?