19 November, 2020

  • Finance Panel for PPPs on health Infra Page 10 (Social Issues)
  • The need for “Maximum government” Page 07 (Economy)
  • New challenges + Decoding Biden’s presidency, for India and the world Page 06 (International Relations)
  • Defer govt. proposal till all-party meet - Page 02 (Art and Culture)
  • Beating the Chill - Page 01 - (Art and Culture)
  • QOD

Prelims Quiz

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    UPSC Current Affairs: Finance panel for PPPs on health infra Page| Page 10

    UPSC Syllabus: | Mains – GS Paper III – Indian Economy  | GS Paper II – Social Justice

    Sub Theme: Public Private partnership in Healthcare |UPSC     

    Context:

    The 15th Finance Commission has mooted a greater role for public private partnerships to ramp up health infrastructure and scale up public spending on health from 0.95% of the GDP to 2.5% by 2024, N.K. Singh, Chairperson of the panel.

    1. Present Problems with Healthcare Sector
    2. Understanding PPP in Healthcare
    3. How PPP can lead to better Health outcomes
    4. Problems/Challenges associated with Healthcare

    Present Problems associated with Healthcare Sector

    Lower Expenditure on Health: The Combined expenditure of Centre and States on Health is around 1.5% of India's GDP. It is much below the target of 2.5% as set under the National Health Policy, 2017.

    Higher Out-of-pocket Expenditure on Health: The out-of-pocket expenditure as percentage of total healthcare expenditure is as high as 60% on account of expenses incurred on medicines, diagnostic tests, consultation fees et. This is considered to be one of the important reasons for pushing the families to below the poverty line.

    Lack of Accessibility: Most of the secondary and tertiary care hospitals are located in Tier-1 and Tier-2 Cities. Similarly, most of the doctors are unwilling to practice in Rural areas.

    Lack of Affordability: The contribution of private sector in healthcare expenditure in India is around 80 percent while the rest 20 percent is contributed by Public Sector. The private sector also provides for 58 percent of the hospitals and 81 percent of the doctors in India. However, since the private sector hospitals work on the profit motive and charge high fees, the private sector hospitals do not address the needs of the poor patients.

    Shortage of Medical Personnel:

    Country

    No. of Qualified doctors per 1000 People

    No. of nurses per 1000 People

    China

    18

    23

    Italy

    41

    59

    India

    3.4

    3.2


    Poor Healthcare Infrastructure

    Country

    No. of Hospital beds per 1 lakh

    No. of ICU beds per 1 lakh

    China

    420

    3.6

    Italy

    340

    12.5

    India

    70

    2.3

    Demographic Changes: India is set to undergo demographic transition in the next 2 decades wherein the share of elderly population is set to increase from 8% (2011) to 16% (2041). This change in demography accompanied by increase in the lifestyle diseases would put additional burden on the existing healthcare infrastructure.

    Understanding PPP in Healthcare

    The Public-Private-Partnership (PPP) in the field of healthcare is a form of agreement between the Government and Private sector for providing various healthcare services to the people. It seeks to leverage the private sector's strength of innovation and efficiency. Further, it redefines the role of the Government from being a health service provider to being both provider and financer of healthcare services. It may take different forms depending upon the extent of participation of private sector. For example, it may involve contracting out the management of Primary Health Centre at village level to private sector. It may be in the form of Government providing the Healthcare Insurance on secondary and tertiary treatment in the private hospitals (PM Jan Arogya Abhiyaan).

    How PPP can lead to better Health Outcomes?

    Improving the Efficiency of Hospital management: Government could hand over the management of an existing public hospital to a well-established private partner under a partnership agreement with the responsibility of investing in the hospital for its-up gradation/expansion and management. The Interest of poor could be protected through fixing the maximum fees to be charged by private sector. The fees of such poor people may be in turn paid by the Government.

    Enhancing Investment in Healthcare Facilities: Government could invest in land and building of a new hospital and private partners could bring in the equipment and staff. The Private sector may be given the exclusive management role with government participating in the governing board. The maximum fee in such hospitals could be fixed by Government. Such a PPP would have multiple benefits such as expansion of healthcare facilities, decrease in Government's burden, leveraging the private sector's expertise in terms of human resources and equipment and protection of interests of poor and weaker sections.

    Addressing the shortage of Medical Personnel: The shortage of doctors within India can also be addressed through PPP Mode. For example, in the Union Budget 2020-21, the Finance Minister has announced that new Medical Colleges would be set up in PPP Mode. These Medical colleges would be linked to existing district hospitals. The Government would provide Viability Gap Funding (VGF) for setting up of medical colleges.

    Reducing out-of-pocket Expenditure: The Government can act as healthcare financer wherein the identified poor can get treatment in the private hospitals and their treatment cost would be paid by the Government leading to decrease in out-of-pocket expenditure. As you know, this is presently done under the PM Jan Arogya Abhiyan and has immensely benefitted the poor people.

    Addressing Accessibility and Affordability: Some of the states such as Odisha have contracted out the management of the Primary Healthcare Centres (PHCs) at the village level to the private sector entities in order to improve the accessibility and efficiency of healthcare services. At the same time, some of the states have also entered into partnership in the Private sector Laboratories in order to provide round-the-clock tests at the government hospitals.

    Ensuring Safe, Effective and Affordable Medicines: The Government is presently implementing the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in order to provide cheaper generic medicines through the network of Janaushadhi Kendras. Now, this is a kind of PPP Mode for mainly two reasons. Firstly, it involves procurement of bulk generic medicines from the Private sector. Secondly, it enables the non-governmental entities such as NGOs, Private Sector hospitals etc. to set up Janaushadhi Kendras.

    Investment in IT Infrastructure:  The Srinath Reddy Committee (2011) on Universal Health Coverage (UHC) had recommended for creation of robust IT infrastructure which could capture various aspects related to healthcare infrastructure such as mortality rates, hospital admission rates, disease profiles, hospital bed occupancy ratios etc. Such an IT infrastructure would greatly benefit us in fact based and evidence-based policy making in the field of health. The Private sector expertise can be leveraged in PPP mode to set up such an IT infrastructure.

    Improving Preventive Care: The Civil society organisations (CSOs) can contribute effectively to community mobilisation, information dissemination, community-based monitoring of health services and capacity building of community-based organisations and workers. Hence, the CSOs can be leveraged under PPP mode to improve the health outcomes of the Government schemes such as National Health Mission (NHM).

    Constraints/Challenges in PPP for healthcare

    Lack of Trust and Cooperation: The Government believes that the Private sector is profit-oriented and is mainly geared towards addressing the needs of the richer sections. On the other hand, the private sector believes that the Government unnecessarily creates barriers in the form of restrictive regulations which make it difficult for them to carry on with their business. So, there is sense of mistrust and lack of cooperation between Government and Private hospitals. Many PPPs have failed due to lack of trust between the Government and Private sector.

    Perceived division of responsibilities: Both the Government and the Private sector have a flawed perception that the Government has the responsibility of primary care, while the Private sector has the responsibility of secondary and tertiary care. Such a flawed perception has to be done away with to ensure the success of PPP models.

    Constraints before the Government: Some of the constraints before the Government include lack of political will, underdeveloped government capacity to design, contract and manage PPPs, delays in government payments, lack of an evidence-based pricing mechanism for services etc.

    Constraints before the Private sector: There are limited financial incentives for the private sector to engage. The Government has failed to provide for appropriate incentives and reimbursements to the private sector.

     

    UPSC Current Affairs:The need for ‘maximum government’| Page 07

    UPSC Syllabus: Mains – GS Paper II – Indian governance |GS Paper III – Indian Economy

    Sub Theme: Futility of economic packages in times of COVID |UPSC                

    Context:  Author in this article while appreciating governments realisation about the major economic problems like unemployment, is apprehensive about the steps the government is taking to solve it. COVID 19 has exacerbated the already existing fault lines in our governance system and has now left INDIA not just with a health crisis but an economic crisis as well.

    • The problem as per the author is the government’s insistence on “minimum government”. Though a slew of economic relief measures were announced in three tranches through the Aatmanirbhar Bharat , however govt has left the onus on the people to “earn” the relief measures by first doing/adhering to the governments pre-conditions.
    • In way it has transferred its responsibility of bringing the economy back from the turmoil on the already suffering people.
    • Eg . in Aatmanirbhar 1.0, out of the ₹20.9 lakh crore package, ₹17.9 lakh crore worth of measures were such which dependents on people’s, such as credit guarantees and liquidity easing. Here the govt has assumed that these measures will motivate business sector to invest thereby kickstarting the economy and household sector to increase consumption, ignoring the fact that economy is so badly hit that investors don’t even have money for sustenance of their business let alone investing more money.
    • Let’s take Corporate investment, it is tied due to lack of sales and/or credit. Revival of investment requires the sale as well as credit availability to go up. A point policy makers have overlooked. The fact that sales are low means factories are running below capacity. If the existing equipment is not being fully utilised, why would businesses add further to capacity just because the cost of loans has declined or the access to credit has been eased?
    • The scenario is worse when it comes to MSME as they are more dependent on sales and profits to make their business grow. So regardless how good a deal is offered to them by govt , they will be reluctant to take new loans
    • Similarly, households too won’t take new loan as their source of income is doubtful in such crisis , despite the fact that loans are cheaper. They will look at their repaying capacity and not the low interest rate being offered. If I am not sure of a regular salary in the immediate (or even distant) future, which affects my capacity to pay EMIs on these loans, however low they may be, I won’t take the risk of taking a loan.
    • Even banks for that matter will be cautious of giving new loans, why ? they are already reeling under the NPA problem. In fact to cover for the losses of the previous NPA , the banks have chosen not to pass on the fall in the policy rate to the consumers i.e. though RBI has reduced the policy rate , the banks haven’t lowered the interest on loans so as to keep enough profit margin to recover previous NPAs. (as confirmed by a RBI report)
    • Another interesting observation has been the increasing assets of the corporate sector. At one hand banks are not extending enough loans yet the fact the assets of corporate sector is increasing shows that the sector doesn’t have a liquidity problem. ( assets are an indicator of a company’s liquidity position).
    • Therefore, these credits, guarantees or cheap loans hardly have an effect on reviving the demand in the economy. They can only act as catalysts to fasten the process. However, they in  themselves aren’t enough to start the process. These actors can at best play a supporting role, not the lead one.

    The real  solution ?

    In short , what can work is -

    • Adherence to FRBM guidelines should be suspended for a while and a fiscal stimulus of at least  ₹10 lakh crore should be injected – either by borrowing or monetising the deficit ( print more money)
    • This stimulus could comprise, among other things, free ration and other essentials like oil, soap and cooking gas for a period of six months; cash transfer till employment opportunities are back; and an urban employment guarantee law.
    • we should also be building a robust public health infrastructure on the principle of public provisioning instead of walking down the insurance route which has spectacularly failed in the U.S.
    • pandemic has given us the opportunity to think about climate change. There should be a green deal, which addresses both the demand and supply side of emissions as well as acts as the much-needed fiscal stimulus which has long-term implications. A comprehensive green deal can be planned, partly financed by the government and partly by carbon tax, which not only changes the energy mix of the economy but also makes the poor and the marginalised a part of a sustainable development process.

    Conclusion

    This crisis has provided us with an opportunity to rethink our health, economic and climate policies. We can choose to act on these or walk down the beaten path. Whatever we choose, it will be good to remember that the future generations will never forgive us for losing an opportunity to fundamentally change course.

     

    UPSC Current Affairs: New challenges + Decoding Biden’s presidency for India and the world | Page 06

    UPSC Syllabus: Prelims – Indian economy and export/import trends

    Sub Theme:  Trends in India’s Merchandise exports/ import | UPSC   

    context:  While U.S. Democratic Party contender and former Vice-President Joseph Biden still needs to tie up some loose ends for an official seal to his victory, it is clear that New Delhi is now preparing to work with a new U.S. administration. 

    Although relations appear to be getting more transactional in the ‘America First’ and ‘India First’ era, the primary structural impediments to an India–US strategic partnership have eroded over the past two decades. Most notable is the removal of US sanctions on India after 2005 for its nuclear weapons program. The United States has become the second largest defence equipment provider to India by value after Russia and has supported India’s membership in major international organisations.

    The trade relationship, which has grown from US$64 billion to US$88 billion over the past five years, underestimates the interconnectedness of the two economies. Nearly 2000 US-based multinational companies now operate in India, many conducting important research and development. US-based multinationals are major job creators in India. Indian investment in the United States has risen almost ten-fold over the past decade. For US tech giants such as Facebook and Amazon, India often represents their largest or fastest-growing user base.

    Furthermore, in contrast to US relations with adversaries such as China and Russia or allies and neighbours such as Germany and Mexico, US ties with India have remained on an upward trajectory despite the transition from the Obama to the Trump administration. Cooperation on counterterrorism, maritime security in the Indian Ocean, infrastructure coordination, defence technology and energy has deepened. There are also hints of some convergence on future telecommunications technology.

    Both countries have become more vocal in their support for freedom of navigation, including in the South China Sea. They both have concerns about China’s Belt and Road Initiative and share similar views about the normative basis of a free, open and inclusive Indo-Pacific as an underpinning for regional order. Given China’s continuing assertiveness and rising concerns about the arc of instability stretching from Pakistan to Yemen, the strategic logic of the relationship is being propelled forward.

    However, the strategic elements of the relationship are not always on the same plane as bilateral relations. There are four big challenges that confront the relationship today. These topped the agenda during both Pompeo’s and Trump’s meeting with Modi.

    The most important concerns differences over trade, many of which predate Trump’s election. Since his election, Trump has repeatedly called out India for its high tariffs and trade surplus. Changes to India’s data localisation norms and a draft e-commerce policy provoked a major response from Washington. The United States moved to suspend tariff-free exports from India under the Generalised System of Preferences scheme. India duly retaliated. While this tit-for-tat has only affected a small proportion of India–US trade, spiralling trade difficulties risk the future of the broader relationship. Efforts will be required to stem that tide.

    The second challenge concerns Russia. Russia is the largest supplier of Indian military hardware despite considerable diversification. Russia provides India with critical spares and maintenance for existing platforms and certain technologies — such as nuclear-powered submarines — that others do not. New Delhi also sees the partnership with Moscow as critical for engagement with Central Asia and for balance in the Indo-Pacific, putting it at odds with Washington.

    A recent deal to acquire Russia’s S-400 anti-aircraft system made India eligible for US sanctions intended to punish Russia. The US Congress has created room for a presidential waiver for India but it is by no means guaranteed. The longer-term issue of India–Russia military-technological relations will remain. It is compounded by the increasingly incompatible security implications of US and Russian military technologies operating in tandem.

    The third challenge relates to renewed US hostility towards Iran following Washington’s unilateral withdrawal from the Joint Comprehensive Plan of Action. The resumption of US sanctions on Iran has had consequences for oil prices, Indian energy companies and Indian investments — especially in the strategically important Iranian port of Chabahar. Oil market stabilisation, high secondary costs, Indian energy diversification, shifting political alignments and US carve-outs for India have already helped address most of these challenges.

    Finally, cracks are likely to emerge in the US and Indian approaches to Afghanistan. Both New Delhi and Washington agree on the broad objective of a stable and democratic Afghan government in Kabul. Both have engaged in considerable state-building efforts there. But New Delhi remains concerned about possible concessions that Washington might make in an effort to finalise a peace agreement with Taliban negotiators.

    None of these challenges have come to a head yet. The first two are fundamental in that they predate and are likely to survive Trump. On each set of issues, plausible solutions are within the realm of possibility. But amid a broader strategic convergence, both countries will have to navigate their differences if relations are to continue on a positive track.



















     

    UPSC Current Affairs: Yamuna cleaning: Delhi CM meets DJB officials|Page 03   

    UPSC Syllabus: Prelims - Indian Culture and Festivals

    Sub Theme: Chatt Puja   | UPSC        

    Context -  Chief Minister Arvind Kejriwal on Wednesday chaired a meeting with Delhi Jal Board (DJB) officials on the swift implementation of a concrete plan to clean up the Yamuna and reduce 90% pollution by March 2023.

    • Chhath is an ancient Hindu Vedic festival historically native to the Indian subcontinent, more specifically, the Indian states of Bihar, Jharkhand and Uttar Pradesh and the Madhesh region of Nepal.
    • The Chhath Puja is dedicated to the solar deity Surya and Shashthi devi (Chhathi Maiya) in order to thank them for bestowing the bounties of life on earth and to request the granting of certain wishes. This festival is observed by Biharis and Nepalese along with their diaspora.
    • The festival does not involve idolatry and is dedicated to worship the Chhathi Maiya (Shashthi Mata) and sun God Surya along with his consorts Usha and Pratyusha the Vedic Goddess of Dawn and Dusk respectively.
    • It is believed that the main sources of Sun’s powers are his wife Usha and Pratyusha. In Chhath, there is combined worship of both the powers along with the Sun. In the morning, worship of the first ray (Usha) of the Sun and the last ray (Pratyusha) of the Sun in the evening are offered to both of them. And the rituals are rigorous and are observed over a period of four days.
    • They include holy bathing, fasting and abstaining from drinking water (Vratta), standing in water for long periods of time, and offering prasad (prayer offerings) and arghya to the setting and rising sun. Some devotees also perform a prostration march as they head for the river banks.
    • Environmentalists have claimed that the festival of Chhath is one of the most eco-friendly religious festivals that should be used to spread the message of nature conservation. Moreover, it’s arguably one of few Hindu festivals that transcend the rigid caste system, which emerged in the post-Vedic period, to touch upon the ideas of equality, fraternity, unity and integrity. Every devotee—elite or middle class (and caste)—prepares almost similar Prasad and other items to offer to the Almighty.
    • All the devotees without any distinction in caste, colour or economy, arrive at the bank of rivers or ponds for extending prayers

    Chhath Puja is a folk festival that lasted four days. This is a four-day festival, which starts with Kartik Shukla Chaturthi and ends with Kartik Shukla Saptami.

    • Nahay Khay (first day) - This is the first day of Chhath Puja. This means that after bathing, the house

     is cleaned and vegetarian food is eaten to protect the mind from the vengeful tendency.

    • Kharna (Second Day) - Kharna is the second day of Chhath Puja. Kharna means the fast of the whole On this day, the devotees are not allowed to drink even a single drop of  water. In the evening, they can eat gur ki kheer (jaggery kheer), fruits and chapati (Bread) full of ghee.
    • Sandhya Arghya (Third Day)-  On the third day of Chhath puja, an arghya is offered to the sun god during the Kartik Shukla Shashthi. In the evening, a bamboo basket is decorated with fruits, thekua and rice laddus, after which devotees offer an arghya to the sun with their families. At the time of Arghya, water and milk is offered to Sun God and the Chhathi Maiya is worshiped from a soop filled with prasad. After the worship of Sun God, Shashthi Devi songs are sung in the night and the vrat katha is heard
    • Usha Arghya (Fourth Day)-  On the last day of Chhath puja in the morning, an arghya is offered to the Sun God. On this day, before sunrise, the devotees have to go to the riverbank to offer an arghya to the rising sun. After this, the protection of the child from Chhathi maiya and the happiness of the entire family is sought for peace.
    • After worship, devotees drink sharbat and raw milk, and eat a little prasad in order to break one’s fast which is called Paran or Parana freedom of scholars to discuss politically and culturally controversial topics, without fearing for their life, studies or profession — an aspect where India is failing terribly.

     

    UPSC Current Affairs: Beating the Chill (image) | Page 01

    UPSC Syllabus: Prelims – Indian Culture

    Sub Theme:  Kangir | UPSC   

    About Kangir

    • A kanger also known as kangri or kangid or kangir) is an earthen pot woven around with wicker filled with hot embers used by Kashmiris beneath their traditional clothing to keep the chill at bay, which is also regarded as a work of art.
    • It is normally kept inside the Phiran, the Kashmiri cloak, or inside a blanket. If a person is wearing a jacket, it may be used as a hand warmer.
    • It is about 6 inches (150 mm) in diameter and reaches a temperature of about 150 °F (66 °C). It comes in different variants, small ones for children and large ones for adults.
    • Charari Sharief town is the most famous for a peculiar kind of kangri called charar kangri . Anantnag is also another major producer. The sector is not organized but is covered under different government schemes
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