Issue 02 October 2018 - Dhyeya IAS
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October 2018 Issue 02
Contents
October- 2018
Issue-2
Seven Important Issues 1-23
Lawmakers as Lawyers: No Need to Ban
An Action Tank: Is Really Doing Action
Ayushman Bharat: To Change India's Healthcare Landscape
India and Maldives: Rebuilding the Relationship
Economic Freedom of the World-2018 and India
Deep Sea Mining: A Race to the Bottom of the Ocean
Behavioural Insights in Policy Making
Seven Subjective Questions with Model Answers 24-28
Seven Important National & International News 29-34
Seven Brain Boosters & Seven MCQ's Based on Them 35-43
Seven Important Facts For Prelims 44
Seven Important Sport Events 45-46
Seven Practice Questions for Main Exam 47
Current Affairs : Perfect 7
SEVEN IMPORTANT ISSUES
1. LAWMAKERS AS LAWYERS: NO NEED TO BAN
Why in News? whose name is interred in the common ¡¡ The second reason cited is that
roll to practise in all courts or before MPs can initiate impeachment
The Supreme Court recently dismissed
any tribunal or authority. But there proceedings against judges and
a plea seeking to ban lawmakers from
practising as advocates. The apex court are restrictions contained in the Bar therefore, appearing before them
said there was no provision either Council Rules. Rule 47 places a bar on as lawyers would be a conflict of
under the Rules and the law regulating an advocate personally engaging in any interest.
the profession of the lawyers to restrict business. Under Rule 48, an advocate ¡¡ The third reason is that both
them from practising on becoming cannot be a Managing Director or law practice and the role of
members of Parliament, state Secretary of a Company but he can representatives of the people
assemblies or state councils. be a Director or Chairman without are full time professions and
the performance of any executive one cannot do justice to both
Introduction functions. simultaneously. The country needs
The Centre did not accept the The real catch is in Rule 49 which dedicated and full-time legislators.
proposition that lawyers should be stipulates that a practising advocate ¡¡ Lawmakers receive their salaries
banned from being legislators. The shall not be a “full-time salaried and perks solely to discharge their
Attorney General said such a ban is not employee of any person, government, public duty.
correct or justifiable as being an MP/ firm, corporation or concern.” On
MLA is not a full time job. The Attorney ¡¡ There is a argument that under
taking up such employment, advocates
General added that there cannot be Prevention of Corruption Act,
are bound to intimate the State Bar
any “prohibition” as membership MLAs and MPs are public servants.
Council under which they are enrolled
of Parliament is not a job under the Allowing them to practice as
and suspend their practice. There is
government of India. advocate and restricting other
a narrow window provided in Rule
The Bar Council of India (BCI) public servants is arbitrary and
52, which allows, with the consent
decided to allow members of violation of right to equality under
of the State Bar Council, part-time
Parliament and legislative assemblies Article 14.
employment, with two riders – that it
to practise as advocates, but said that It amounts to "professional
does not come into conflict with law ¡¡
those who move an impeachment misconduct" when MLAs and MPs,
practice and is not inconsistent with
motion against any judge of the who get salary and other benefits
the dignity of the legal profession.
higher judiciary will not be allowed from the public fund appear against
to appear before that court. The BCI Arguments against the the government. The lawmakers
said that the lawyer-MPs have their
Verdict appear as advocates even when
privilege as parliamentarians to move
The principal objection to parliament or assemblies in session
impeachment motion, but “as lawyers, ¡¡
the BCI can put the condition under legislators donning the black robes and participates in matter that
which they can be allowed to practise is that as they draw salaries from affects financial interests of the
or not”. the Consolidated Fund of India, country despite receiving salaries
they are ‘employees’ of the State, a and other perquisites drawn on the
Rules position that warrants suspension public exchequer.
Section 30 of the Advocates Act, 1961, of practice under the Advocates ¡¡ Many lawmakers are regularly
confers the right on every advocate Act and Bar Council Rules. seen on television and at news
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conferences and tend to have a advocate under the statute and that State Assembly). The mere fact that
heavy social media presence. Such he was ready to give an undertaking they draw salary under the Salaries and
visibility is against the BCI rules. that during court hours he would not Allowances of Member of Parliament
carry on his medical practice. The Act, 1954 or different allowances under
Arguments in Favour of Court visualised a possible dilemma of the relevant Rules framed under the
Verdict a practising surgeon having to perform said Act does not result in creation of a
¡¡ A public servant is not allowed emergency operations or deal with relationship of employer and employee
to practise as an advocate and patients beyond court hours and the between the government and the
lawmakers are public servants dictates of the legal profession involving legislators, despite the description of
under Section 21 of the Indian meeting clients, getting instructions, payment received by them in the name
Penal Code and Section 2(c) of the reading briefs and preparing for of salary.
Prevention of Corruption Act. arguments for the next day in court. The apex court said that although
¡¡ Legislators, many of whom are The apex court was unambiguous in the legislators are deemed to be public
designated Senior Counsel, argue the Dr. Haniraj Chulani case noting servants, their status is unique and
that their law practice does not that “law is a jealous mistress that calls certainly not one of a full-time salaried
involve signing vakalats and drafting for undivided loyalty and unflinching employee of any person, government,
work that other advocates need to attention”. firm, corporation or concern as such.
do and that their court appearances The Supreme Court in R.S. Nayak The legislators being elected
will not be during the Parliament Vs A.R. Antulay had held that the people's representatives occupy a seat
or Assembly sessions. Further, with legislators do not fall under the rubric in Parliament/ Legislative Assembly
a battery of juniors and briefing of public servants within the meaning or Council as its members but are
counsel, clients will not suffer due of Section 21 of the Indian Penal Code. not in the employment of or for that
to their dual roles. And with staff But, in the P.V. Narasimha Rao case, the matter full-time salaried employees as
to man their MP or MLA offices, majority view was that legislators are such. They occupy a special position
they need not necessarily be torn public servants for the purpose of the so long as the House is not dissolved.
between conflicting loyalties. Prevention of Corruption Act. The fact that disciplinary or privilege
¡¡ The legal qualification of legislators action can be initiated against them
Supreme Court Verdict by the Speaker of the House does not
should be seen as an asset as it
helps in improving the quality of The Supreme Court held that the mean that they can be treated as full-
lawmaking. provisions of the Advocates Act, 1961 time salaried employees. Similarly, the
¡¡ Lateral entry from legal profession and the Rules framed there under, participation of the legislators in the
or some field of expertise is do not place any restrictions on the House for the conduct of its business,
not necessarily a bad thing. It is legislators to practise as advocates by no standards can be considered as
supposed to enrich and improve during the relevant period. The closest service rendered to an employer.
parliamentary discourse. rule framed by the Bar Council of The court, further, observed that
India is Rule 49 which, however, has legislators are not appointed but are
Past Judgements no application to the elected people's elected by the electors from respective
In an interesting and landmark case in representatives as they do not fall in the territorial constituencies. The fact that
which a medical doctor who studied law category of full-time salaried employee they have to take oath administered by
challenged the Bar Council’s rejection of any person, firm, government, the President/Governor before they
of his application for enrolment as an corporation or concern. take their seat in the House, does not
advocate, the Supreme Court in Dr. The top court said that legislators mean that they are appointed by the
Haniraj L.Chulani Vs Bar Council of cannot be characterised as full- President/Governor as such, unlike in
Maharashtra and Goa held that “the time salaried employees as there the case of the Prime Minister/Chief
legal profession requires full time is no relationship of employer and Minister and Ministers in the Council
attention and would not countenance employee. The employment postulates of Ministers.
an Advocate riding two horses or more a master-servant relationship and the The legislators receive payment in
at a time”. The doctor had contended government of India is not the master the form of salary and allowances or
that the medical profession was in no of a Member of Parliament. The status pension from the Consolidated Fund,
way a less dignified profession, that of legislators (MPs, MLAs and MLCs) is is not enough to debar them from
he was qualified to be enrolled as an of a member of the House (Parliament/ practising as advocates, sans being a full-
October 2018 A Issue-2 2
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time salaried employee of the specified will sincerely attend Parliament on all of the legal profession. Traditionally
entities. They continue to remain only working days when called upon to do and historically, the lawyers have
as members of the House representing so. It had also said that the MPs had the played a major role in parliamentary
the territorial constituencies from power of voting on the impeachment affairs and public life and it would be
where they have been elected until the of judges of the Supreme Court and the a very regressive step to debar them
House is dissolved or if he/she resigns high courts. from parliament.
or vacates the seat for having incurred Thus, the scope of Article 19(1)
disqualification as may be prescribed Way Forward
(g) of the Constitution on the freedom
by law. Fundamentally lawmakers, either to practise any profession and the
The three-judge bench said as MPs or MLAs, are expected to be reasonable restrictions, in the context
that merely because the advocate sufficiently qualified in law so as to help of law-makers also functioning as
concerned is an elected people's lawmaking bodies in enactment of law. lawyers, has tso be seen in broader
representative, it does not follow that In fact, it should be desirable if India perspective.
he or she has indulged in professional was to advance and bring in the best
misconduct. Similarly, the conferment piece of legislation it could even be
of power on the legislators (MPs) to considered for members of legislative General Studies Paper- II
move an impeachment motion against bodies to have minimum qualification Topic: Structure, organization
the judges of the Constitutional Courts of graduation in law. and functioning of the Executive
and the Judiciary; Ministries and
does not per se result in conflict There cannot be interference with
Departments of the Government:
of interest or a case of impacting the profession. The only condition pressure groups and formal/informal
constitutional morality or for that is that no one should be engaged in associations and their role in the
matter institutional integrity. anything that causes indignity to the Polity.
The top court also refused to go legal profession.
into the question that India needed Being an MP or MLA does not in any mmm
dedicated and full-time legislators, who way put a question mark on the dignity
2. AN ACTION TANK: IS REALLY DOING ACTION
Why in News? National Institution for Transforming contributed to severe distortions in
India (NITI). The remit and functioning public spending. Often, the Planning
NITI Aayog is introducing new ideas
of NITI Aayog will become clearer as it Commission came up with discretionary
and bringing about a greater level
evolves over time. transfers to states to meet nonplan
of accountability in the system.
India cannot transform with new Not many will shed tears on the revenue deficits negating the norms
ideas without having a paradigm of abolition of the Planning Commission. set by the Finance Commissions. The
planning for development. So it will In fact, the previous prime minister presence of a member of the Planning
need to evolve into a much stronger himself had called for redefining its Commission as a parttime member of
organisation than it is now. role to suit changing realities. The the Finance Commission did very little
planning exercise that was followed to correct this anomaly.
Introduction had hardly any relevance for the
market economy. It did very little Need of the New Institution
There have been wide ranging
discussions on the role of the new to plan and implement even public There were two contradictions between
institution to replace the Planning sector investments for infra structure the Indian development strategy
Commission ever since the Prime and its role in promoting public and the institutional framework
Minister in his 2014 Independence private partnership was mostly seen constraining structure deficits and
Day address declared that the Planning as obstructive. The whole exercise the lack of competitiveness of the
Commission would be replaced by of giving approvals to state plans economy. However, the framework
a new institution. In the cabinet smacked of dispensing patronage. failed to adapt to the transition after
resolution passed in 7th January 2015, The proliferation of various centrally the liberalising reforms were initiated.
the government has come out with the sponsored schemes (CSS) with “one With fiscal constraints becoming more
broad contours of the new institution, size fits all” design and conditionality and more binding and political economy
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factors crowding out infrastructure institution to promote “Coasean ¡¡ Sustainable development, by
spending with subsidies and transfers, bargains” in the spirit of cooperative protecting environment.
the planning exercise lost much of its federalism and ensure resolution of ¡¡ Transparency that uses technology
relevance. issues when such bargains fail. to make government visible and
The architecture, engineering and responsive.
National Institution for
management aspects of the new
Transforming India (NITI) Role and Remit
institution, NITI Aayog, will have to be
Aayog
crafted carefully, if it has to serve as The cabinet resolution lists 13
an institution to impart dynamism The National Institution for different tasks to it which may be
to the developmental process in a Transforming India, also called NITI grouped under four major heads,
harmonious manner. Aayog, was formed via a resolution namely: (i) fostering cooperative
of the Union Cabinet on January 1, federalism by providing structured
¡¡ Economic liberalisation has
2015. NITI Aayog is the premier policy support to states on a continuous basis;
created a vibrant private sector
‘think tank’ of the government of (ii) formulation of a strategic vision and
and the new institution should
India, providing both directional and long term policies and programme
assist in policy making to enable
policy inputs. The government of India, framework both for the macro
private entrepreneurs to unleash
in keeping with its reform agenda,
their animal spirits and not to Planning Commission
constituted the NITI Aayog to replace
constrain them. The Planning Commission was set up by
the Planning Commission instituted
Horizontal and vertical competition a Resolution of the hovernment of India
¡¡ in 1950. This was done in order to in March 1950 in pursuance of declared
in a multilevel fiscal system can be better serve the needs and aspirations objectives of the government to promote
an important source of economic of the people of India. An important a rapid rise in the standard of living of
dynamism so long as a certain evolutionary change from the past, the people by efficient exploitation of
measure of “competitive equality” the resources of the country, increasing
NITI Aayog acts as the quintessential
production and offering opportunities to
and “cost benefit appropriability” platform of the government of India all for employment in the service of the
are ensured and predatory to bring states to act together in community. The Planning Commission
competition is prevented. national interest and thereby fosters was charged with the responsibility of
Cooperative Federalism. The governing making assessment of all resources of the
¡¡ “Laboratory federalism” can be a country, augmenting deficient resources,
source of innovations, imitations council consists of all state Chief formulating plans for the most effective
and learning and facilitating this is Ministers, Chief Ministers of Delhi and balanced utilisation of resources and
important. and Puducherry, Lieutenant Governor determining priorities. Jawaharlal Nehru
of Andaman and Nicobar and vice was the first Chairman of the Planning
¡¡ At the core of NITI Aayog’s creation Commission.
chairman nominated by the Prime
are two hubs – Team India Hub Finance Commission after emergence of
Minister. In addition to full members,
and the Knowledge and Innovation NITI Aayog
there are two parttime members and
Hub. The Team India Hub leads The abolition of the Planning Commission
four exofficial members and a chief
the engagement of states with paves the way for restoring the role of the
executive officer. The temporary Finance Commission to assess the total
the Central government, while the
members are selected from the leading requirements of the states in the revenue
Knowledge and Innovation Hub universities and research institutions. account without making a distinction
builds NITI’s thinktank capabilities. between plan and nonplan spending.
In essence, effective governance in
These hubs reflect the two key However, the Finance Commission does
India will rest on following ‘pillars’: not have a comparative advantage in
tasks of the Aayog.
¡¡ Pro-people agenda that fulfils the recommending specific purpose transfers
¡¡ Coordination costs are higher when unless it is made a permanent body.
aspirations of the society as well as
there are coalition governments Of course, the constitutional provision
individual. does not require it to be a temporary
and the parties in power in the
¡¡ Pro-active in anticipating and body – Article 280 simply states that the
states are different from that of commission should be appointed every five
the centre. responding to their needs.
years or earlier; the appointed commission
There is an urgent need for ¡¡ Participative, by involvement of can continue until the new commission
an institution to promote healthy citizenry. is appointed. However, so long as the
Finance Commission continues to be a
intergovernmental competition while ¡¡ Inclusion of all groups.
temporary body, the NITI Aayog will have
preventing the “race to the bottom”. ¡¡ Equality of opportunity to our a role in designing and implementing these
All these underline the need for an country’s youth. programmes.
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economy and for different sectors; (iii) in the system. The NITI Aayog was the innovation ecosystem in India.
acting as a knowledge and innovation formed to bring fresh ideas to the With its current mandate that
hub and providing research inputs by government. Its first mandate is to is spread across a range of sectors
undertaking and accessing globally act as a think tank. It can be visualised and activities, and with its unique
available research; and (iv) providing as a funnel through which new and and vibrant work culture, NITI Aayog
a platform for interdepartmental innovative ideas come from all possible remains an integral and relevant
coordination. sources — industry, academia, civil component of the government’s plans
The second contradiction was society or foreign specialists — and to put in place an efficient, transparent,
between the centralised command flow into the government system for innovative and accountable governance
over resource allocation and the implementation. system in the country.
developmental role of the states in a ¡¡ Initiatives like Ayushmaan Bharat
federal polity. The end of single party and the draft bill to establish the Argument against the NITI
rule and the emergence of coalition National Medical Commission to Aayog
governments and regional parties replace the Medical Council of India In the original Nehruvian vision, the
as members of the central coalition have all been conceptualised in NITI public sector was entrusted with the
brought to the fore the contradiction Aayog and are being taken forward economy, given the weak market
between centralised planning in a by the respective Ministries. In that mechanism which was dominated by
federal framework. The response sense, NITI Aayog as an action tank mercantile capital and a feudalistic
of the central government was to rather than just a think tank. system, especially in rural areas.
further centralise even by intruding Even then, the Planning Commission
¡¡ By collecting fresh ideas and
into the legislative domains of the controlled only half of the total
sharing them with the Central
states by various means including investment in India, since what was
and state governments, it pushes
the proliferation of CSS. The consciously adopted was a mixed
frontiers and ensures that there is
consequence of the above was that the economy system. It also fitted well
no inertia, which is quite natural
two important sources of economic with our republican democratic
in any organisation or institution.
dynamism, the private sector and the Constitution. India cannot transform
states, had to function in a constrained If it succeeds, NITI Aayog could
emerge as an agent of change over with new ideas without having a
environment.
time and contribute to the Prime paradigm of planning for development.
How different it is from Minister’s agenda of improving ¡¡ The rise of neoliberalism, the
Planning Commission? governance and implementing decline of erstwhile socialist
innovative measures for better regimes worldwide, and the rise of
The major differences between NITI
delivery of public services. right-wing market fundamentalists
Aayog and Planning Commission are:
¡¡ It also work to cut across the within the country paved the way
¡¡ Role of States increased, which was
silos within the government. NITI for the demise of the Planning
limited in Planning commission. Commission. Its replacement by
Aayog is best placed to achieve
¡¡ Planning Commission followed NITI Aayog looks more apologetic
this convergence across a number
topdown approach while Niti Aayog of Ministries and between Central than substantial for the task of
is based on Bottom –up approach and state governments and push transforming a deeply unequal
of policy formation. the agenda forward. society into a modern economy
¡¡ While the Planning Commission that ensures the welfare of all its
¡¡ NITI Aayog has established a
used to formulate Government Development Monitoring and citizens, irrespective of their social
Plans, NITI Aayog is mainly Evaluation Office which collects identity.
responsible for evaluating the ¡¡ It has no role in influencing, let
data on the performance of various
implementation of programmes. alone directing, public or private
Ministries on a real-time basis. The
¡¡ The Planning Commissions data are then used at the highest investment. It does not seem to
function of allocating funds to policymaking levels to establish have any influence in policymaking
States has been scraped in this new accountability and improve with long-term consequences (for
arrangement. performance and improving the instance, demonetisation and the
efficiency of governance. Goods and Services Tax).
Argument in favour of the
¡¡ The Atal Innovation Mission, ¡¡ NITI Aayog is supposed to be a
NITI Aayog
which is also established under think tank. This implies that while
It is introducing new ideas and bringing NITI Aayog, has already done generating new ideas, it maintains
about a greater level of accountability commendable work in improving a respectable intellectual distance
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from the government of the day. became the “factory of the world” — important to transform them to meet
Instead, what we see is uncritical backed by an industrial policy driven the new require ments. Similarly,
praise of government-sponsored, by the National Development and the Constitution requires the
acronym-infested schemes. Reforms Commission. Similarly, in establishment of district planning
¡¡ It sings paeans to the virtues of all East Asian and Southeast Asian committees and metropolitan planning
the private corporate sector as countries, industrial policy was committees. Their role in the new
planned and executed as part of five- environment needs to be specified.
the saviour of the Indian economy
year or longer-term plans. It was Although the cabinet resolution states
without realising, let alone
precisely because these countries had that NITI Aayog will facilitate grass
appreciating, the foundational and
planning institutions which went hand roots planning, how exactly this will be
socially oriented contribution of
in hand with industrial policy that they carried forward needs to be seen.
India’s vast public sector.
managed to steer policies through
turbulent times in the global economy, If NITI Aayog is to implement
Achievement of NITI Aayog such a strategy within a planning
thus sustaining growth.
The NITI Aayog established with framework in India, two major changes
In most of Latin America/
the aim to achieve Sustainable in governance structures are needed.
Caribbean (LAC) countries and in
Development Goals and to enhance First, planning will have to become
Subsaharan Africa (SSA), two full
cooperative federalism by fostering more decentralised, but within a
decades of potential economic growth
the involvement of state governments and human development were lost five-year plan framework. Second,
of India in the economic policy-making when per capita income barely rose bureaucracy will need to change
process using a bottom-up approach. even as populations continued to from generalist to specialist, and its
Its initiatives include "15 year road grow. These countries abandoned accountability will have to be based on
map", "7-year vision, strategy and planning and became captives of the outcomes achieved, not inputs or funds
"3 year action plan", AMRUT, Digital Washington Consensus. On the other spent. NITI Aayog should spell out how
India, Atal Innovation Mission, Medical hand, the important identifier of East these reforms will be implemented.
Education Reform, agriculture reforms Asian and Southeast Asian countries, The success of the institution
(Model Land Leasing Law, Reforms of which did not experience such “lost in achieving interministerial, inter-
the Agricultural Produce Marketing decades” in the 1980s and 1990s, were departmental coordination will depend
Committee Act, Agricultural Marketing their planning structures, backed by on the trust and cooperation it receives
and Farmer Friendly Reforms Index an industrial policy and implemented from them and the harmony with
for ranking states), Indices Measuring by learning bureaucracies. That is how which the Aayog and various ministries
States’ Performance in Health, they were able to ride the wave of their work. There could be tensions
Education and Water Management, demographic dividend, which comes between the technocrats in the Aayog
Sub-Group of Chief Ministers on but once in the life of a nation. India and various ministers on the one hand
Rationalization of Centrally Sponsored cannot risk going the LAC/ SSA way,
and between the technocrats and
Schemes, Sub-Group of Chief since it is already past the midpoint of
bureaucrats on the other. There is also
its dividend.
Ministers on Swachh Bharat Abhiyan, the danger of bureaucratisation of the
Sub-Group of Chief Ministers on While East Asian and Southeast Aayog. Similarly, success in fostering
Skill Development, Task Forces on Asian countries still had and have, cooperative federalism will depend
Agriculture and Elimination of Poverty five-year plans, what was also integral on the trust of and cooperation from
to their planning was productive use
and Transforming India Lecture Series, the states. In particular, the first Aayog
of labour, through an export-oriented
were some of work done by NITI Aayog will have a tremendous task of shaping
manufacturing strategy. It was this
ofter its formation. the character and charting a course
strategy that was lacking in India’s
Learning from the experience of to make it an important institution
planning. Giving ‘planning’ per se a bad
the now-industrialised countries, the in Indian fed eral polity to transform
name for poor policy is indicative of an
Chinese state ensured that after its India.
ahistorical understanding of planning.
market-oriented economic reforms
began, its State Planning Commission Conclusion General Studies Paper- II
became more powerful in the state The legacy issues do not end merely Topic: Statutory, regulatory and
apparatus. The result was growth with the abolition of the Planning various quasi-judicial bodies.
and poverty reduction on a scale Commission. There are parallel
unprecedented in history. China institutions in the states and it is mmm
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3. AYUSHMAN BHARAT: TO CHANGE INDIA'S HEALTHCARE LANDSCAPE
Why in News? supply cannot therefore, be left to be its population has universal access
regulated solely by the invisible hand to good quality health care services
India takes a giant leap towards
of the market. Nor can it be established without anyone having to face financial
providing accessible and affordable on considerations of utility maximizing hardship as a consequence.
healthcare to the common man with conduct alone.
the launch of Ayushman Bharat – Background
Healthcare has become one of
Pradhan Mantri Jan AarogyaYojana (AB-
India's largest sectors both in terms In the matter of inclusion, over 15
PMJAY) by the Prime Minister, on 23rd
of revenue and employment. During years ago, the Vajpayee government
September, 2018 at Ranchi, Jharkhand.
2008-22, the market is expected to commissioned the Institute of Health
This is the “world’s largest government
record a Compound Annual Growth Systems (IHS), Hyderabad to develop a
funded healthcare program” targeting
Rate (CAGR) of 16.28 per cent. The ‘family welfare linked health insurance
more than 50 crore beneficiaries.
total industry size is expected to touch policy’. In 2003, the Director of the
Introduction US$ 160 billion by 2017 and US$ 372 IHS Hyderabad delivered a broad-
billion by 2022. Indian companies are based Family Health Protection Plan
Health and health care need to be
entering into merger and acquisitions (FHPP), open to all individuals. The
distinguished from each other for no
with domestic and foreign companies fact is that any discourse on universal
better reason than that the former
to drive growth and gain new markets. health care in India gets stymied by
is often incorrectly seen as a direct
The hospital industry in India stood at the sheer size and ambivalence of the
function of the latter. Heath is clearly
not the mere absence of disease. Rs 4 trillion (US$ 61.79 billion) in 2017 numbers involved. This 2003 solution
Good health confers on a person or and is expected to increase at a CAGR of the Vajpayee-era recommended,
groups freedom from illness - and of 16-17 per cent to reach Rs 8.6 trillion inter alia , that good governance lies
the ability to realize one's potential. (US$ 132.84 billion) by 2023.
in aligning the income lines for health
Health is therefore best understood India has achieved significant and housing. In other words, de-link
as the indispensable basis for defining public health gains and improvements entitlement to health care from the
a person's sense of well being. The in health care access and quality over poverty line. In that event, the income
health of population is a distinct key the last three decades. The health lines for housing (updated from time
issue in public policy discourse in sector is amongst the largest and to time), could be simultaneously
every mature society. They include its fasting growing sectors, expected to applicable for health entitlement.
cultural understanding of ill health and reach US$ 280 billion by 2020. At the The government could then proceed,
well-being, extent of socio-economic same time, India’s health sector faces as per capacity, to scale the health
disparities, reach of health services immense challenges. It continues to premium subsidy in line with housing
and quality and costs of care and be characterized by high out-of-pocket
categories — economically weaker
current bio-medical understanding expenditure, low financial protection,
sections (entitled to 75-90%), lower
about health and illness. low health insurance coverage amongst
income (entitled to 50%), and middle
Health care covers not merely both rural and urban population. It is a
income groups (entitled to 20%).
medical care but also all aspects of matter of grave concern that we incur
pro preventive care too. Nor can it be a high out-of-pocket expenditure on For the government, Ayushman
limited to care rendered by or financed account of health and medical costs. Bharat is an attempt at creating
out of public expenditure- within the 62.58% of our population has to pay for purchasing capacity among the poor.
government sector alone but must their own health and hospitalization There are two ways of tackling the
include incentives and disincentives expenses and are not covered through problem of affordable healthcare. It’s
for self care and care paid for by private any form of health protection. Besides either by financing services to keep
citizens to get over ill health. Where price affordable or by financing the
using their income and savings, people
as in India, private out-of-pocket paying capacity of people. The first
borrow money or sell their assets to
expenditure dominates the cost of
meet their healthcare needs, thereby idea hasn’t worked as more than 70%
financing health care, the effects are
bound to be regressive. Health care at pushing 4.6% of the population below of the healthcare is concentrated in
its essential core is widely recognized the poverty line. The government of the private sector. It’s a known fact
to be a public good. Its demand and India is committed to ensuring that that government facilities suffers from
7 October 2018 A Issue-2Current Affairs : Perfect 7
acute shortage of human resources so ¾¾ In May 2018, the government of India Health Care (CPHC), covering both
the old school model of government- approved financial outlay of Rs 14,832 maternal and child health services and
run clinics hasn’t worked. It was against crores (US$ 2.30 billion) for FY2017-18 non-communicable diseases, including
to FY2019-20. free essential drugs and diagnostic
this backdrop that Rashtriya Swasthya
¾¾ In May 2018, the government of services.
Bima Yojana (RSBY) was designed. India approved Rs 1,103 crore (US$
However, RSBY (which preceded 170.14 million) for setting up All India Financial protection from
PMJAY) got plagued by a host of issues. Institute of Medical Sciences (AIIMS) catastrophic expenditure: 71st
in Deoghar, Jharkhand. Round of National Sample Survey
“The cover of Rs. 30,000 was found
¾¾ In March 2018, the Union Cabinet Organization (NSSO) has found
to be low and many states started of India approved the continuation
introducing their own scheme with of National Health Mission with a
85.9% of rural households and 82%
a higher cover and it covered tertiary budget of Rs 85,217 crore (US$ 13.16 of urban households have no access
care as well,” said Malti Jaswal, former billion) from 1st April 2017 to 31st to healthcare insurance/assurance.
March 2020. PMJAY primarily targets approximately
chief operating officer of Health
¾¾ In April 2018, the government of 10.74 crore identified the poor,
Insurance TPA of India Ltd, who now is India approved to sign Memorandum deprived rural families and identified
consulting on Ayushman Bharat. of Understanding (MoU) with the
medical agencies of BRICS countries occupational category of urban
Apart from focusing only on workers’ families as per the latest
for cooperation in the field of medical
insurance cover, the government, products. Socio-Economic Caste Census (SECC)
under PMJAY, is establishing wellness ¾¾ In April 2018, the government of India data for both rural and urban areas as
centres that will focus on primary, apprised the signing of Memorandum well as the active families under the
preventive and promotive healthcare of Agreement (MoA) between India
and World Health Organisation to
Rashtriya Swasthya BimaYojana (RSBY).
through public facilities. Further,
facilitate in improving public health in Hospitalization cover and post
Ayushman Bharat not only provides a India hospitalisation care: The objectives of
comprehensive cover, but its sheer size the Yojana are to reduce out of pocket
can pull the pricing down. Pradhan Mantri Jan Arogya hospitalisation expenses, fulfil unmet
Yojana needs and improve access of identified
Health Initiatives in india
Universal health coverage is getting families to quality inpatient care and
Some of the major initiatives taken by the
government of India to promote Indian prioritised as a part of political reform day care surgeries. The Yojana will
healthcare industry are as follows: with the launch of two pillars of the provide a coverage up to Rs. 5,00,000
¾¾ In August 2018, the government of Pradhan Mantri Jan Arogya Yojana per family per year, for secondary and
India has approved Ayushman Bharat- (PMJAY): Ayushman Bharat (AB), where tertiary care hospitalization through
National Health Protection Mission a network of Empanelled Health Care
1.5 lakh health sub-centres are being
as a centrally sponsored scheme
converted into health and wellness Providers (EHCP).
contributed by both center and state
government at a ratio of 60:40 for all centres; and the National Health Pradhan Mantri Jan Arogya
states, 90:10 for hilly North Eastern Protection Mission (NHPM), which Yojana in alliance with the States: The
states and 60:40 for Union Territories aims to provide health cover of Rs. 5 scheme architecture and formulation
with legislature. The center will
contribute 100 per cent for Union lakh per family, per annum, reaching has undergone a truly federal process,
Territories without legislature. out to 500 million people. with stakeholder inputs taken from all
¾¾ The government of India has launched States and UTs through the national
Mission Indradhanush with the aim of Features of the Scheme conclaves, sectoral working groups,
improving coverage of immunisation Ayushman Bharat- Pradhan Mantri intensive field exercises and piloting of
in the country. It aims to achieve
Jan Arogya Yojana (PMJAY) will provide key modules. States have the option to
atleast 90 per cent immunisation
coverage by December 2018 which a cover of up to Rs. 5 lakhs per family use an existing trust/society or set up
will cover unvaccinated and partially per year, for secondary and tertiary care a new trust/society to implement the
vaccinated children in rural and urban hospitalization. It adopts a continuum scheme as state health agency and will
areas of India. be free to choose the modalities for
of care approach, comprising of two
¾¾ In April 2018, the government of India implementation.
inter-related components: Creation of
apprised the signing of Memorandum
of Agreement (MoA) between India 1,50,000 health and wellness centres Fraud detection and Data privacy:
and World Health Organisation to which will bring health care closer to Detailed guidelines have been
facilitate in improving public health in the homes of the people. These centres prepared to address the issues around
India. will provide Comprehensive Primary potential fraudulent activities that
October 2018 A Issue-2 8Current Affairs : Perfect 7
could be committed by any individual district hospitals to government largely to poor regulation that failed
or organization. medical colleges and teaching hospitals to check insurers cutting corners or
Anti-fraud cells will be established will enhance capacities at the district medical procedure inflation on the part
at the national and state level, and level. Service providers will become of health providers looking for a heftier
strong IT tools will be deployed to accountable for cost and quality if they insurance payout.
prevent and detect fraud. are bound to the nuts and bolts of good In the absence of healthcare
governance outlined above. regulations, some believe that PMJAY
IT systems update: Beneficiary
Identification System (BIS) has been The lack of proper hospitals in will meet with little success. But for
developed to identify and verify the smaller towns and few empanelled others, the sheer magnitude of the
beneficiaries at CSCs and point of hospitals, can lead to unhappy scheme will herald much needed
care. Transaction Management System experiences. While PMJAY creates health insurance regulations. Indeed,
(TMS) has been developed to facilitate demand, it will need to provide the architecture of PMJAY inspires
transactions from hospitals (such as supply—for that to happen, the private hope. “For the first time we have
filing pre-authorization requests and sector will have to rise to the occasion. seen the focus on national pricing for
claims submission). The immediate challenge is to get the health services, standardized protocols
private sector to participate. Ayushman and coding. It has led to the creation
Challenges Bharat, at present, has about 8,500 of an independent body (National
The NHPM is pushing for hospitalisation hospitals empanelled, and this includes Health Agency) that will coordinate
at secondary- and tertiary-level private public hospitals as well. According to and improve the scheme over time,
hospitals, while disregarding the need experts, there are about 30,000-40,000 through investments in a robust IT
for eligible households to first access eligible hospitals in the country. infrastructure. “If successful, this can
primary care, prior to becoming ‘a The population is underserved well be replicated for the remaining
case for acute care’. We are in danger when it comes to healthcare. This 60% of the population on a contribution
of placing the cart (higher level care) means that many of its healthcare basis. The scheme also gives incentives
before the horse (primary care). The needs are either unrealized or taken to hospitals that get accredited for
National Health Policy 2017 proposed care of outside the formal healthcare quality.
“strategic purchasing” of services from system. If Ayushman Bharat is able The next issue relates to the
secondary and tertiary hospitals for a to deliver on the outreach and desirable level of public expenditure
fee. infrastructure front, a rise in walk-ins towards health services. China devotes
The “best health care at the and the subsequent realization of risk 4.5% to its GDP as against India devoting
lowest possible cost” should be: are inevitable. 5.1%. But this hides the fact that in
inclusive; make health-care providers Another challenge with regard China, public expenditure constitutes
accountable for cost and quality; to Ayushman Bharat relates to 38% whereas in India, it is only 15% of
achieve a reduction in disease burden, unavailability of data with insurers. total health expenditure. An optimistic
and eliminate catastrophic health Insurers live and die by data—actuaral forecast would be that the level of
expenditures for the consumer. All of databases that allow them to calculate public expenditure will be raised
this is not happening overnight simply probability distributions for different progressively such that about 30% of
because an audacious, nation-wide health risks and treatments. No such total health expenditure would be met
health-care programme is on the anvil. data exists in India for the vast segment out of public funds by progressively
The credo for participating private of the population that Ayushman increasing the health budget in states
providers should be “mission, not Bharat will cover. and the central and charging user
margin”. Health-care providers (public/ The travails of Ayushman Bharat’s fees in appropriate cases. The figure
private) should be accredited without predecessor, the Rashtriya Swasthya mentioned would perhaps correspond
any upper limit on the number of service Bima Yojana (RSBY), point to another to the proportion of the population
providers in a given district. The annual challenge. RSBY’s outcomes were which may still need assistance is social
premium for each beneficiary would unflattering. In targeting and effects development.
be paid to those service providers, for of Rashtriya Swasthya Bima Yojana on
up to one year only (renewable), as access to care and financial protection, Conclusion
selected by beneficiaries. The resultant it had failed both in targeting and in Elimination of catastrophic health
competition would enhance quality reducing health-related poverty in the expenditures for the consumer can
and keep costs in check. Upgrading households it did reach. This was down come about only if there is sustained
9 October 2018 A Issue-2Current Affairs : Perfect 7
effort to modernise and transform the address a majority of community/ The scaleable and inter-operable
primary care space. Bring together all individual health needs. The health IT platform being readied for the
relevant inter-sectoral action linking and wellness clinics must connect Ayushman Bharat is encouraging. As
health and development so as to with early detection and treatment. we integrate prevention, detection
universalise the availability of clean Robust delivery of preventive, clinical and treatment of ill-health, the PMJAY
drinking water, sanitation, garbage and diagnostic health-care services will win hearts if people receive a well-
disposal, waste management, food will result in early detection of cancers, governed ‘Health for All’ scheme.
security, nutrition and vector control. diabetes and chronic conditions,
The Swachh Bharat programme must mostly needing long-term treatment
be incorporated in the PMJAY. These and home care General Studies Paper- II
steps put together will reduce the Technology and innovation are Topic: Issues relating to development
disease burden. further reducing costs. AI-powered and management of Social Sector/
Services relating to Health,
Kerala and Tamil Nadu have mobile applications will soon provide
Education, Human Resources.
demonstrated that high-performing, high-quality, low-cost, patient-
primary health-care systems do centric and smart wellness solutions. mmm
4. INDIA AND MALDIVES: REBUILDING THE RELATIONSHIP
Why in News? in the Indian Ocean commenced its consists of 1192 islands out of which
journey toward a controlled regime. about 200 hundred are inhabited.
On September 23, 2018, the Maldives’
Jailing rivals and judges, cracking down The other remaining islands are used
joint opposition coalition candidate
on dissent, suppression of freedom of either for tourism or agriculture.
Ibrahim Mohamed Solih emerged
speech and expression and stringent Maldives is spread over roughly 90,000
victorious in the presidential elections.
media control, were increasingly visible square kilometres and is one of the
Voters in Maldives have decisively
facets of Yameen’s presidential tenure. world’s most geographically dispersed
ensured that their country remains countries. It is the smallest south
firmly within the comity of democratic Moreover, the country seemed to be
drifting out of the political orbit of the Asian country in both land area and in
nations, by voting out incumbent population. The Maldivian islands have
and controversial President Abdulla United States, the United Kingdom and
India, and toward China. an average groundlevel elevation of
Yameen. The result also validates 1.5 meters above sea level that makes
India’s strategic patience to await Solih campaigned in the election it the lowest country of the planet.
the election result, without being on the promises of reviving the Historically, this country has been
stampeded into any intervention in the economy, putting a check on rising linked to the Indian subcontinent.
domestic affairs of a friendly neighbour. extremism, reviving democratic
The islands gained independence
The election result will reopen avenues institutions and rebuilding ties with
from the United Kingdom in 1965,
for mending fences and bringing India- the Maldives’ neighbours, especially
becoming a republic in 1968. Maldives
Maldives ties to an even keel. India. International media simplified became a member of the United
the election battle into a choice Nation in 1965 and is one of the
Introduction between “pro-China” Yameen and founding members of the South Asian
In the third multi-party presidential “pro-India” Solih. Some analysts are of Association for Regional Cooperation
election, democratic values, institutions the opinion that with the victory of the (SAARC). It is also a member of the
and the survival of both were at stake. “pro-India” candidate, India is assured Commonwealth of Nations, the
New President-elect Solih is viewed greater engagement with its Indian Organization of Islamic Cooperation
as a clean and efficient lawmaker in Ocean neighbour and convergence of (OIC) and the Non-Aligned Movement.
the Maldives, where corruption and interests in the region, which indirectly
nepotism remain prominent issues. means a lessening of China’s influence. Importance of Maldives
The dwindling state of the economy The importance of the Maldives
and popular protests had brought
Background is because of its crucial geo-strategic
Yameen to power as the Maldives’ The Maldivian islands are situated location. It sits astride important Sea
President in 2013 after Nasheed close to the South-Western tip of the Lanes of Communication (SLOCs). The
resigned. Then the fragile democracy mainland India. The archipelago nation world’s three major economies China,
October 2018 A Issue-2 10Current Affairs : Perfect 7
Japan and India depend for their The strategic significance of
energy supply on the Gulf oil. This Maldives for India has been growing
further enhances the importance of over the last many years. In addition
the Maldives. to the growing influence of China in
The Indian Ocean has always been the country, Maldives has been getting
crucial to global connectivity and increasingly radicalized and coming
all world powers have sought their under the influence of fundamentalist
presence here. Now China too claims Wahhabi ideology. Islamic State (IS)
status of a global power. It also wants and Lashkar-e-Taiba are also reported
to be a maritime power. To prevent to have established bases in the on its part, still claims that it sees its
Chinese from enhancing their influence security interests through the lens of
country. Several hundred young men
in the Maldives, Americans are playing India and Sri Lanka, but other powers
and women have deserted their homes
their own games. too want to be its security partners,
to fight for the IS in Syria and Iraq. The
India and Maldives Relations rapid growth of radical Islam in India’s namely China and the US.
vicinity is a matter of serious concern Certainly, American presence in
India’s relations with Maldives have
for India and for regional security. the Maldives would have dramatically
been frayed for some time and
changed the strategic landscape of
particularly since 2012 when Nasheed, In addition, India has about 25,000
the IOR. However, from the Indian
the first democratically elected Indian expatriates in Maldives who are
perspective, to counter increasing
President, was deposed by force and engaged in a number of professional Chinese naval presence in the Indian
Abdullah Yameen became President in pursuits. Their safety and security is a Ocean, welcoming increased US military
2013 after a highly controversial and matter of acute concern. India could be presence in the region may not be a very
dubious election. Since then, Maldives forced to take some military action if its judicious idea. It is not necessary that
has progressively cosied up to China
nationals come under imminent threat. increased American military presence
at the expense of India. This started
No indication of this has been evident in the Indian Ocean region would be
with the cancellation of the Indian
so far. benign and to India’s advantage. It
company GMR’s contract for building
As in Malaysia, where a pro-Beijing may only create further complications
Male airport and awarding it to China
regime was ousted in recent elections, for the Indian foreign policy towards
during President Xi Jinping’s 2015 visit.
the Maldives and worsen rivalry
Yameen has enthusiastically boarded Mr Solih’s victory is expected to lead
among external powers in the IOR.
the bandwagon of the Maritime Silk to intensified scrutiny of China’s
Road initiative launched by China in investments in the Maldives. For India is trying to develop
2013. During Yameen’s presidency, India, which has described Mr Solih’s cooperative structures in the IOR
Maldives has leased out several islands through Indian Ocean Rim Association
win as the triumph of democratic
to China which could be used for (IORA), Bay of Bengal Initiative for
forces, the latest developments
building bases as part of the “string Multi-Sectoral Technical and Economic
provide an opportunity to forge a
of pearls” strategy to encircle India Cooperation (BIMSTEC) and more
closer relationship with the new
and reduce its influence. The latest recently through the trilateral maritime
administration agreement with Sri Lanka and the
development in this narrative was the
signing of an Free Trade Agreement Impact on the Security Maldives. However, the desire of China
(FTA) with China after a suspiciously to become a maritime power has also
Environment in the Indian Ocean
hurried approval by the Maldivian brought in competition in this region.
Region (IOR)
Parliament. The Chinese are already trying to
India needs to tread cautiously in project power by sending submarines
India has two main interests in the
Maldives. It wants political stability in promoting democracy in the Maldives in the Indian Ocean. These submarines
the country. It also wants to prevent the as the democratic transition in the have docked at Colombo and Gwadar
Maldives from falling under influences country has coincided with greater and a submarine is also suspected to
(both state and non-state) that are rivalry for the control of the IOR. The have travelled in the Maldivian waters.
inimical to Indian security interests. Chinese, of course, want to increase For this, India needs an effective
The Indian foreign policy seems to be their hold over the Maldives, especially national maritime security strategy
facing difficulty in meeting both these after losing their political influence in that creates a synergy between its
objectives. Sri Lanka and Myanmar. The Maldives, foreign policy, the strength of Indian
11 October 2018 A Issue-2Current Affairs : Perfect 7
Navy, and the domestic defence and the China-built Hambantota Port to a India can and should earn goodwill by
maritime industry which in turn can Chinese company on a 99-year lease. extending whatever assistance is asked
create lasting friendly relations with all This has given China a long-term of it as Mr Solih takes on the task of
littorals in the region. foothold very close to Indian shores. rebuilding the fragile democracy in the
This lesson has not gone unnoticed Maldives.
Issues and Challenges
in Maldives. The election result is a India has been a timely friend
Maldives, which is famous for its high- direct reflection of this concern and for the Maldives, which is evident
end Indian Ocean resorts, has become other mostly domestic issues. Solih from numerous efforts by India in
a scene of strategic contestation has also promised to review Chinese- helping maintain stability in Male.
between India and China. This situation funded projects to avoid being sucked From “Operation Cactus” in 1988 to
has been leavened by Maldivian into a Chinese debt trap leading to fending off a severe water crisis in
President Yameen Abdul Gayoom, who unintended consequences. the island nation, India has played the
is trying to extricate his country from But the establishment in India role of a responsible neighbor. It is in
India’s arc of influence by building should not forget that it is not so easy India’s interest to continue with such
close a relationship with China. to push aside China’s hard economic critical engagements and work toward
The root cause of the mistrust power and its “debt-trap” diplomacy. building confidence and assurances to
between India and the Maldives has The case of Sri Lanka is a classic example. the extent that Maldives emerges out
been the growing Chinese footprint Even though the current establishment of its “Big Brother Syndrome.”
on the archipelago. The geostrategic tried to reassess the nature of Chinese Moreover, strengthening
significance of the Maldives lies investments and reframe what it called democratic institutions, infrastructure
in its proximity to the Sea Lines of “unjust” conditions when it came to support and capacity building should
Communication in the Indian Ocean. power, Sri Lanka has to live with the remain India’s priorities in engagement
More than 60% of trades and energy reality of Chinese debt and its presence with the Maldives. India has proved
supplies traverse via this. China’s in the strategically located Hambantota its commitments in the past with the
foothold in the Maldives became a sore port. The case of Pakistan is somewhat establishment of a medical complex,
point for India, as well as the USA. For similar, where Islamabad has decided the Indira Gandhi Memorial Hospital,
India, China’s spreading tentacles into to go ahead with the China-Pakistan in Male, as well as the Maldives’
the neighbourhood pose a strategic Economic Corridor (CPEC) without
first institute of technical education
threat to the nation’s security given any reassessment by the new
China’s hegemonic ambitions have which was set up as a grant-in-aid
administration. China’s ubiquitous
been evident in the South China Sea. project of India in 1996. Policymakers
presence in the Maldives cannot
The Maldives, under Yameen, emerged in India have a renewed chance
be erased easily due to economic
second only to Pakistan for its growing for fruitful engagement with Male.
entanglements. Moreover, the United
embrace of China. India’s neighbours This opportunity should not be lost
States and the United Kingdom enjoyed
have all played the China card, to in weighing third parties’ interests
more diplomatic dividend than India
varying degrees for balancing India. and involvement. India should act
even when Nasheed was in power.
responsibly by allowing the internal
The Chinese sponsored Belt and
Road Initiative (BRI) and dollops of Way Forward equations in the Maldives to settle
first and then engage constructively
hard cash doled out as bribes were This election result is an opportunity
in the process of restoring democratic
the tools of geo-economic seduction for India to gain some lost ground.
institutions. A stable Maldives is
to which Yameen and his collaborators There should, however, be no doubt
essential for a stable neighborhood
succumbed easily. During Yameen’s that even a friendly Solih government
across South Asia.
tenure, Pakistan and Saudi Arabia also will continue to balance China and
became major players in the Maldives. India, albeit in a more nuanced manner.
China’s sustained effort to spread China is likely to mount a major effort General Studies Paper- II
its influence and create strategic to protect its strategic investments and Topic: India and its neighborhood-
beachheads in the Indian Ocean, has ongoing projects in Maldives. Clearly, relations.
led Sri Lanka into a debt trap which some deft diplomacy will be required
was “resolved” by handing over of to address a host of pressing issues but mmm
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