The Cabinet Committee on Economic Affairs, chaired by the Hon’ble Prime Minister Shri Narendra Modi, has approved a subsidy of Rs.200 per 14.2 kg cylinder for up to 12 refills per year to be provided to the beneficiaries of Pradhan Mantri Ujjwala Yojana (PMUY). The subsidy is credited directly to the bank accounts of the eligible beneficiaries.
How many beneficiaries are there in PMUY?
As on 1st March 2023, there are 9.59 crore PMUY beneficiaries.
Is it a new initiative?
No, because many Public Sector Oil Marketing Companies Namely Indian Oil Corporation Ltd. (IOCL), Bharat Petroleum Corporation Ltd. (BPCL) and Hindustan Petroleum Corporation Ltd. (HPCL) have already been providing this subsidy since 22nd May 2022.
Who is eligible for the targeted subsidy to Pradhan Mantri Ujjwala Yojana?
All PMUY beneficiaries are eligible for this targeted subsidy.
What is the Pradhan Mantri Ujjwala Yojana?
To make Liquified Petroleum Gas (LPG), a clean cooking fuel, available to rural and deprived poor households, Government launched Pradhan Mantri Ujjwala Yojana in May 2016, to provide deposit-free LPG connections to adult women of poor households.
It is a scheme for providing Physical Aids and Assisted-living Devices for Senior citizens belonging to the BPL category.
What is the type of Rashtriya Vayoshri Yojana?
This is a Central Sector Scheme, fully funded by the Central Government.
What is the funding source of Rashtriya Vayoshri Yojana?
The expenditure for implementation of the scheme will be met from the "Senior Citizens' Welfare Fund".
Who will implement Rashtriya Vayoshri Yojana?
The Scheme will be implemented through the sole implementing agency - Artificial Limbs Manufacturing Corporation (ALIMCO), a PSU under the Ministry of Social Justice and Empowerment.
Who is eligible under Rashtriya Vayoshri Yojana?
Under the scheme, physical aid will be provided only to the senior citizens of the nation. This implies those who are aged above 60 years will get free assisted living aids and physical devices which are required for their sustainability.
The main criteria for the senior citizens to get full benefits of the Rashtriya Vayoshri Yojana (RVY) scheme is that they must belong to a BPL family and should hold a valid BPL card issued by the concerned authority.
Where Rashtriya Vayoshri Yojana will be implemented?
Also, the govt. has selected the list of cities where the scheme will be implemented.
ADIP Scheme is one of the major initiatives of the Ministry of Social Justice & Empowerment, Govt. of India.
What is the purpose of AIDP?
This scheme is implemented to assist the needy disabled person in procuring durable, sophisticated and scientifically manufactured, modern, standard aids and appliances to promote physical, social, and psychological rehabilitation of Persons with Disabilities by reducing the effects of disabilities and at the same time enhancing their economic potential.
Assistive devices are given to PwDs to improve their independent functioning and to arrest the extent of disability and occurrence of secondary disability. The aids and appliances supplied under the Scheme must have due certification.
Who is eligible for the benefits of the scheme?
A person with disabilities fulfilling the following conditions would be eligible for assistance under ADIP Scheme:
An Indian citizen of any age.
Holds a 40% Disability Certificate.
Has monthly income from all sources not exceeding Rs. 20,000/- per month.
In the case of dependents, the income of parents/guardians should not exceed Rs. 20,000/- per month.
Who has not received assistance during the last 3 years for the same purpose from any source?
However, for children below 12 years of age, this limit would be one year.
Note: - Income certificates of beneficiaries staying in orphanages and halfway homes etc. will be accepted on certification of the District Collector or Head of the organization concerned.
This shiver is held to the Distribution of Aids and Assistive Devices to Divyangjan and Senior Citizens in Kannauj District, U.P. by Union Minister of State for Social Justice and Empowerment Sushri Pratima Bhoumik.
Under Which scheme the shivir is held?
The shivir is held under the ADIP (SCHEME OF ASSISTANCE TO DISABLED PERSONS FOR PURCHASE/FITTING OF AIDS/APPLIANCES) and Rashtriya Vayoshri Yojana scheme respectively of the Ministry of Social Justice and Empowerment, Government of India.
Who organised the shivir
The camp was organized by the Department of Empowerment of Persons with Disabilities (DEPwD) in association with
ALIMCO (Artificial Limbs Manufacturing Corporation) and
Context: 36th Board Meeting of Stop TB Partnership took place in India.
About Stop TB Partnership
STOP TB Partnership is a UN hosted organisation that aims for a world free of TB, until then, making diagnosis, treatment and care available to all who need it.
It was founded in 2001 to eliminate TB by 2030.
Secretariat: The Secretariat of Stop TB Partnership is hosted and administered by UNOPS in Geneva, Switzerland.
Union Minister for Health & Family Welfare is the current chairman of the Board of Stop TB Partnership.
Membership: Membership of Stop TB Partnership is open to national governments, NGOs, and scientific institutions.
Objectives of STOP TB
Ensure that every person with TB has access to effective diagnosis, treatment & cure.
Stop transmission of TB.
Reduce the inequitable social and economic toll of TB.
Develop, implement and increase access to new preventive, diagnostic and therapeutic TB tools, products & strategies.
Amplify the voices of people with and affected by TB and secure meaningful change through strategic advocacy & communication.
Initiatives by Stop TB Partnership
Global Drug Facility: Stop TB Partnership Global Drug Facility (GDF) facilitates global access to quality-assured, affordable TB diagnostics and treatments. GDF serves three objective:
Shape the market: GDF works with suppliers, donors & other stakeholders to ensure the availability of quality assured and sustainably priced products that respond to market needs.
Facilitate access to innovative medicines & diagnostics: GDF provides technical assistance to facilitate the introduction and uptake of innovative medicines and diagnostics in client countries.
Provide best in class procurement & supply services for tuberculosis medicines & diagnostics.
TB REACH: This initiative aims to identify not diagnosed, not treated or not reported by providing funding to test pioneering approaches that reach more people with TB. TB Reach provides funding for projects that:
Context: More than three years after the COVID-19 pandemic began, newer variants have emerged with an uptick in cases, hospitalisations, and even deaths.
Major Highlights:
After Kappa, Delta, BA.2.75, and BA.2.76, the latest variant (first detected in India) is the Omicron recombinant XBB.1.16. This variant accounts for over 30% of all sequenced genomes in March 2023, and its proportion has been increasing.
However, there is no need for alarm as there has been no concomitant increase in hospitalisations, even among vulnerable groups, which suggests that clinical severity in infected people might not be a concern.
India is fully relying on hybrid immunity arising from vaccination and natural infection for extended protection.
Fortunately, the estimated 95% of India’s populationabove 12 years possessing hybrid immunity has been shielding people from serious COVID-19 disease even when a few Omicron variants caused a spike in 2022.
Way Forward:
People, especially from vulnerable groups, carry a higher risk of infection from COVID, so they need to follow basic precautions such as wearing a mask in closed space settings when newer variants emerge.
There is a need to increase whole genome sequencing to help track the new variants that might emerge and gear the country for any major outbreak.
Hybrid immunity:
Hybrid immunity refers to the protection against a disease that results from a combination of natural immunity gained through infection and vaccination-induced immunity. E.g., A person who had previously contracted COVID-19 and then received a COVID-19 vaccine would have hybrid immunity to the virus.
Research suggests that hybrid immunity may provide better protection against certain diseases than either natural or vaccine-induced immunity alone. However, the extent of protection and the duration of hybrid immunity is an area of active research and varies depending on the specific disease and the individual's immune response.
Context: Congress leader Rahul Gandhi’s conviction and sentencing in a 2019 defamation case by a court in Gujarat has put a question mark over his continuation as a Lok Sabha MP. Experts have differing views on whether the conviction and sentencing means immediate disqualification or the Wayanad MP gets time if he appeals.
So this particular raises two issues which are extremely pertinent in Indian context:
Disqualification of elected members of the houses.
Criminal Defamation and its utility in democratic India.
So the following discussion will have two components:
Disqualification
Disqualification and Its importance
Constitutional provisions
Lily Thomas Case
Defamation
What is defamation all about?
Defamation is an exception to the Right to Freedom of Speech
Why is defamation a crime?
Why defamation should remain a criminal offence?
Disqualification and Its importance:
The disqualification procedure in India is an important mechanism for maintaining the integrity of the electoral process and ensuring that elected representatives meet certain standards of conduct and eligibility.
Under the Constitution of India, certain criteria have been laid down (See below) for the eligibility of candidates contesting elections to the Lok Sabha (lower house of parliament) and the state legislative assemblies. These criteria include age, citizenship, and lack of criminal convictions, among others. If a person is found to be ineligible based on these criteria, they can be disqualified from holding elected office.
Similarly, if an elected representative violates certain rules or engages in behavior that is deemed unethical or illegal, they can be disqualified from their position.
For example, under the Representation of the People Act, an elected representative can be disqualified for offenses such as corrupt practices, electoral malpractices, or holding an office of profit.
The disqualification procedure is important because it ensures that those who are elected to public office are held to high standards of conduct and behavior. It also helps to prevent individuals who are ineligible or have engaged in unethical or illegal activities from holding elected office and making important decisions on behalf of the people.
Overall, the disqualification procedure in India plays a crucial role in maintaining the integrity of the electoral process and ensuring that elected representatives are held accountable for their actions.
Disqualifications specified in the Constitution of India for Members of Parliament:
Disqualifications specified in the Constitution of India for Members of Legislative Assembly:
(Lily Thomas Case 2013) Immediate Disqualification of Convicted MPs and MLAs
In 2013, the Supreme Court held that charge sheeted Members of Parliament and MLAs, on conviction for offences, will be immediately disqualified from holding membership of the House without being given three months’ time for appeal, as was the case before.
The concerned Bench of the Court struck down as unconstitutional Section 8 (4) of the Representation of the People Act (1951) that allows convicted lawmakers a three-month period for filing appeal to the higher court and to get a stay of the conviction and sentence. The Bench, however, made it clear that the ruling will be prospective and those who had already filed appeals in various High Courts or the Supreme Court against their convictions would be exempt from it.
The Bench said: “A reading of the two provisions in Articles 102 and 191 of the Constitution would make it abundantly clear that Parliament is to make one law for a person to be disqualified for being chosen as, and for being, a Member of either House of Parliament or Legislative Assembly or Legislative Council of the State. Parliament thus does not have the power under Articles 102 and 191 of the Constitution to make different laws for a person to be disqualified for being chosen as a member and for a person to be disqualified for continuing as a Member of Parliament or the State Legislature.”
The Bench said: “Section 8 (4) of the Act which carves out a saving in the case of sitting members of Parliament or State Legislature from the disqualifications under the Act or which defers the date on which the disqualification will take effect in the case of a sitting member of Parliament or a State Legislature is beyond the powers conferred on Parliament by the Constitution.”
The Bench held: “Looking at the affirmative terms of Articles 102 and 191 of the Constitution, we hold that Parliament has been vested with the powers to make law laying down the same disqualifications for person to be chosen as a member of Parliament or a State Legislature and for a sitting member of a House of Parliament or a House of a State Legislature. We also hold that the provisions of Article 101 and 190 of the Constitution expressly prohibit Parliament to defer the date from which the disqualification will come into effect in case of a sitting member of Parliament or a State Legislature. Parliament, therefore, has exceeded its powers conferred by the Constitution in enacting sub-section (4) of Section 8 of the Act and accordingly sub-section (4) of Section 8 of the Act is ultra vires the Constitution.”
In order to nullify the above ruling of the Supreme Court, the Representation of the People (Second Amendment and Validation) Bill, 2013 was introduced in the Parliament. However, the Bill was later withdrawn by the Government.
BASED ON HIGH COURT OR SUPREME COURT’S ORDER
When Disqualification Continues
When Disqualification Ends
If the Higher Court on appeal stays the operation of only the execution of sentence of imprisonment passed by the trial Court >>> then such stay on the execution of sentence given by the Higher Courts will not have any effect on the person’s disqualification --- So, the disqualification continues.
Disqualification will be suspended where the Higher Court stays both the conviction and the operation of sentence.
Defamation:
So this has again brought the limelight on defamation issue.
What is defamation all about?
Defamation is an exception to the Right to Freedom of Speech
Why is defamation a crime?
Why defamation should remain a criminal offence?
What is defamation all about?
Defamation is the general term for a legal claim involving injury to one's reputation caused by a false statement of fact and includes both libel (defamation in written or fixed form) and slander (spoken defamation). The crux of a defamation claim is falsity. Truthful statements that harm another's reputation will not create liability for defamation (although they may open you up to other forms of liability if the information you publish is of a personal or highly private nature).
Defamation refers to the act of publication of defamatory content that lowers the reputation of an individual or an entity when observed through the perspective of an ordinary man. If defamation occurs in spoken words or gestures (or other such transitory form) then it is termed as slander and the same if in written or printed form is libel. Defamation in India is both a civil and a criminal offence.
Defamation is an exception to the Right to Freedom of Speech
Article 19 of the Constitution grants various freedoms to its citizens.
However, Article 19(2) has imposed reasonable exemption to freedom of speech and expression granted under Article 19(1) (a). Contempt of court, defamation and incitement to an offence are some exceptions.
Legal Provisions
Sections 499 and 500 OF IPC
Sections 499 and 500 in the IPC deal with criminal defamation. While the former defines the offence of defamation, the latter defines the punishment for it.
Section 499: Whoever, by words either spoken or intended to be read, or by signs or by visible representations, makes or publishes any imputation concerning any person intending to harm, or knowing or having reason to believe that such imputation will harm, the reputation of such person, is said, except in the cases hereinafter expected, to defame that person.
Section 500:
Whoever defames another shall be punished with simple imprisonment for a term which may extend to two years, or with fine, or with both.
Why is defamation a crime?
Reputation is an asset to each and every one. Any damage to such asset can be legally dealt with. Defamation laws have been enacted to prevent person maliciously using their right to freedom of speech and expression. The Indian law has rightly not made any distinction between libel and slander. Otherwise there could have been chances for committing slander and escaping from the laws that there is no written publication of matter.
Why defamation should remain a criminal offence?
Arguments ‘In favor’:
Income inequality
Defamation should remain a penal offence in India as the defamer may be too poor to compensate the victim in some cases.
Anonymity provided by Internet
Since there is no mechanism to censor the Internet from within, online defamation could only be adequately countered by retaining defamation as a criminal offence.
Also, criminalization of defamation is part of the state’s “compelling interest” to protect the right to dignity and good reputation of its citizens.
Changes have been made from time to time
Sections 499 and 500 have 10 exceptions.
These exceptions clearly exclude from its ambit any speech that is truthful, made in good faith and/or is for public good.
Arguments ‘Against’:
Against the global trend
Many countries worldwide are in favor of treating defamation as a civil wrong, not as a criminal offence.
Also, in 2011, the Human Rights Committee of the International Covenant on Civil and Political Rights called upon states to abolish criminal defamation, noting that it intimidates citizens and makes them shy away from exposing wrongdoing.
Misuse by “Influential”
The misuse of law as an instrument of harassment is also pervasive in India.
Often, the prosecutor’s complaint is taken at face value by courts, which send out routine notices for the appearance of defendants without any preliminary examination whether the offending comments or reports come under one of the exceptions spelt out in Section 499.
Thus, the process itself becomes the punishment.
Criminal defamation has a pernicious effect on society: for instance, the state uses it as a means to coerce the media and political opponents into adopting self-censorship and unwarranted self-restraint.
The law can also be used by groups or sections claiming to have been hurt or insulted and abuse the process by initiating multiple proceedings in different places.
Public order concerns taken care by other sections
Defamatory acts that may harm public order are covered by Sections 124, 153 and 153A, and so criminal defamation does not serve any overarching public interest. Even though Section 499 provides safeguards by means of exceptions, the threat of criminal prosecution is in itself unreasonable and excessive.
The Rehabilitation Council of India (RCI) was set up as a registered society in 1986.
Statutory status of RCI
On September 1992 the RCI Act was enacted by Parliament and it became a Statutory Body on 22 June 1993. The Act was amended by Parliament in 2000 to make it more broad-based.
to standardise syllabi and to maintain a Central Rehabilitation Register of all qualified professionals and personnel working in the field of Rehabilitation and
Special Education.
The Act also prescribes punitive action against unqualified persons delivering services to persons with disability.
What are the statutory rights of the people who need medical rehabilitation?
Service by a qualified and trained rehab professional who has been registered by the Council.
Maintenance of a certain standard of professional conduct by the rehabilitation providers. If not met, then the professionals face disciplinary action and even removal from RCI.
Guarantee that all rehabilitation professionals are under the regulation of a statutory council, which comes under the preview of the central government.
Issues associated with rehabilitation in India
Non-compliance with standards.
Limited access to assistive devices. For example, hearing aid distributors found that the current production level of hearing aids only meets 10% of the worldwide need. In developing countries, that number is reduced to 3%! Of all the people who require hearing aid in countries like India and Africa, only 3% get them. Limited access to assistive devices leads to:
Deterioration in health
Restricted activity
Constraint with Participation
Increased dependency
Reduced quality of life
Rehab centres are limited to urban areas like Chennai. This centralisation and concentration of medical rehabilitation have left tier 2 and 3 cities with inadequate access to services.
Another issue in India is the insufficient rehabilitation personnel with appropriate training and experience. The lack of proper physiatrists is a significant hurdle physical medicine and rehabilitation have to overcome.
What is the Way forward?
More investment and financing are required so that every person in the nation can get easy access to rehab facilities.
The supply and capacity of personnel need to be amplified. For this, education and training are a must; followed by recruitment and retention.
The delivery of rehabilitation services must be integrated with the current healthcare system. For example, by coordinating with a hospital in Chennai, we are able to deliver crucial help to dozens of patients each year. It ensures early intervention which leads to more recovered patients.
The last but not least step required to make the lives of those who live with disability better is assistive technology. More local manufacturing, reduction in taxes and good follow-up can make a world of difference.
Context: Lok Sabha passed the Demands for Grants for Budget 2023-24 and the Appropriation Bill by a voice vote without any discussion. Speaker applied guillotine and put demands for grants of all ministries to vote.
Guillotine in the context of Indian legislature
Discussion on a matter of general public importance can take place only when motion made with the consent of the presiding officer.
Guillotine is a type of motion which falls under the category of closure motion.
Closure Motion
It is a motion moved by a member to cut short the debate on a matter before the House. If the motion is approved by the House, debate is stopped forthwith and the matter is put to vote.
Types of closure motions
(a)Simple Closure:It is one when a member moves that the ‘matter having been sufficiently discussed be now put to vote’.
(b)Closure by Compartments:In this case, the clauses of a bill or a lengthy resolution are grouped into parts before the commencement of the debate. The debate covers the part as a whole and the entire part is put to vote.
(c)Kangaroo Closure:Under this type, only important clauses are taken up for debate and voting and the intervening clauses are skipped over and taken as passed.
(d)Guillotine Closure: It is one when the undiscussed clauses of a bill or a resolution are also put to vote along with the discussed ones due to want of time (as the time allotted for the discussion is over).
In legislative parlance, to “guillotine” means to bunch together and fast-track the passage of financial business. It is a common procedural exercise in Lok Sabha during the Budget Session.
Procedure
Parliament goes into recess of three weeks after the presentation of the budget. This recess allows Standing committees of the house to examine the demands for grants and presenting its report for the same.
After the reassembly of the Parliament , Business Advisory committee (BAC) prepares a schedule for the discussion on demands for grant , but due to paucity of time BAC picks up few selected ministries for the discussion.
Once the House is done with these debates, the Speaker applies the “guillotine”, and all outstanding demands for grants are put to vote at once. This usually happens on the last day earmarked for the discussion on the Budget. The intention is to ensure timely passage of the Finance Bill, marking the completion of the legislative exercise with regard to the Budget.
Context: WHO has released a report on Sodium intake.
Functions of Sodium
Essential nutrient involved in the maintenance of normal cellular homeostasis and in the regulation of fluid and electrolyte balance.
Crucial for maintaining extra-cellular fluid volume because of its osmotic action.
Essential for muscle and nerve cell function.
Essential for transport of nutrients through plasma membrane.
In many high-income countries, and increasingly in low- and middle-income countries, a significant proportion of sodium intake can be attributed to processed food.
Guidelines for Sodium Intake
Sodium intake is extremely unlikely in healthy individuals. The minimum intake level required for physiological needs is not well established although it is estimated to be <500 mg/day. Hence, most populations are consuming much more sodium than sodium than is physiologically necessary.
However, there adverse effects with a diet high in sodium:
Raised blood pressure.
Gastric cancer
Obesity
Meniere's disease
Osteoporosis
WHO Guidelines on Sodium Intake recommends
A reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults. WHO recommends a maximum intake of <2000 mg/day sodium (<5g/day salt) in adults.
A reduction in sodium intake to control blood pressure in children. Recommended maximum intake of <2000 mg/day sodium and (<5 g/day salt) in adults should be adjusted downward based on the energy requirements of children relative to those of adults.
Lowering sodium content in food products
Implementing front of pack labelling to help consumers select food products with lower sodium content.
Conducting mass-media campaigns to alter consumer behaviour around sodium.
Implementing public food procurement and service policies to reduce sodium content in food served or sold.
All 194 Member States of WHO have committed to reducing population sodium intake by 30% by 2025 in 2013. However, as no country in the world is on track to attain this target. WHO has proposed 30% reduction target for 2030.
WHO has documented progress to date on policies through Sodium Country Score Card. It assesses country implementation of sodium reduction policies and other measures, allocating a score from 1 (for lowest level of implementation) to 4 (for highest level of implementation).
Suggestions for reducing Sodium Intake
Maximum sodium content limits in foods: Setting of global sodium benchmarks is critical to facilitate reformulation of food products, which contributes to driving progress in sodium reduction.
Healthy public food procurement & service policies: Government should lead by example through the implementation of mandatory policies of sodium reduction that cover food and beverages purchased, subsidised, prepared, served in public agencies.
Nutrition Labelling: This tool empowers informs consumers about ingredients; nutrition content of food and influences consumers to make healthier choices and induce food manufactures to develop healthier food products. Mandatory labelling policies should also include nutrient declarations, including sodium, on the package and clear and simple interpretive front of pack labelling schemes.
Marketing restrictions: Implementing mandatory marketing restrictions is needed to limit exposure to unhealthy foods and beverages, to decrease demand for these products and to provide industry incentive to reformulate and market healthier products.
Fiscal policies: Fiscal policies to reduce population sodium intake include taxes on unhealthy foods and beverages or removing tax benefits for development and marketing of foods high in sodium. They can be strengthened by earmarking revenue for subsidies for fresh fruits and vegetables, or for implementation of other sodium reduction strategies.
Prioritisation: Action is required to increase the demand for change, drive societal shift, catalyse response and influence policy and decision makers to prioritise mandatory legislation.
Data: Regular reporting of data on sodium content in foods, and global access to such data, are needed to develop, monitor and evaluate sodium reduction policies and other measures.
The recently concluded Budget session of the Rajasthan Assembly revived the debate around the Right to Health Bill. The legislation, if passed, will provide mandatory free and affordable medical services in hospitals, clinics and laboratories — both public and privately owned. Rajasthan would be the first State government to establish and protect the legal rights of patients to access equitable healthcare services. The Bill also provides for strengthening the public healthcare system.
Fault lines have emerged around the legislation’s passage. Private hospital doctors object to the Bill citing it is hastily drafted, ignores ground realities and may tighten norms in an already over-regulated field. Civil society groups and activists, however, note that while the Bill needs clarity and could be sharpened to avoid implementation loopholes, it is an important starting point in framing healthcare as a tangible “right” for citizens.
If we look at the syllabus of GS Paper II:
Questions in Mains:
2020. In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss.
In Questions like these Rajasthan Bill can be used as a case study.
So we will:
Importance of Health in Indian Context
There are several important health statistics in India, some of which include:
Does the Constitution guarantee a right to health?
What does the Bill say?
Importance of Health in Indian Context:
Health is essential for economic development as a healthy population is more productive and can contribute to the growth of the economy. Poor health can result in increased absenteeism, reduced productivity, and higher healthcare costs, which can negatively impact the economy.
Poor health can contribute to poverty, and poverty can, in turn, lead to poor health outcomes. Access to healthcare services, clean water, and sanitation can help reduce poverty and improve health outcomes.
Health is essential for social development as it is linked to education, gender equity, and social justice. Improved health can lead to better educational outcomes, increased gender equity, and reduced social inequalities.
Health is essential for national security as it can affect the readiness of the armed forces and the ability of the country to respond to public health emergencies.
Health is a key component of sustainable development as it is linked to environmental sustainability, economic development, and social equity.
The current state of health in India is complex and multifaceted. On the one hand, there have been significant improvements in health indicators over the past few decades, such as increased life expectancy, reductions in maternal and child mortality, and improved access to healthcare services.
However, there are still several challenges that need to be addressed, including high rates of malnutrition, a high burden of communicable and non-communicable diseases, inadequate healthcare infrastructure in rural areas, and a shortage of healthcare workers.
The COVID-19 pandemic has also highlighted the need for increased investments in public health infrastructure, strengthening of healthcare systems, and preparedness for future health emergencies. While progress has been made in addressing some of these challenges, more needs to be done to ensure better health outcomes for all citizens in India.
There are several important health statistics in India, some of which include:
Life expectancy: According to the World Health Organization (WHO), the average life expectancy in India is around 69 years.
Infant mortality rate (IMR): As per the National Family Health Survey-4 (2015-16), the infant mortality rate in India is 32 per 1000 live births.
Maternal mortality rate (MMR): The maternal mortality rate in India, as per the latest estimates from the WHO, is 174 deaths per 100,000 live births.
Malnutrition: India has one of the highest rates of malnutrition in the world, with 38.4% of children under the age of five being stunted, 21% being wasted, and 35.8% being underweight, as per the Global Nutrition Report 2020. Non-communicable diseases (NCDs): NCDs are responsible for 61% of deaths in India, with cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes being the leading causes, according to the Global Burden of Disease Study 2019.
Health expenditure: According to the National Health Accounts Estimates for India 2017-18, the total health expenditure in India was 3.6% of GDP, with the government contributing 32.3% of the total expenditure.
Doctor-patient ratio: India has a doctor-patient ratio of 1:1456, as per the National Health Profile 2021.
Health insurance coverage: As per the National Health Accounts Estimates for India 2017-18, only 27% of the total health expenditure was covered by health insurance, with out-of-pocket expenditure accounting for the rest.
Does the Constitution guarantee a right to health?
The Indian Constitution does not explicitly talk about a right to health.
A “right to health”, in theory, is derived from the right to life and liberty as guaranteed under Article 21 of the Constitution.
Previously, courts have highlighted the State’s obligation to protect and promote the health of citizens, pointing to Constitutional provisions such as Article 38 (promoting the welfare of people) and Article 47 (which directs the government to meet the nutrition and health requirements of the population).
In Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996), the Supreme Court averred that it is the government’s responsibility to provide medical aid in the interest of bolstering public health.
In this regard, The current legislation tabled in Rajasthan is a welcome step.
What does the Bill say?
The Bill provides rights to patients and healthcare providers, places the obligation on the government to protect these legal rights and mandates the setting up of grievance redressal mechanisms.
The legislation will be a “progressive reduction in out-of-pocket expenditure in seeking, accessing or receiving health care” for patients, the preamble states.
Rajasthan residents will be entitled to free check-ups, drugs, diagnostics, emergency transport and care at all public health institutes, along with affordable surgeries. The Bill frames medical services as a public service rather than a vehicle for making money. If enacted, the Act will have a recurring annual expenditure of Rs. 14.5 crores.
Clause 3 of the Bill lays down 20 rights a State resident will be entitled to — including the right to informed consent, to seek information (in the form of medical records and documents) regarding diagnosis and treatment, to keep this data confidential and private and to receive treatment without discrimination based on caste, class, age, gender, among other markers.
Clause 4 of the Bill shifts the burden of responsibility in providing adequate medical services to the government.
The government is “obligated” to provide funds, set up institutions and constitute grievance redressal systems.
They must take the initiative to set up a State Health Authority and district health authorities. Beyond resolving complaints, the authorities would be tasked with planning healthcare services, monitoring services and conducting routine clinical, social and economic audits.
Moreover, the Bill also talks about the safety of healthcare providers and improving public health infrastructure.
Clause 4 mandates that the government develop a Human Resource Policy for Health ensuring the availability and equitable distribution of doctors, nurses and other healthcare workers at all levels of the system across regions.
Hence, recognizing and protecting the right to health is certainly a good step in India, as it has the potential to improve the health outcomes of millions of people in the country.
India faces several health challenges, including high rates of infectious and non-communicable diseases, inadequate healthcare infrastructure, and unequal access to healthcare services.
Recognizing the right to health can help address these issues by promoting equitable access to healthcare services, ensuring that healthcare facilities and services are of high quality and available to all, and addressing the social determinants of health such as poverty, education, and access to clean water and sanitation.
Moreover, recognizing the right to health can help strengthen India's healthcare system by making it more responsive to the needs of its citizens.
It can also help hold the government accountable for ensuring that the health needs of its citizens are met, and provide a framework for addressing health disparities and promoting health equity.
Overall, recognizing the right to health is a positive step in India, and can help improve the health outcomes of its citizens and strengthen its healthcare system.
Multilateralism refers to the coming together of three or more states, in formal or informal institutional settings, to discuss issues of mutual interest and coordinate their policies.
An example of multilateral institution is United Nations (UN) since it has universal membership. All countries, irrespective of their size and power, enjoy equal status in the form of one-country, one vote.
If such a grouping is small in size, it is best referred to as a mini-lateral or plurilateral forum.
One example of a plurilateral forum is BRICS, of which India is a member along with Brazil, Russia, China and South Africa. Another example is G20, a grouping of top 20 economies of the world based on their GDPs (at PPP). Both these are cross-regional forums. Examples of regional multilateral forums are South Asian Association for Regional Cooperation (SAARC), Gulf Cooperation Council (GCC), etc
Difference from Multi-alignment
Multi-alignment, on the other hand, refers to the policy of formation of several alliances, not necessarily military, to fulfil national interests ranging from the more tangible security and development related ones to the more intangible ideational ones.
Multi-alignment conveys a sense of engagement and participation and a strong pragmatic outlook aimed not only at a better India but also a better world.
But multilateralism cannot be completely isolated from power politics. The Bretton Woods institutions, for instance, with their contribution-based quotas and weighted voting are standing edifices of realpolitik. Normatively, multilateralism is a counter to unilateralism.
Challenges to Multilateralism
Dominance of West: The postcolonial backlash against the predominance of the West and the rising tide of populism have been profoundly eroding the liberal values underpinning the multilateral system
Crisis in UN: The UN and its manifold agencies have been losing their lustre, criticised for their lack of efficiency, institutional sclerosis and ideological infighting.
Trade Talks: The WTO has failed to conclude the negotiations of the Doha Agenda started in 2001, as bilateralism and protectionism are resurging worldwide, and its dispute settlement system has stalled
Climate: Multilateral efforts to address climate change have made symbolic progress at best.
Digital Space: The governance of the internet is forfeiting its initial aspiration of a borderless knowledge society as a few private companies are hoarding data exponentially and authoritarian states are misusing it as a tool of surveillance and repression.
Rise of Nationalistic politics: Seen in global as well emerging powers. Example: BREXIT or withdrawal of UK from the EU marks a dent to the spirit of multilateralism. The powerful nations are challenging the multilateral world order.
Changing Geopolitics: Rise of China, concretization of Russia China axis, SCO etc. has made West conscious of preserving its hegemony. West sees China as a challenger to US led world order and does not seem to cooperate with China and Russia. At the same time, China and Russia try to counter the west. This competition has led to erosion of spirit of cooperation and collaboration, hurting multilateralism.
Why is it difficult to Reform
Multilateralism is deeply entrenched in global power politics. As a result, any action in reforming multilateral institutions and frameworks automatically transforms into a move that seeks changes in the current distribution of power.
The status quo powers see multilateral reforms as a zero-sum game. For instance, in the context of the Bretton Woods system, the U.S. and Europe believed reform would reduce their influence and dominance. This makes decisions about reform in these institutions, by consensus or voting, hard.
Multilateralism appears at odds with the realities of the emerging multiplex global order. The emerging order seems more multipolar and multi-centred. Such a situation facilitates the formation of new clubs, concerts and coalitions of the like-minded, which makes the reform of older institutions and frameworks more challenging.
What G20 and India can do
G-20 should first focus on setting proper narratives of multilateral reform. G-20 may constitute an engagement group dedicated to bring the narrative to the forefront of global discourse. India should also urge the upcoming chairs of the grouping, Brazil and South Africa, to place multilateral reforms as their presidential priorities
It should be acknowledged that limitations of multilateral cooperation. Competing interests and the dominance of powerful states are there to stay in multilateral platforms. Therefore, while supporting multilateral cooperation, G-20 should continue encouraging mini lateral groupings as a new form of multilateralism and try to transform them into multi-stakeholder partnerships
Creating networks of issue-based mini laterals, particularly in areas related to the governance of the global commons will be helpful in preventing competitive coalitions where other actors play the same game to their advantage, leading to a more fragmented world order.
The group needs to be more inclusive without sacrificing efficiency. For example, including the African Union as a permanent member and the UN Secretary-General and General Assembly President as permanent invitees would be helpful to enhance its legitimacy.
G-20 should put all its efforts into solving one or two pressing global issues and showcase it as the model of new multilateralism. Food, fuel and fertilizer security can be one such issue. On the one hand, it falls under the ‘low politics’ of world politics, so cooperation is more achievable.
INDIA’s STRATEGY OF REFORMING MULTILATERALISM
India’s strategy for reformed multilateralism rests on 5S pillars which includes
1. Samman (Respect)
2. Samvad (Dialogue)
3. Sahyog (Cooperation)
4. Shanti (Peace)
5. Samriddhi (Prosperity)
Moreover, India has to engage with regional groupings in stronger ways though China has a pre-eminent position in the architecture of these organisations. Interdependence in the economy cannot be overlooked, especially for an emerging state like India.
India must continue to pursue institutionalisation of multilateral frameworks irrespective of regional conflicts. On such occasions, one has to look at the possibility of strengthening neighbourhood multilateral frameworks (such as SARRC
India needs to build multilateral trade blocs/economic groupings involving its South Asian neighbours along with Indian Ocean neighbours, while rejuvenating organisations such as BIMSTEC and IOR-ARC.
Thus India should not allow a “recession for multilateralism” in its diplomatic vision as it can be concluded that the multilateral system is merely undergoing a profound mutation and one that might even end up making it more effective and better adapted to the realities of the 21st century.
