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Public healthcare in India: Need to move from ‘biggest’ to ‘finest’ – Comment

Healthcare in India today is tale of two groups. The first group is the wealthy and upper middle-class who receive their healthcare primarily from private sector providers. Overall, that healthcare is of good quality and easily accessible but can be expensive.



Picture Credit : HealthSpace.Asia

India’s public healthcare system is sick. In late September, Prime Minister Narendra Modi’s administration launched Ayushman Bharat, meaning Long Life India, to address this illness.

This initiative, which has been described as the “world’s biggest healthcare programme” will insure more than 500 million Indian citizens who currently have no coverage. Will “Modicare”, as the programme has been labeled, cure what ails India’s public health care system?

The answer is maybe. That answer must be equivocal because of the enormity of India’s healthcare needs, concerns regarding the adequacy of funding to address those needs, and uncertainty regarding Modicare’s implementation.

Healthcare in India today is tale of two groups. The first group is the wealthy and upper middle-class who receive their healthcare primarily from private sector providers. Overall, that healthcare is of good quality and easily accessible but can be expensive.

The second group is the lower middle-class and the poor who receive their healthcare primarily from public sector providers. Overall, that healthcare is of poor quality, difficult to access and the money spent on it is insubstantial.

In 2015, India’s public expenditure on public healthcare was approximately one per cent of its GDP. This compares quite unfavorably to other countries who provide some form of universal healthcare coverage. For example, Singapore expended 2.2 per cent of its GDP, South Korea expended 4.2 per cent and the United States expended 8.5 per cent.

India’s small expenditures are reflected in its healthcare performance. Some of the deficiencies of the current system are:

* The per capita insurance expenditure on healthcare is one of the lowest in the world. Over 75 per cent of Indians have no health insurance.

* Because the states carry the primary burden for healthcare coverage, there is a significant difference in the scope and nature of that coverage across the country.

* There is a huge rural-urban disparity in terms of the quantity and quality of coverage.

* Compared to the rest of the world, India has an average number of doctors but they attend to only one third of the Indian population.

* The lack of adequate insurance coverage and availability of public sector health care causes Indians to have to cover more than 60 per cent of their expenses personally.

Ayushman Bharat is structured to address these conditions. It provides poor families insurance of up to $6,950 (nearly Rs 500,000) for hospitalisation, calls for the establishment of 150,000 health and wellness centres to provide primary care throughout India and emphasises holistic healthcare ideas such as yoga as part of this intervention.

The programme will expand the public health network far beyond the existing governmental hospitals. It will pay public and private sector facilities a fixed rate for covered services. To date, 15,000 hospitals have applied to be certified providers.

This appears to be a solid framework for launching this new initiative. The government has appropriated $1.5 billion for Modicare health insurance for 2018-19 and 2019-20. Of this, $300 million is allocated for the first year of the programme.

This seems like a lot of money. But, $1.5 billion divided by 500 million covered lives means this is only $3,000 per individual — a very modest amount.

The total allocation also seems insufficient when unknowns are considered: What percentage of the-newly insured will take advantage of their coverage in year one? Who provides payment when an insured individual or family exceeds it coverage? To what extent will private sector providers deliver their services at fixed rates to public sector patients, if they can get full payment from more affluent clients?

Another problem is the issue of implementation and roll-out. The new scheme looks good on paper. But establishing 150,000 health and wellness centres is much easier said than done. This is especially true given that doing this will require extensive collaboration and coordination with India’s 29 states and seven Union Territories which have varying levels of capacity and competence.

In sum, this is not a negative or pessimistic perspective on India’s new healthcare programme, but a realistic one. Modicare represents a beginning and an initial step that must be taken to bring India’s healthcare system into the 21st century.

Some have criticised the introduction of this new programme as a political stunt designed to influence the results of the national elections to be held in 2019. Regardless of why it was done, this action was essential given the sad and sorry state of India’s current public healthcare system.

The challenge and opportunity is to continue to move the healthcare ball up the field. The goal for whomever becomes the next Prime Minister should be to make India’s healthcare programme not only the “world’s biggest” but also among its finest. Accomplishing this will help to move India from a developing to a developed nation and bring it closer to becoming a full-fledged world leader.

Frank F. Islam

(Frank F. Islam is an entrepreneur, civic and thought leader based in Washington, D.C. The views expressed are personal. He can be contacted at [email protected])


YouTube testing new video recommendation format: Report



San Francisco, Jan 16 : Google-owned video sharing platform YouTube is testing a new video recommendation format that displays blue bubbles on the screen with relevant keywords and related topic suggestions, facilitating easier browsing, media reported.

“The screenshots obtained show these blue bubbles just underneath the video player showing more specific video recommendations,” The Verge reported on Tuesday.

The video-sharing platform is currently testing the feature with some users on its main desktop page as well as on the mobile app.

For sometime now users have been complaining that the videos recommended on the side on YouTube’s interface often have little to do with the current video, making recommendations a point of contention for the platform.

“It’s unclear if the videos that populate from the new recommendation bubbles will face similar algorithmic issues that YouTube’s recommendation feed currently suffers,” the report added.

There has not been any word from YouTube as of now on the working of these blue bubbles and whether or not they will roll out the test feature to a bigger group in the coming months.

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2002 Gujarat riots: Judge P.B. Desai ignored evidence, says activist Harsh Mander



Harsh Mander

New Delhi, Jan 9 : Special SIT court judge P.B. Desai “ignored evidence” that former Congress MP Ehsan Jafri, who was killed in a mob attack in Ahmedabad’s Gulberg Housing Society during the 2002 riots, did all that was possible within his power to protect Muslims from the “rage of the mob” and instead echoed the position of then Chief Minister Narendra Modi that his killing was only a “reaction” to his “action” of shooting at the mob, says human rights activist Harsh Mander.

He says that “the learned judge”, who retired in December 2017, overlooked statements by surviving witnesses that Jafri made repeated desperate calls to senior police officers and other persons in authority, “including allegedly Chief Minister Modi”, pleading that security forces be sent to “disperse the crowd” and rescue those “against whom the mob had laid a powerful siege”.

Mander, who quit the IAS in Gujarat in the wake of the riots, makes these observations in his just released book, “Partitions of the Heart: Unmaking the Idea of India”, published by Penguin.

The 66-year-old activist, who works with survivors of mass violence and hunger as well as homeless persons and street children, goes on to quote the late journalist Kuldip Nayar to establish that Jafri had desperately telephoned him, “begging him to contact someone in authority to send in the police or the Army to rescue them”.

Mander says Nayar rang up the Union Home Ministry to convey to it the seriousness of the situation. The Home Ministry said it was in touch with the state government and was “watching” the situation. Jafri called again, pleading with Nayar to do something as the mob was threatening to lynch him.

In the chapter titled “Whatever happened in Gulberg Society?”, Mander contends that Jafri did everything within his power to protect “those who believed that his influence would shield them from the rage of the mob”. Mander says Jafri begged the mob to “take his life instead” and in a show of valour went out “to plead and negotiate” with the angry crowd.

“When he realised that no one in authority would come in for their protection, he also did pick up his licensed firearm and shoot at the crowd…,” Mander notes, describing it as the “final vain bid” on behalf of Jafri to protect the Muslims in the line of fire.

The author notes that in describing Jafri’s final resort to firing as an illegitimate action, the judge only echoed the position taken repeatedly by Modi, who had given an interview to a newspaper in which he had said that it was Jafri who had first fired at the mob.

“He forgot to say what a citizen is expected to do when a menacing mob, which has already slaughtered many, approaches him and the police has deliberately not responded to his pleas,” says Mander.

He says that it was as if even when under attack and surrounded by an armed mob warning to slaughter them, “and with acid bombs and burning rags flung at them”, a good Muslim victim should do nothing except plead, and this would ensure their safety.

Ehsan Jafri’s wife Zakia Jafri, according to Mander, was firmly convinced that her husband was killed because of a conspiracy that went right to the top of the state administration, beginning with Modi. The author notes that the court, in its judgement running into more than 1,300 pages, disagreed.

“It did indict 11 people for the murder but they were just foot soldiers,” observed Mander.

He further says that the story the survivors told the judge over prolonged hearings was consistent but Judge Desai was convinced that there was “no conspiracy behind the slaughter” and that the administration did all it could to control it.

“Jafri, by the judge’s reckoning, and that of Modi, was responsible for his own slaughter,” he laments.

Mander also argues in the book that recurring episodes of communal violence in Ahmedabad had altered the city’s demography, dividing it into Hindu and Muslim areas and Gulberg was among the last remaining “Muslim” settlements in the “Hindu” section of the city.

He says that Desai also disregarded the evidence in the conversations secretly taped by Tehelka reporters, mentioning that superior courts, according to Desai himself, have ruled that while a person cannot be convicted exclusively based on the evidence collected in such “sting operations”, such evidence is certainly “admissible as corroborative proof”.

“But he chose to disregard this evidence, not because there was proof that these video recordings were in any way doctored or false but simply because the Special Investigative Team (SIT) appointed by the Supreme Court of India chose to ignore this evidence,” says Mander.

According to Mander, the Tehelka recordings “certainly supported the theory that there was indeed a plan to collect, incite and arm the mob to undertake the gruesome slaughter”.

The SIT was headed by R.K. Raghavan, today Ambassador to Cyprus. Mander contends in the book that just because the investigators did not pursue Tehelka recordings in greater depth, Desai concluded that the “recordings cannot be relied upon as trustworthy of substantial evidence and establish any conspiracy herein”.

In the book, Mander takes stock of whether India has upheld the values it had set out to achieve and offers painful, unsparing insight into the contours of violence. The book is now available both online and in bookstores.

(Saket Suman can be contacted at [email protected])

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Number of suicides highest in Army amongst three services

In the Air Force, the number of suspected suicides was 21 in 2017 and 19 in 2016. For the Navy, these numbers were 5 and 6 for 2017 and 2016, respectively.



Ajit Doval

New Delhi, Jan 7 : The number of defence personnel committing suicide was highest in the Army amongst the three services in the last three years, data shows.

In 2018 alone, as many as 80 Army personnel are believed to have committed suicide. This number is 16 for Air Force and 08 for the Navy, Minister of State (MoS) for Defence Subhash Bhamre told the Rajya Sabha in a written reply on Monday.

In 2017, the number of Army men who are suspected to have committed suicide was 75, while in 2016 this number was 104.

In the Air Force, the number of suspected suicides was 21 in 2017 and 19 in 2016. For the Navy, these numbers were 5 and 6 for 2017 and 2016, respectively.

In his reply, the Minister said that various steps have been taken by the armed forces to create healthy environment for their officers and other ranks.

“Some of the steps include provision of better facilities such as clothing, food, married accommodation, travel facilities, schooling, recreation etc and periodic welfare meetings, promoting yoga and meditation as a tool for stress management, and training and deployment of psychological counsellors,” the reply read.

It said mental health awareness is provided during pre-induction training.

Besides, institutionalisation of projects “MILAP” and “SAHYOG” by the Army in Northern and Eastern Commands to reduce stress among troops has been done.

A helpline has also been established by the Army and the Air Force to provide professional counselling.


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