Daily Mains Newsletter For UPSC
| RaghukulCS

21 May 2021


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Mains Analysis

Topic No

Topic Name



The fault line of poor health infrastructure

The Hindu


They are still hungry

Indian Express

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Centre asks WhatsApp to withdraw privacy policy update

Syllabus–GS 2: Health, Governance

Analysis: –

  • It is on the shoulders of these frontline workers that the bulk of the burden of fighting this pandemic falls. Doctors put themselves in harm’s way to help their patients.
  • The Indian Medical Association released its latest list on Thursday, stating that 329 doctors succumbed to the COVID-19 infection.
  • This is probably a conservative figure, but an occasion to record the lives and work of these people, sometimes until the very last breath they drew.
  • Anas Mujahid, 26, died on May 9 within hours of being admitted to the very hospital he was serving in.
  • The young doctor, a junior resident at Delhi’s Guru Tegh Bahadur (GBT) Hospital, a designated COVID-19 hospital, lost his battle to the disease. The doctor was reporting to duty till Saturday (a day before he passed away).
  • A medical officer of the Primary Health Centre (PHC) at Anuppanadi in Madurai, 32-year-old Dr.Shanmugapriya continued to work in the midst of the raging pandemic.
  • “She sought maternity leave when she was seven months pregnant but it was not sanctioned, citing the increase in the number of patients with COVID-19.
  • She texted me that there was a regular flow of patients with COVID-19 symptoms to the PHC,” he said.

China builds key highway through Brahmaputra Canyon in Tibet close to Arunachal Pradesh border

Syllabus -GS 2: IR

Analysis: –

  • China has completed the construction of a strategic highway through the Brahmaputra Canyon, stated to be the world’s deepest, close to the Arunachal Pradesh border ahead of its plan to build a mega-dam over the gorge.
  • Construction of a highway costing $310 million passing through the YarlungZangbo Grand Canyon, known as the world’s deepest gorge with a maximum depth of 6,009 meters, was completed on Saturdaylast, state-run Xinhua news agency reported.

Mains Analysis

The fault line of poor health infrastructure

Why in News?

In the second COVID-19 wave there have been several shortcomings in the health system of our country which have been exposed by it.

Syllabus–GS 2: Health

  • We are all, unfortunately, seeing very clearly the devastating second wave of the Covid-19 tragedy and its impact on health care systems of the nation and the ripple effects this can have on virtually all other aspects of life.
  • This unprecedented crisis has highlighted how India remains badly placed to tackle the rapid spread ofthe second wave ofcoronavirusdespite several reforms and increase investments in the healthcare sector.
  • Moreover, the significant inefficiency, dysfunction, and acute shortage of the healthcare delivery systems are leading people to struggle to save their lives.
  • More than 80 percent of the population still does not have any significant health insurance coverage and about 68 percent of the population has limited or no access to essential medicines.
  • The low level of public spending on health is the main cause for the poor quality, limited reach, and insufficient public provisioning of healthcare.

India’s worsening Situation: –

  • With 5.5 hospital beds per 10,000 population and 8.6 physicians per 10,000, the country’s healthcare sector is not equipped for such a crisis.
  • The number of beds per 10,000 is used as an indicator of health infrastructure in general and the poor bed availability points to India’s failure to expand its health infrastructure in keeping with the growth in population.
  • India, which is the world’s biggest vaccine maker, expanded its inoculation program to include everyone above the age of 45 to be inoculated.
  • But so far it has vaccinated only about one in 25 people compared with nearly one in two in Britain and one in three in the United States.

Concerns: –

  • The poor state of health can be understood by the data of World Bank on Health systems across the world.
  • World Bank data reveal that India had 85.7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan),
  • It had 53 beds per 1,00,000 people (in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan)
  • 7 nurses and midwives per 1,00,000 people (in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan)

 Stagnant expenditure

  • Current situation is a direct result of the low public health expenditure.
  • According to Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that this has been stagnant for years: 1% of GDP 2013-14 and 1.28% in 2017-18.
  • Health is a State subject in India and State spending constitutes 68.6% of all the government health expenditure.
  • Because the Center is the key player as major bodies like ICMR etc are under its control so the onus lies on centre.

 Inter-State variation

  • The interactive graphic shows the inter-State variation in per capita health-care expenditure in 21 major States and how this has changed from 2010-11 to 2019-20. Kerala and Delhi have been close to the top in all the years.
  • Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in all years, are struggling to cope with the pandemic.
  • Odisha is noteworthy as it had the same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh. This is reflected in its relatively good COVID-19 management.
  • India has among the highest out-of-pocket (OOP) expenditures of all countries in the world.
  • The World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
  • Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha have a high ratio of OOP expenditures in total health expenditure.
  • Thus, the most vulnerable sections, are the worst victims of a health emergency.

Government’s role critical

  • The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
  • Centre controls major decisions of health , including additional resources raised specifically for pandemic relief, PM CARES Fund.
  • Data by CEDA shows that first round of vaccination was biased as it showed Inter state disparity, which was neither explained by the case load nor by the share of eligible (45+) population.
  • Centre can bargain vaccines for a good price from vaccine manufacturers in its capacity as a single large buyer and benefit from the economies of scale in transportation of vaccines into the country.
  • These could be distributed across States equitably in a needs-based and transparent manner.
  • Distribution of constrained resources (medical supplies, financial resources) can internalise the existing disparities in health infrastructure across States.
  • Author argues that decentralized management exacerbates the inter state inequalities as the richer states can compete better in procuring resources.

Following suggestions would help tackle pandemic properly:

  • Pandemic Preparedness Unit” (PPU) by the central government, which would streamline disease surveillance and reporting systems;
  • coordinating public health management and policy responses across all levels of government;
  • formulating policies to mitigate economic and social costs,

Way Forward: –

  • We all must acknowledge that the second wave is real and adopt a revised control strategywith strict compliance to Covid -19 protocols in every possible way.
  • If these measures are not taken, the number of cases will continue to rise, and many lives will be lost.
  • Poor people are at higher risk of death because they cannot access and/or afford advanced care to save their lives.
  • In short, failure to act decisively now will have a doubly deadly impact on the millions of impoverished persons in India.

Question: –

The central government needs to deploy all available resources to support the health and livelihood expenses of COVID-19-ravaged families immediately. After this wave, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States. Comment.

They are still hungry

Why in News?

For millions, still suffering from the after-effects of the first Covid wave, ‘dal-chawal’ is the oxygen needed to survive.

Syllabus–GS2: Issues related to Poverty & Hunger.

  • The first wave of the pandemic was proof that Indian villages — comprising more than half of the country’s population — are not really part of development agendas, and even in times of crisis they come last, after the needs of the big cities have been attended to.
  • Farmers are merely seen as providers of our food, and distressed farmers as migrant workers or labour in our factories, buildings and homes.
  • A recently released report shows us the way. ‘State of Working India 2021: One year of Covid-19’, a report released by the Centre for Sustainable Employment at the Azim Premji University packs some robust lessons that we can use in handling the second wave.
  • A team of economists, led by Professor Amit Basole, has mined through data from the regular Consumer Pyramid Survey of the Centre for Monitoring Indian Economy (CMIE) and other studies to provide a glimpse of how the first wave affected lives and livelihood.

Challenges: –

  1. First, rumours of economic recovery are premature. Just as we should have been cautious in celebrating our victory over the coronavirus, we need to take claims of V-shaped recovery with a fistful of salt. Employment and income did bounce back somewhat by year end. But of the 10 crore workers rendered unemployed by the last lockdown, 1.5 crore were still out of job in December 2020.
  2. Second, informal economy continues to be the real Indian economy. While much of our discussion on economy focuses on the formal, organised sector — corporates, IT, big industry — it was the informal sector — daily wage labourers, hawker-vendors, petty business, farming — that came to our rescue. The 2020 lockdown forced nearly half of regular salaried workers to move into self-employment, irregular salaried jobs or casual wage labour.
  3. Third, obsession with supply-side economics must give way to focus on demand. Most of the claims about economic recovery are based on figures of GST collection, freight movement, electricity generation and production of some goods. But an economic recovery would need consumers for these goods. That is where the real challenge lies.

Way Forward: –

  • With increasing supply, daily wages are decreasing & at the same time there is lack of work in the market.
  • As 2nd wave enters rural India, it’s already late for preparedness & resource equipment.
  • When major cities failed to tackle the resource scarcity, the already disadvantaged villages kept a gloomy future & mammoth crisis before the nation.
  • Another dimension of the crisis is the missing picture of hardships that are facing by the Disabled, LGBTQIA & Sex workers community who lack
  • Access to a nutritious diet to counter the effect of the medicine.
  • For most 2nd wave is about ventilators & oxygen to keep people alive but for many getting access to basic medicines can be lifesaving & access to simple food is no lesser than access to oxygen.

Questions: –

The second wave is a “top-up” crisis. With millions of families already in deep distress due to the first wave, we must look beyond the issue of oxygen and pay attention to abject hunger among the millions of people in the country. Critically evaluate.

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