QUESTION : What lessons can be learnt by India’s healthcare sector during the time of covid-19 pandemic and suggestive ways to strengthen this ? Discuss.
Public Health Emergency
WHY IN NEWS ?
Much of Europe is witnessing a menacing second wave of COVID-19, which is seemingly worse than the first.
2nd WAVE OF COVID-19 AND CHALLENGES AHEAD :
- Desensitised Public: Living with the pandemic for months together has had a desensitising effect on the collective psyche.
- Reduced Urgency: Owing to such ‘desensitisation’, disasters that are not sudden and striking – like the second wave of COVID-19 pandemic- tend to be minimised.
- Impacting Disaster Management Framework: Unfortunately, the above two has characterised and thus weakened India’s disaster management framework in dealing with many pressing public health issues.
INDIA’S DISASTER MANAGEMENT FRAMEWORK :
- In 2005, India enacted the Disaster Management Act(DMA), which laid an institutional framework for managing disasters across the country
- What hitherto comprised largely of reactive, ad hoc measures applied in the event of a disaster, was to be replaced under the Act with a systematic scheme for prevention, mitigation, and responding to disasters of all kinds.
- Disaster management considerations were to be incorporated into every aspect of development and the activities of different sectors, including health.
- The Disaster Management Act is one of the few laws invoked since the early days of COVID-19 to further a range of measures — from imposing lockdowns to price control of masks and medical services.
- Concerns with respect to Disaster Management Framework: While some headway has indeed been achieved with the enactment of Act, the approach continues to be largely reactive, under-emphasizing of Public Health concern and presence of significant gaps in terms of medical preparedness for disasters.
Experience of using DMA during Pandemic and lessons learnt
DRAWBACKS IN PVT. SECTOR :
- Weak regulations: The Indian private sector is characterised by weak regulation and poor organisation.
It is incapable for mounting a strong and coordinated response to disasters.
A large majority of private hospitals in the country are small enterprises which cannot meet the inclusion criteria for insurance.
- Overcharging by hospitals: It illustrates how requisitioning of private sector services during disasters can hardly be a dependable option in the Indian context.
This is important since the future development of hospital care services is being envisaged chiefly under publicly financed health insurance, which would very likely be private-sector led.
- Business interests: They are generally averse to infectious diseases and critical cases with unpredictable profiles.
Disaster preparedness does not make a strong “business case” for hospitals, which prefer to invest in more profitable areas.
- Lesson Learnt: Strong public sector capacities are therefore imperative for dealing with disasters. There is a strong case for introducing a legal mandate to strengthen public sector capacities via disaster legislation
WEAKNESS IN DMA :
- DMA fails to identify progressive events (which nevertheless cause substantial damage, often more than sudden catastrophes) as disasters, thus neglecting pressing public health issues such as tuberculosis and recurrent dengue outbreaks
- Had they been identified as disasters, they would have attracted stronger action in terms of prevention, preparedness, and response
- Inadequate Integration with primary care: Primary care stands for things such as multi-sectoral action, community engagement, disease surveillance, and essential health-care provision, all of which are central to disaster management. This area of disaster management, especially relevant for low-income setting, has been overlooked.
WAY FORWARD :
- Medical preparedness for disasters
- Strong public sector capacities are therefore imperative for dealing with disasters.
- Integration of disaster management with primary care
- Synergies with the National Health Mission:
- The National Health Mission espouses a greater role for the community and local bodies
While the novel coronavirus pandemic has waned both in objective severity and subjective seriousness, valuable messages and lessons lie scattered around. It is for us to not lose sight and pick them up.
QUESTION : Write important functions of the Finance Commission? Discuss the terms of reference of the 15th finance commission and various apprehensions about it.
15 Finance Commission Report on State Finances
WHY IN NEWS ?
Fifteenth Finance Commission submitted its report with recommendations on the formula for sharing the divisible pool of tax revenues between the Centre and States for the next 5 years to the President.
ABOUT 15TH FC :
- The 15th Finance Commission was constituted by the President of India under the chairmanship of NK Singh.
The term of the commission was originally set to end in October 2019 but was extended to November 30, 2019.
- Its recommendations will cover a period of five years from April 2021 to March 2026.
FUNCTIONS OF FC :
- The Commission makes recommendations to the President of India on the distribution of tax proceeds between the Union and the States and the share of each state.
- The Commission also decides the principles that govern the payment of grants-in-aid to states from the Consolidated Fund of India.
- The President of India can also refer any other matter to the Finance Commission in the interest of building a sound financial system
CONSTITUTIONAL PROVISIONS :
Several provisions to bridge the fiscal gap between the Centre and the States were already enshrined in the Constitution of India, including Article 268, which facilitates levy of duties by the Centre but equips the States to collect and retain the same.
ARTICLE 280 of the Indian Constitution defines the scope of the commission:
- The President will constitute a finance commission within two years from the commencement of the Constitution and thereafter at the end of every fifth year or earlier, as the deemed necessary by him/her, which shall include a chairman and four other members.
- Parliament may by law determine the requisite qualifications for appointment as members of the commission and the procedure of selection.
- The commission is constituted to make recommendations to the president about the distribution of the net proceeds of taxes between the Union and States and also the allocation of the same among the States themselves. It is also under the ambit of the finance commission to define the financial relations between the Union and the States. They also deal with the devolution of unplanned revenue resources.
WHY NEED THE FINANCE COMMISSION ?
- As a federal nation, India suffers from both vertical and horizontal fiscal imbalances.
- Vertical imbalances between the central and state governments result from states incurring expenditures disproportionate to their sources of revenue, in the process of fulfilling their responsibilities.
- However, states are better able to gauge the needs and concerns of their inhabitants and therefore more efficient at addressing them.
- Horizontal imbalances among state governments result from differing historical backgrounds or resource endowments and can widen over time.
- The first FC was established in 1951 by Dr B.R. Ambedkar, the then-incumbent law minister, to address these imbalances.
- The 15th Finance Commission said it had taken the unique requirements of each State on board and come up with State-specific considerations in its report, which was submitted to President Ram Nath Kovind .
- Apart from its main recommendation on devolution of funds between the Centre and the States for the period 2021-22 to 2025-26, the Commission addressed all its unique terms of reference, such as considering a new non-lapsable fund for financing national security and defence spending and offering performance incentives to the States that deliver on reforms
- Apart from the main report, uniquely titled Finance Commission in Covid Times, the 15th Finance Commission presented two volumes as part of its submissions.
- The first one focuses on the state of the Centre’s finances, with an in-depth scrutiny of the key departments, the medium-term challenges facing the Centre and a road map for the future.
- The other volume is dedicated to the States, with the finances of each analysed in great depth.
- The panel has come up with State-specific considerations to address the key challenges that individual States face, as per a statement issued by the Commission after a meeting with the President.
- Commission chairman N.K. Singh was accompanied by members Ajay Narayan Jha, Anoop Singh, Ashok Lahiri and Ramesh Chand for the report’s submission to the President. The report is expected to be presented to Prime Minister Narendra Modi soon, and will be available in the public domain once it is tabled in Parliament along with an action taken report on its recommendations.
- The Commission was asked to give its recommendations on many unique and wide-ranging issues in its terms of reference. Apart from the vertical and horizontal tax devolution, local government grants, disaster management grant, the Commission was also asked to examine whether a separate mechanism for funding of defence and internal security ought to be set up and if so how such a mechanism could be operationalised.
- Though its original remit was to make recommendations for the period 2020-21 to 2024-2025, the Commission has submitted an interim report for 2020-21 last year, stressing that it was difficult to make projections for five years when the economy is slowing down after structural reforms like the GST and the insolvency code. The interim report had reduced the States’ share in the divisible pool of taxes from 42% to 41% for the current year, after the dissolution of Jammu and Kashmir as a State
- The need of the hour is to address the concerns of stakeholders and evolve principles that lead to an equitable distribution of resources between states and between centre and states