ias-toppers-healthcare-in-india
Editorial Notes

Editorial Notes 21st December 2016

India’s Healthcare System; Triple disease burden; Three essential principles necessary to build successful health systems; Trade ties between India and Bangladesh; Teesta River Water Dispute.
By IT's Editorial Notes Team
December 21, 2016

 

GS (M) Paper-2: “Bilateral, regional and global groupings and agreements involving India and/or affecting India’s interests”

 

India and Bangladesh need to bring the Teesta out of muddled waters

Introduction:

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  • India and Bangladesh have failed to arrive at an agreement over sharing of waters of the river Teesta.
  • Even in 2011, during former Prime Minister Manmohan Singh’s visit to Bangladesh, the two nations were set to sign a water-sharing pact, but at that time West Bengal chief minister Mamata Banerjee objected to the formula agreed upon.
  • In the draft, the two sides had agreed on a 50-50 water sharing ratio during lean season.

Why West Bengal government opposed it?

  • To Mamata Banerjee, this was against the interests of her state.
  • Since the Teesta originates in Sikkim and flows through West Bengal before entering Bangladesh, the consent of the state government is essential.
  • Even the Constitution places water under the state list. When negotiations couldn’t break the impasse, the issue remained pending.

Trade ties between India and Bangladesh:

  • In spite of the steady growth in India-Bangladesh ties in the past few years, the non-resolution of Teesta waters has been a sore point.
  • The trade and economic relationship is booming.
  • India has given duty-free access to all products made in Bangladesh and provided $3 billion as economic aid to its neighbour for development of infrastructure.
  • During Sheikh Hasina’s visit, the two countries were expected to sign a raft of agreements on a wide range of issues including infrastructure-development, trade and investment and military cooperation.
  • All these positives couldn’t move forward as the non-resolution of the Teesta issue continues to attract attention in the popular discourse and is a cause for much heart-burn in Bangladesh.

About Teesta River:

  • The Teesta River originates from the Pahunri glacier above 7,068 metres and flows southward through Sikkim and West Bengal to merge with the Brahmaputra in Assam and (Jamuna in Bangladesh) before going to Bay of Bengal through Bangladesh.
  • It carves out from the verdant Himalayas in temperate and tropical river valleys and forms the border between Sikkim and West Bengal.
  • It flows through the cities of Rangpo, Jalpaiguri and Kalimpong and joins the Jamuna (Brahmaputra) in Bangladesh.
  • Its left-hand tributaries include Dik Chhu, Rangpo River, Lang Lang Chu, Lachung River, Rani Khola. The right-hand tributaries include Ranghap Chhu, Rangeet, Ringyong Chhu.

Importance of Teesta River:

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  • Water is an emotive issue in Bangladesh as the people’s lives revolves around rivers.
  • The Teesta is a major source of sustenance for India and Bangladesh as agriculture has evolved in the catchment areas of the river in both the countries.
  • To support agriculture, the two nations have constructed barrages: In India at Gozaldoba and in Bangladesh at Dalia.
  • Bangladesh has been complaining that it doesn’t get enough water during lean season as the barrage upstream in Gozaldoba draws water unilaterally leaving very little for Bangladesh.
  • Besides, riparian concerns (relating to the natural course of a river) have also made Bangladesh pitch for a viable agreement, since dams are being constructed upstream in Sikkim. They fear that this might alter the Teesta’s flow further.
  • In the context of India-Bangaldesh ties, the issue becomes even more sensitive.

Historical reasons for the heightened sensitiveness:

  • To begin with, Bangladesh perceives India to be harbouring a Big Brother syndrome.
  • Secondly, its experience with the Farraka barrage (which allegedly caused water shortage downstream, a charge India denies) further deepens Bangladesh’s apprehensions.
  • Finally, its relationship with India has been fodder for much political chest-beating in that country.
  • The Opposition accuses Sheikh Hasina of being pro-India and often overlooking the interests of Bangladesh.
  • The non-signing of the Teesta is considered her failure. In Bangladesh, every bilateral visit with India is measured on a strict barometer of gains and losses, and the signing of the Teesta pact has itself become a benchmark.
  • Besides, Hasina has been facing criticism for the growing radicalisation in the country. With the elections likely to be held in 2019, the resolution of the Teesta issue is crucial for her to thwart further criticism.
  • One hopes the two countries recognise each other’s limitations and work for a win-win solution.
[Ref: Hindustan Times]

 

GS (M) Paper-2: “Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.”

 

Reforming healthcare in India

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Triple disease burden faced by India:

  • Maternal & child health
  • Infectious diseases
  • Non-communicable diseases

Annual spending on healthcare in India:

  • Over Rs.6 trillion for 1.3 billion population

Factors preventing India’s healthcare system from delivering world-class services?

  • India’s tax-based funding of healthcare is far too low and barely supports a government-owned health system which is almost exclusively focused on basic maternal and child health.
  • Health insurance covers less than 5% of total health expenditure.
  • The formal private network is a minuscule component of India’s health sector and is focused on secondary and tertiary care for urban India.

Result of such unplanned health expenditure:

  • 60% of healthcare expenditure in India is incurred by individuals whenever they seek care.
  • Money is spent on seeking healthcare services from several informal providers and on purchasing large quantities of irrational medicines directly from pharmacies.
  • India’s largely unorganized healthcare sector is focused on curing sick people rather than preventing sickness itself.

Free-market solutions to work in healthcare:

  • Unlike other expenses, those on healthcare tend to have a high degree of variability and are most often
  • Humans also have an innate tendency to not even think about health until they get sick.
  • People don’t buy health insurance, but are prepared to spend heavily on hospitals, while almost completely avoiding expenses on primary care and early diagnosis to treat incipient conditions.
  • This is compounded by the fact that an average individual is not even aware of his/her health status and is completely dependent on the doctor or surgeon for medical advice.

Three essential principles necessary to build successful health systems:

  • Pre-payment with pooling – Either higher taxation levels can be used or mandatory purchase of some health insurance is required.
  • Example- Britain is a largely tax-financed health system while Germany is reliant on mandatory health insurance. Japan mandates citizens to enrol with one of its several insurers for universal coverage. The money thus collected is then aggregated into large pools which are able to absorb the high level of variability of health expenditure.
  • Concentrated purchasers with organized providers– Pools when managed by one or more large agencies discipline both providers & consumers. There is also distinction between purchaser & provider of healthcare.
  • Example- Britain uses public trusts, Germany sickness funds, Japan uses multiple insurers and Thailand adopts a single national health security office which buys only from primary care-led integrated providers.
  • Government’s role as an active shaper and steward of the entire health system- active role in designing and supervising the entire health system, instead of focusing only on the management of a health system owned by itself.
  • Example-Leading health systems, such as Thailand and the privately-owned Kaiser Permanente in the US, have gone one step further and now require providers to share the risk of the ill-health of the customer, thus ensuring that providers become sharply focused on customers’ well-being and continued good health.

How can this type of effective health system be achieved?

  • In the 1960s, countries such as Thailand, Brazil and South Korea had health statistics similar to or worse than India’s in 2010, but transformed the status quo over four decades.
  • In India, each state represents a different social, economic, and cultural environment, and will need a customized approach towards its health systems’ redesign.
  • The global experience has shown that using the core design principles will reform the healthcare system without relying on the free markets.
[Ref: LiveMint]

 

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