- Medical education needs continuous reforms; the National Medical Commission Bill could be the first step towards this
Relevance: mains: G.S paper II & G.S paper III
Over the past few days, there have been expressions of concern in various fora over a few clauses of the National Medical Commission (NMC) Bill, now enacted. Even medical professionals have protested. According to media reports, there are five primary concerns. These pertain to the National Eligibility-cum-Entrance Test (NEET)/National Exit Test, empowering of community health providers for limited practice, regulating fees for only 50% seats in private colleges, reducing the number of elected representatives in the Commission, and the overriding powers of the Centre.
On examinations
First, a focus on the examinations. For the past few years, a separate NEET is being conducted for undergraduate and postgraduate courses. In addition there are different examinations for institutes such as the All India Institute of Medical Sciences and the Jawaharlal Institute of Postgraduate Medical Education and Research. This Act consolidates multiple exams at the undergraduate level with a single NEET and in turn avoids multiple counselling processes. NEXT will act as the final year MBBS examination across India, an entrance test to the postgraduate level, and as a licentiate exam before doctors can practise. It aims to reduce disparities in the skill sets of doctors graduating from different institutions. It would also be a single licentiate exam for graduates across the world. Thus, the government has in effect implemented a ‘One-Nation-One-Exam’ in medical education.
Second, concerns have been expressed over the limited licence to practise for community health providers. We have to appreciate that even with about 70% of India’s population residing in the rural areas, the present ratio of doctors in urban and rural areas is 3.8:1; 27,000 doctors serve about 650,000 villages of the country. A recent study by the World Health Organisation shows that nearly 80% of allopathic doctors in the rural areas are without a medical qualification. The NMC Act attempts to address this gap by effectively utilising modern medicine professionals, other than doctors in enabling primary and preventive health care. Evidence from China, Thailand and the United Kingdom shows such integration results in better health outcomes. Chhattisgarh and Assam have also experimented with community health workers. Further, the Act requires them to “…qualify such criteria as may be specified….” thereby ensuring quality.
Fee structure
The next issue relates to the capping of fees. It is an open secret today that private medical colleges are capitation fee-driven, resort to a discretionary management quota and often have charges of corruption levelled against them. The Indian Medical Council Act, 1956 has no provision for fee regulation. Until now, ‘not-for-profit’ organisations were permitted to set up medical colleges, a process involving enormous investments and a negotiation of cumbersome procedures. The NMC Act removes the discretionary quota by using a transparent fee structure. It empowers the NMC to frame guidelines for determination of not only fees but all other charges in 50% of seats in private colleges to support poor and meritorious students.
It would be simplistic to assume that a rise in unethical practices in this profession is solely the result of private medical education. While a cap on fees is necessary, there is also a need for incentives to attract private investors. In any case, the transparency that NEXT provides would lead to fee regulation through market forces. The Act also provides for rating of colleges. Thus, reducing entry barriers for setting up medical colleges, along with their rating, is expected to benefit students. They would be able to make an informed decision before seeking admission.
The next issue is of representation in the NMC. A report of the then vice-chancellor, NITI Aayog, on reforms in medical education says: “The current electoral process of appointing regulators is inherently saddled with compromises and attracts professionals who may not be best suited for the task at hand. Indeed, there is ample evidence that the process has failed to bring the best in the field in regulatory roles. The process is based on what is now widely regarded as a flawed principle whereby the regulated elect the regulators.” The Act, therefore, provides for a transparent search and selection process with an eclectic mix of elected and nominated representatives, both in the search committee and the commission itself. The government has further addressed the concern of preponderance of selected members in the commission by adding members from State medical councils and universities.
Finally, we need to view the issue of overriding powers of the Centre in the context that the Medical Council of India, even if directed by the government on critical matters, may not always pay heed. In public emergencies, citizens expect the government to address issues. In the current set-up, it may not be possible all the time. Also, the government should be able to give directions so that NMC regulations align with its policy. Hence, these powers. The use of such authority would follow the principle of natural justice: the NMC’s opinion would be sought before giving directions.
In a nutshell
While some sections of people have sought to create a negative perception about select clauses of the Act, they have not highlighted other features. The Act establishes the Diplomate of National Board’s equivalence to NMC-recognised degrees — a long-pending demand. It also promotes medical pluralism. Then, there is a paradigm shift in the regulatory philosophy from an input-based, entry barrier for education providers without corresponding benefits, to its becoming outcome-focused. Both the number of doctors and their skill sets are expected to improve. Autonomy to boards and segregation of their functions will avoid a conflict of interest and reduce rent-seeking opportunities. And ‘quacks’ are liable to face imprisonment or be fined or both. The Act ends inspector raj.
The efforts of successive governments have now culminated with the NMC Act replacing the IMC Act. There is no denying that medical education needs continuous reforms in order to usher in improvements in health care. There cannot be just one solution. The NMC Act is a serious attempt to meet the primary need of more medical professionals in the country; it is a beginning.
(Source: The Hindu)
- Law and justice:
Relevance: mains: G.S paper II: Indian Polity
Instead of a separate law on triple talaq, Centre should have framed a just law for all
The intention of the Triple Talaq bill was to bring Muslim women into the gamut of secular family laws, which are applicable to all other women from all religions in India. However, the current Act is a far cry from such an objective.
The Muslim Women (Protection of Rights on Marriage) Bill 2019, now a law, has been hailed as a victory for gender justice by Law Minister Ravi Shankar Prasad and other supporters of the Bill. The question is: Will this law really provide justice to Muslim women? To answer it, we need to inspect the Bill’s content as well as the intention with which it has been brought in.
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The issue of triple talaq is definitely real in India. For decades, many Muslim women activists have been engaged in a struggle to change discriminatory family laws. The agenda had been holistic, covering not only one form of talaq but traditions like halala and polygamy and demanding a more comprehensive “gender just law”. The intention was to bring Muslim women into the gamut of secular family laws, which are applicable to all other women from all religions in India. However, the current Act is a far cry from such an objective.
The Bill has many flaws. Its first provision says: “Any pronouncement of talaq by a Muslim husband upon his wife, by words either spoken or written or in electronic form or in any other manner whatsoever shall be void and illegal.” In fact, such a practice had already been declared unconstitutional by the Supreme Court in its judgment on August 21, 2017. The SC had sought legislation in support of its judgment and the law would have been sufficient with just this one section. However, the government has included unwarranted criminal provisions in the Bill.
The next provision talks about punishment of the husband with imprisonment up to three years and a fine. This is, in itself, a contradiction. If triple talaq has no legal validity (by virtue of the SC verdict), how can you punish it? Also, the personal laws of all communities are civil matters. This is the first time that criminal provisions are being laid out in matters of marriage and divorce.
The next provision talks about the husband providing a subsistence allowance. How can a jailed person provide money? Further, the woman in a case of triple talaq, will receive no support from her in-laws, since she will be seen as being responsible for putting her husband in jail.
There are existing laws which protect Hindu women and those from other communities in cases of domestic violence. Instead of this new law, in case a husband insists on triple talaq by unlawful means, he could have been booked under the Protection of Women from Domestic Violence Act. A common gender-just law could be a solution, rather than separate religion-specific laws. The BJP has batted for a common civil code since decades. Ironically, when the time came, they opted for a sharia-based law.
Currently, there is a sense of apprehension in the Muslim community, given the backdrop of mob lynching and the talk by political leaders of imposing the National Register of Citizens not only in the Northeast but across the country. The fear is that the triple talaq law will be used as a tool to harass men from the community.
The way in which the Bill was passed in the Rajya Sabha is also a concern. Many members who opposed it in the debate helped the BJP by remaining absent during voting. This was irresponsible and shows apathy towards issues concerning Muslims.
This law will only serve the political purpose of the BJP. Affected Muslim women will continue to suffer. In fact, the law will add to their suffering.
(Source: The Indian Express)
- The great growth story of China awaits a modern-age epilogue
Relevance: mains: G.S paper II: International Relation
Most mental models about the Chinese economy are quite understandably based on the spectacular transformation of that country over the past four decades, from a miserably poor country to a powerhouse that could challenge American dominance of the global system. It is a record with no parallel in history.
The development model was something like this. China recorded high rates of economic growth, saved nearly half its national income, relentlessly focused on capital accumulation, powered an export engine to overcome a limited domestic market, welcomed foreign direct investment, plugged into global supply chains and kept its public finances more or less in order.
It also gamed the multilateral trading system to capture markets as well as absorb new technology that would raise productivity, which means that the grand American gamble in the 1990s to get China into the international economic system so that it would eventually become a liberal capitalist economy has failed. The ongoing trade war is a belated recognition that the gambit has not worked.
China was a free trader in theory, but mercantilist in practice. The journey was obviously not without bumps in the road—including episodes of inflation and financial fragility. The overall record is of staggering success, which even its worst critics cannot deny. However, there are now growing signs that the China of the immediate future will not resemble the China of the immediate past.
A new report by the International Monetary Fund (IMF) on the Chinese economy was released last week. It makes for interesting reading. Much of the analytical focus of the report is obviously on the current challenges faced by the second largest economy in the world. The view ahead is also important. Here are four big transitions that Indian policy makers should focus on.
First, it is well known that China is in the midst of a secular slowdown. The days of sustained double-digit growth are over. The IMF says that the Chinese economy will be expanding at 5.5% by 2024. A forthcoming working paper by M. Zhu, L. Zhang and D. Peng estimates that Chinese economic growth will slow to 4% by 2030. Some private sector economists say that China could end up growing at half that rate if the strategic squeeze being applied by the US right now is successful.
Second, the drivers of Chinese economic growth are rapidly changing. Domestic consumption is becoming more important in the growth mix while domestic investment is losing ground. The external trade story is likely to change dramatically, with China slipping into a minor current account deficit by 2024. In other words, the excess of domestic savings over domestic investment will disappear. China will continue to have a trade surplus in industrial goods, but that will be cancelled by a growing trade deficit in services.
Third, China is battling financial fragility. The effect of successive credit expansions to keep economic growth on target after the 2008 financial crisis is now showing. The IMF says that true fiscal deficit is now around 11% of gross domestic product, if off-balance-sheet borrowing for investment is taken into account. The credit splurge means that important parts of the Chinese economy are over-leveraged—the government, the corporate sector and households. There have also been episodes of large capital outflows from China, although these have moderated of late.
Fourth, there is already mounting evidence that Chinese manufacturing is moving up the global value chain. The widespread belief that China is still trapped in the lower end of the manufacturing value chain is not quite true. Hiau Looi Kee of the World Bank and Heiwai Tang of the University of Hong Kong have shown in their recent work based on enterprise data that China has expanded its domestic base in the intermediate input sectors, leading to an increase in domestic value addition in exports. The IMF notes that the share of hi-tech in China’s industrial value added was 43% in 2015, comparable to richer countries such as Belgium and Spain.
These are just four illustrative examples to show that China is in the midst of a profound change in its economic model. Such transformations are rarely smooth. The tiger economies of East Asia had to undergo gut wrenching pain during the 1997 Asian financial crisis before they could change direction. The difference is that they were minnows in the global economy compared to what China is today.
China has so far beaten back at least a decade of forecasts about its imminent collapse. So what it does over the next few years matters a lot. This is where the trade war with the US comes in. The US sees this as an opportunity to push back a country that is likely to emerge as its main geopolitical rival. The trade war is actually not about trade alone, but issues such as intellectual property protections, the foreign investment regime, dominance of newer technologies such as Artificial Intelligence, cyber security and much more.
It is an opening salvo in a deeper geostrategic battle. The question is: How does India take advantage?
(Source: LiveMint)
- Biodiversity in the time of deluge
Relevance: mains: G.S paper III: Environment
As it weathers repeated floods, Kerala needs to take steps to protect its fragile ecology
In mid-August 2018, Kerala experienced severe floods and is still struggling to deal with their devastating impact. It is a matter of deep concern that, a year later, the State is facing a similar situation. This only shows that there is a considerable human-induced natural imbalance in the State, making it vulnerable to the vagaries of climate change.
Such floods impact the poorest strata of the society the most, causing a loss of lives, livelihood options and assets. They also place an enormous burden on the government in terms of reconstruction budgets. In this context, a broader assessment of floods from a ‘sustainable development’ perspective, by limiting economic growth options to within the carrying capacity of the ecosystem, is the need of the hour.
True, the root cause of such floods, not only in Kerala but elsewhere, is the high precipitation levels. However, one cannot discount the role of anthropogenic factors like unscientific development and over-exploitation of nature in aggravating the damages.
Impact of climate change
In recent decades, the global climate has been changing in an unpredictable manner. As per an IPCC report, the Global Green House Gases emissions grew by 70% between 1970 and 2004. Global warming has had critical effects on the hydrological cycle and water is the primary medium through which the climate change impacts trickle down to the people.
The changing precipitation alters the hydrological systems, resulting in floods and droughts in different regions. With the certainty that climate change is already impacting most countries, there is no option but to take adequate precautions through dam management and timely public alerts.
In the case of Kerala, a structural transformation and changing patterns of land use are affecting its environment. Agriculture is becoming insignificant (11.3% of State GDP) and services (63.1%) and industry (25.6%) sectors dominate the State’s economy. Further, a high population density — as per the 2011 census, it was 860 persons per sq. km, much higher than the Indian average of 382 — the shift from a joint family system to a single-family one and a greater inflow of money, particularly from Gulf countries, has resulted in an increased construction of luxurious houses and resorts.
The government, on its part, has also been developing extensive infrastructure to support the booming services and industry sectors.
Speaking of construction, it is important to take the appropriate decision on the type and size of the structure, its location, materials it proposes to use, and permissible damages it will cause to the nature. One cannot just replicate the Gulf model of construction in Kerala’s fragile and ecologically sensitive landscapes. Land transactions suggest that people in the State have bought land from farmers over the decades not for cultivation, but for construction. If this trend continues, vast tracts of paddy fields and other low-lying places will get converted to plots or buildings. A loss in wetland area will naturally impact the State’s ability to handle floods.
People fail to account for the damage done to natural ecosystems while estimating losses suffered due to natural disasters. Floods also wash away top soil and substantial biodiversity of the area, resulting in a reduced river-water flow, death of earthworms and spread of viral and bacterial diseases among crops. There is, at present, a lack of clarity on how best these natural assets could be restored. However, the urgency to devise suitable corrective measures has never been greater.
(Source: The Hindu)