12 September 2024 : The Hindu Editorial Analysis
1. Perils of decentralisation with Chinese characteristics
(Source – The Hindu, International Edition – Page No. – 8)
| Topic: GS2 – Indian Polity |
| Context |
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Introduction
- The Prime Minister of India, in his Independence Day speech, urged Indian states to compete for attracting investors.
- Contrastingly, China’s extreme subnational economic competition has reached its limit, with decentralisation turning counter-productive.
Decentralisation in China
- In China, 51% of government spending occurs at sub-provincial levels, unlike in India, where local governments account for less than 3%.
- Local governments in China hold responsibility for unemployment insurance and pensions, typically managed by the national government in India.
- Despite decentralisation, China is not a federal country, as local powers can be dissolved by the central government.
Issues With Decentralisation in China
- High Subnational Spending: Local governments account for 51% of total government spending, responsible for areas like unemployment insurance and pensions.
- Economic Growth Focus: Local governments prioritise industrial development to boost regional economic growth, often at the cost of public services.
- Land Use Incentives: Local authorities offer discounted industrial land to attract investors, creating regional competition for economic expansion.
- Overcapacity and Wasteful Investment: The focus on industrial growth has led to structural overcapacity, where excess production outstrips demand, resulting in wasteful investments and loss-making industries.
- Lack of Fiscal Autonomy: Post the 1994 Tax-Sharing Reform, local governments lost significant revenue-raising powers, leading to financial struggles and dependence on central government transfers.
- Centralised Control: Although highly decentralised in fiscal matters, China lacks constitutional protection for local powers, with the central government retaining ultimate control over local governance.
- Geopolitical and Market Pressures: China’s decentralised model of export-oriented growth is now facing challenges due to geopolitical tensions and shrinking international demand.
Learnings for India
- Balanced Decentralisation: India can focus on a balanced decentralisation model, ensuring local governments have sufficient autonomy without undermining central oversight.
- Fiscal Reforms: Strengthening local fiscal capacity through transparent revenue-sharing mechanisms can empower local bodies and reduce over-dependence on state and central grants.
- Avoid Overcapacity: India should avoid overemphasis on industrial growth at the expense of public services, ensuring that local development is sustainable and balanced.
- Policy Flexibility: Allowing regional experimentation with policy solutions, while setting broad central guidelines, can promote innovation without leading to inefficiencies.
- Focus on Services: India should ensure that local governments prioritise essential public services alongside industrial development to ensure inclusive growth.
| PYQ: Assess the importance of the Panchayat system in India as a part of local government. Apart from government grants, what sources the Panchayats can look out for financing developmental projects. (250 words/15m) (UPSC CSE (M) GS-2 2018) |
| Practice Question: Discuss the challenges associated with decentralisation in China. What lessons can India learn to improve its own decentralisation efforts? (150 Words /10 marks) |
2. India’s sickle cell challenge
(Source – The Hindu, International Edition – Page No. – 9)
| Topic: GS2 – Social Justice – Health |
| Context |
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National Sickle Cell Anaemia Elimination Mission
- In 2023, Prime Minister Narendra Modi launched the National Sickle Cell Anaemia Elimination Mission with a goal to eliminate sickle cell disease as a public health issue by 2047.
- Sickle cell disease is prevalent in tribal regions of India, particularly across Odisha, Jharkhand, Chhattisgarh, Madhya Pradesh, and Maharashtra.
| Sickle Cell Anaemia |
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Challenges in India
- Burden of Disease: India has the second-highest burden of sickle cell disease worldwide, with over a million affected people.
- Genetic Abnormality: The disease is inherited when both parents carry the sickle cell trait. Patients have crescent-shaped red blood cells, leading to severe health complications and shortened lifespans.
- Social Stigma: Patients face significant social stigma, with misconceptions like the disease being linked to curses or black magic. This stigma leads to diminished marital and social prospects.
- Treatment Access: Despite government initiatives, only 18% of sickle cell patients receive consistent treatment. Patients drop out at various stages of the healthcare process—screening, diagnosis, treatment initiation, and adherence.
Challenges in Diagnosis and Treatment
- Diagnostic Gaps: Many patients do not seek diagnosis due to the stigma or rely on traditional healers who often misdiagnose the condition. Tribal communities, in particular, have historically mistrusted the public health system, further hampering diagnosis rates.
- Treatment Adherence: No permanent cure exists for sickle cell disease, and adherence to treatments like hydroxyurea is poor due to inconsistent medicine availability and long distances patients must travel for care. Vaccinations to reduce complications are also poorly covered.
The Way Ahead
- Addressing Stigma: Reducing stigma is critical to improving healthcare access. Targeted media campaigns, similar to successful polio and HIV campaigns, can help raise awareness and bust myths about sickle cell disease.
- Increasing Screening: Expanding newborn screening in endemic areas can lead to early detection and intervention, reducing the long-term burden of the disease.
- Improving Treatment Access: Drugs like hydroxyurea must be made more accessible, and treatment adherence support should be strengthened at local health and wellness centres. Patients should not have to travel long distances for basic care.
- Vaccination Coverage: Vaccination programs that help reduce infection rates and improve quality of life must be expanded to ensure all sickle cell patients receive the necessary immunizations.
- Tailored Healthcare in Tribal Areas: Health services in tribal regions should be enhanced to address the unique challenges these areas face, including increased funding and operational capacity.
- Research and Development: More research is needed to understand sickle cell disease in India and develop new treatments. Philanthropic and civil society involvement can play a crucial role in supporting government efforts to combat the disease.
Conclusion
- The National Sickle Cell Anaemia Elimination Mission holds great promise in addressing India’s significant sickle cell disease burden.
- By reducing stigma, improving early detection, ensuring treatment adherence, expanding vaccination coverage, and strengthening healthcare infrastructure in tribal areas, the Mission can make significant strides toward eliminating this debilitating disease by 2047.
| Practice Question: Discuss the challenges in addressing sickle cell disease in India, particularly among tribal populations. How can the National Sickle Cell Anaemia Elimination Mission contribute to eliminating the disease by 2047? (250 Words /15 marks) |
