9 September 2024 : The Hindu Editorial Analysis

1. Policy paralysis, a weakened public health sector

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – Social Justice – Health

Context

The article critiques India’s public health policies over the last decade, highlighting a shift from strengthening public sector healthcare to prioritising publicly funded health insurance schemes like Ayushman Bharat. This shift, favouring private healthcare providers, has weakened primary health institutions and failed to adequately address the healthcare needs of the vulnerable population.

Public Health Needs and Policies

• Public health needs are diverse and differ across social strata. Policies are formulated by the government based on available resources to address these needs.
• Health needs are either felt (experienced by the population) or projected (identified by experts).
• Recent public health policies in India, especially in the last decade, have been critiqued for failing to address these needs, particularly after the introduction of the Pradhan Mantri Jan Arogya Yojana (PMJAY).

Felt Needs in Public Health

1. Diseases of Poverty:
   • The poor and vulnerable face diseases like tuberculosis, malaria, and undernutrition.
   • Preventive measures for these diseases are essential but also challenging due to their impact on livelihoods.
2. Middle Class and Upper-Class Issues:
   • Environmental concerns such as pollution (air, water), waste management, and lack of proper infrastructure.
   • Rise in chronic illnesses, traffic accidents, and climate change further exacerbate the health needs of this group.
3. Curative Care:
   • Curative care remains the most controversial and critical aspect of public health policy.
   • The poor rely on public sector institutions like primary health centres (PHCs) for affordable care.
   • Secondary-level care has historically been neglected, and tertiary care is currently addressed by PMJAY.

Public Health Policies in the Last Decade

• National Rural Health Mission (NRHM) (2005) and National Health Mission (NHM) (2013) were instrumental in reviving India’s public healthcare system.
• These policies focused on strengthening primary health care, fostering trust in public sector health institutions, and improving infrastructure.
• However, the momentum was not sustained, and the government has since shifted focus to health insurance schemes like PMJAY under Ayushman Bharat, implemented from 2018.

Publicly Funded Health Insurance Schemes (PFHI)

• The primary focus has shifted to PFHI schemes, such as PMJAY, which mainly benefit private health care providers.
• Issues with PFHI:
  • The scheme only covers hospitalisation expenses, not outpatient care, which is a deviation from global health insurance norms.
  • Outsourcing secondary and tertiary care to the private sector demonstrates the government’s lack of intention to strengthen the public health infrastructure.
  • The majority of the population, not covered by government schemes, is left to rely on expensive, commercialised private healthcare.

Weakening of Public Sector Health Care

1. Private Sector Dominance:
   • Private hospitals have monopolised healthcare services, offering market-rate treatments under the guise of government schemes.
   • This practice has further weakened public sector healthcare, especially secondary- and tertiary-level services.
2. Transformation of Public Health Centers:
   • In 2018, sub-centers, PHCs, and community health centres (CHCs) were transformed into Health and Wellness Centers (HWCs).
   • These HWCs are now portrayed as new institutions, despite similar facilities already existing, as per 2015 data.
   • The initiative to place community health officers with minimal training at these centres undermines their original purpose, reducing them to minimal curative care providers.
   • Trust in public healthcare is deteriorating due to inadequate curative care and overstretched infrastructure.

Challenges Facing the Public Health System

• The public health challenges in India are immense, with felt needs often going unaddressed.
  • For the poor, basic primary- and secondary-level care is essential.
  • Historically, institutions like PHCs provided these services and preventive measures, but their weakening has created a gap in healthcare delivery.
• Loss of Trust:
  • The private sector’s commercial interests and the public sector’s overcrowded facilities have led to a loss of trust in healthcare providers.
  • The failure to strengthen secondary and tertiary healthcare in the public sector has further exacerbated this issue.

Conclusion

• Primary healthcare institutions, once the cornerstone of India’s public health system, have been weakened by turning them into curative care centres without acknowledging their original purpose in preventive care.
• This has resulted in a major threat to the future of India’s public health system, as the basic needs of the vulnerable population remain unaddressed.

PYQ: Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? (200 words/12.5m) (UPSC CSE (M) GS-2 2015)

Practice Question:  Critically analyse the shift in India’s public health policy from strengthening public sector healthcare to prioritising publicly funded health insurance schemes like Ayushman Bharat. How has this shift impacted the accessibility and quality of healthcare for the vulnerable population? (250 Words /15 marks)

2. With or without Chinese companies is the question

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – International Relations, GS3 – Indian Economy

Context

The Indian government aims to transform the country into a global manufacturing hub through initiatives like ‘Make in India’ and the PLI scheme. However, Chinese smartphone companies have dominated the market, benefiting from these initiatives despite geopolitical tensions, while India’s domestic manufacturing sector faces infrastructure and supply chain challenges.

Government’s Manufacturing Vision

• The central government remains confident about his agenda to transform India into a global manufacturing hub, despite the coalition status of the government after the 2024 general election.
• The ‘Make in India’ initiative, launched in 2014, and the Production Linked Incentive (PLI) scheme are key parts of this transformation plan to attract domestic and foreign capital.
• The 2024-25 Union Budget supports this vision, with a significant boost to the PLI scheme for large-scale electronics manufacturing, increasing its allocation to ₹6,125 crore from ₹4,499 crore in the 2023-24 Budget.
• A focus on research and development in the electronics and IT sectors is evident, with an allocation of ₹1,148 crore, up from ₹600 crore in the previous year.

Chinese Companies and the ‘Make in India’ Initiative

• Chinese smartphone companies have been major beneficiaries of the ‘Make in India’ initiative, dominating the Indian market despite political tensions between India and China.
• According to the International Data Corporation, four of the top five smartphone brands in India by the end of 2023 were Chinese, with a combined market share of over 50%.
• The widespread use of Android smartphones, which hold about 70% market share, has helped these companies thrive in India.
• Chinese companies have used strategies such as aggressive marketing, customer segmentation, celebrity endorsements, and sponsorships of popular culture to build a strong presence in India.
• Even after the 2020 Galwan Valley clash and the Indian government’s push to boycott Chinese products, these companies have managed to adapt and continue operations in India.

Government’s Efforts to ‘Indianise’ Manufacturing

• The Indian government has introduced measures to Indianise Chinese companies’ operations, such as involving Indian equity partners, appointing Indian executives, partnering with Indian manufacturers for production, and expanding exports from India.
• This strategy mirrors how China developed its own domestic manufacturers before expanding operations globally.
• Tata Electronics’ entry into smartphone manufacturing, with its acquisition of Taiwanese supplier Wistron’s India operations and ongoing negotiations to acquire Pegatron, is an example of Indianisation in the sector.

Challenges in Indianising the Smartphone Sector

• Despite government efforts, Chinese smartphone companies have been cautious but have begun complying with Indian directives, such as partnering with local distributors and manufacturers to benefit from the PLI scheme.
• However, India’s goal of creating a robust local supplier network faces challenges.
• The country lacks ancillary industries, technological clusters, uninterrupted power and water supply, and suitable working conditions for large-scale manufacturing.
• Chinese companies are also hesitant to share technology without clearer terms regarding equity participation in India.

Ground Realities and Policy Challenges

• India’s Ministry of Electronics and Information Technology and Ministry of Commerce and Industry have been working to ease visa norms for Chinese technicians, indicating the difficulty in managing both Indian and Chinese companies’ operations.
• The Economic Survey, released before the Union Budget, advocates promoting Foreign Direct Investment (FDI) from China, despite earlier moves toward a China Plus One strategy for diversification.
• The government faces the challenge of balancing the development of home-grown manufacturing players while allowing continued Chinese investments to meet its manufacturing goals.

Conclusion

• While India strives to become a global manufacturing hub through initiatives like ‘Make in India’ and PLI, challenges such as inadequate infrastructure, dependency on foreign expertise, and competition from Chinese companies continue to hinder significant progress in the sector.

PYQ: Faster economic growth requires increased share of the manufacturing sector in GDP, particularly of MSMEs. Comment on the present policies of the Government in this regard. (150 words/10m) (UPSC CSE (M) GS-3 2023)

Practice Question:  Discuss the key challenges facing India in becoming a global manufacturing hub, despite initiatives like ‘Make in India’ and the Production Linked Incentive (PLI) scheme. How do infrastructure limitations and foreign competition affect India’s manufacturing ambitions? (250 Words /15 marks)