The Hindu Editorial Analysis | 14th August’19 | PDF Download

Deliberate, don’t disrupt

• Legislators could do well by adhering to a model code of conduct
• One of the most unedifying sights in public life is lawmakers taking to organised disruption of legislative business. Such displays became common in Parliament in the past decade as political parties and legislators demonstratively advertised their points of view without recourse to debate. A number of crucial bills have taken an inordinate time to be enacted due to disruption, while others were not enacted despite a broad consensus — such as the Women’s Reservation Bill — due to the behaviour of a few naysayers. Many sessions of Parliament in the recent past saw little business being done due to repeated disruption. In this context, Vice President Venkaiah Naidu’s exhortation to political parties to incorporate a model code of conduct for their legislators in State Assemblies and in Parliament is welcome. He suggested that the code should include stipulations on members not entering the well of the House, and desisting from sloganeering and unruly acts. If indeed parties adopt a code, it will go a long way in making parliamentary work meaningful. Otherwise, the general public will lose interest in the procedural aspects of parliamentary democracy and limit their participation to just voting in the elections.
• But the absence of disruption alone does not make for meaningful debate. The current Budget session sailed through with minimal disruption. Yet the high productivity during the session came without sufficient deliberation over crucial bills, several of which were rushed through without vetting by parliamentary standing and select committees. These committees have in the past been useful in expanding discussion over laws with civil society and experts from various streams of the larger society. They have also facilitated an enhanced cross-party coordination over issues. By not sending a single Bill among the 28 that were introduced and passed to a standing or select committee for scrutiny, the current session accentuated the trend that has minimized the importance of such committees over the last few years.
• Unlike the 15th Lok Sabha (2009-2014), when 71% of the bills were referred to such committees, in the 16th Lok Sabha, they constituted only a fourth of the overall number of bills. Time spent on debates in the current session in both the Lok Sabha and Rajya Sabha was barely a third of the overall business. This does not augur well for lawmaking. As Mr. Naidu has also pointed out correctly, deliberation is an important component of parliamentary democracy apart from legislation and accountability of lawmakers. All three aspects must cohere for a thoroughgoing procedural democracy.

War within war

• As the Saudi-led coalition crumbles, Yemen needs a nationwide ceasefire
• The Saudi-led coalition’s intervention in Yemen is proof of how things can go wrong with an ill-conceived, poorly strategized and geopoliticsdriven military interference that cares little about human lives. After four years of war, the Saudis have not met their declared goal — pushing back the Shia Houthi rebels from the capital Sana’a and restoring the ousted government which is now temporarily headquartered in the southern city of Aden. On the contrary, the war has pushed Yemen into what the UN calls the worst humanitarian crisis. Thousands have been killed, tens of thousands displaced and about two thirds of the country’s 28 million people do not have enough to eat. And now, there is a rebellion within the coalition. Last week, the Southern Transitional Council (STC), a militia group that was fighting the Houthis as part of the Saudi-led coalition, turned against their masters and captured the presidential palace in Aden as well as the city’s main port. In return, Saudi jets targeted STC fighters before a tenuous ceasefire set in.
• It now looks like a three-way conflict. The Shia Houthis, who the Saudis claim are backed by Iran, are controlling much of the country’s north including Sana’a. Yemen’s internationally-backed government of Abdrabbuh Mansur Hadi, the Saudi ally, is controlling the south, though Mr. Hadi is running the purported administration from Saudi Arabia. The STC wants the south to be an independent entity, like it was till the Yemeni unification in 1990.
• The STC’s rebellion also signals the growing friction in the multi-national coalition Saudi Arabia has stitched together to fight the Houthis. The STC is backed by the UAE, a crucial partner of Saudi Arabia in its foreign policy adventures. They stayed together in propping up the military dictatorship of Abdel Fattah el-Sisi in Egypt, in countering the spread and influence of the Muslim Brotherhood in the Arab world, in opposing the Iran nuclear deal and on blockading Qatar. But when it comes to Yemen, the Saudis see the Hadi government and Sunni Islamic parties, including the Islah, as allies who could stabilise and rebuild the whole country after the Houthis are defeated, while the UAE, already frustrated by the coalition’s failure to defeat the rebels, counts on the STC and is staunchly opposed to the Islah party, which has ties to the Brotherhood. The UAE has already pulled out of the Yemen war leaving it to Saudi Arabia to defeat the Houthis. And with their continued backing to the STC, the Emiratis appear less concerned about defeating the Houthis than maintaining their influence in southern Yemen. This should be a moment of reckoning for Mohammed bin Salman, the Saudi Arabian Crown Prince and the main architect of the Yemen intervention. He has lost the war and his coalition is crumbling, while Yemen is left with unimaginable human suffering. It is time for a nationwide ceasefire and talks with all stakeholders under the mediation of a willing UN to find a political settlement to the crisis.
• 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

1. National eligibility-cumentrance test (NEET)/national exit test,
2. Empowering of community health providers for limited practice,
3. Regulating fees for only 50% seats in private colleges,
4. Reducing the number of elected representatives in the commission, and the
5. 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 practice. 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 utilizing 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.
• 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.

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