The Hindu Editorial Analysis | 19th Feb’20

Table of Contents

Powering the health-care engine with innovation

It has been close to 18 months since the Prime Minister, Narendra Modi, launched the country-wide implementation of Ayushman BharatPradhan Mantri Jan Arogya Yojana (PM-JAY), or the national health protection scheme; the initial momentum has been very encouraging.
The scheme is currently being implemented in 32 of 36 States and Union Territories.
It has provided 84 lakh free treatments to poor and vulnerable patients for secondary and tertiary ailments at 22,000 empanelled hospitals, countrywide.
Under PM-JAY, there is one free treatment every three seconds and two beneficiaries verified every second.
As the scale of this scheme grows, a key area of focus is to expand the secondary and tertiary hospitals empanelled under PM-JAY and ensure their quality and capacity while keeping the costs down.
At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
In the coming years, considering 3% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
This means physical and human infrastructure capacity would need to be augmented vastly.
Conservative estimates suggest the we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.

Transformative solutions

The entrepreneurial spirit of India
Systematic push for the development of a start-up ecosystem
It is estimated that there are more than 4,000 health-care technology start-ups in India.
Start-ups are working to bring innovative technologies and business models that leapfrog infrastructure, human resources, cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings
Tele-ICU platforms to bridge the gap in high-skilled critical care personnel
Centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably.
It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.

Addressing the constraints

One challenge is non-uniform regulatory and validation standards.
Hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
Lack of standards in this area leads to a huge variation in validation requirements at States and hospitals, forcing the start-up into a spiral of piloting studies.
Health-care start-ups spend long periods of time in the early development of their product.
The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up. Start-ups also face procurement challenges in both public and private procurement.
We need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
There is a need to facilitate standardised operational validation studies that are required for market adoption.
Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where hospitals actively engage with health-care startups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals, as opposed to being mere suppliers of technology or services.
Name the CEO of Ayushman Bharat-PM-JAY and National Health Authority.
Visa power
British Labour MP Debbie Abrahams: detained and deported
GoI revoked her e-business visa 3 days prior to her travel.
Frequent criticism of India on the issue of human rights in Jammu and Kashmir.
The government is well within its rights to deny entry to anyone that it desires to.
Where governments like those in Turkey and Malaysia have themselves been critical, India’s response has been equally sharp.

Birds hitq

Birds are under increasing pressure from human activity.
State of India’s Birds 2020: scientific report points out that once-thriving endemic or migrant bird populations have been decimated over the past quarter century in India An alarming picture of long-term declines of several species for which enough data is available over a 25- year period, as well as a more recent trend of annual losses. Some bird species assessed as ‘least concern’ by the IUCN, were found in peril in India.
Habitat loss
Pesticides
Hunting
trapping for pet trade
Remarkably, in spite of having a rich ornithological tradition, only 261 species out of 867 spotted qualified for a full analysis, based on robust long-term data; 52% of them are now classified as being of ‘high concern’.
The heartening news is that sparrow numbers remain stable overall, although the bird has largely disappeared from some of the big cities.
But the Western Ghats offer bleak prospects, and the abundance index of 12 endemic species there has dropped by 75% since 2000.
The fortunes of the Nilgiri Pipit, Nilgiri Thrush and several Sholakilis are tied to the survival of the high shola forest-grasslands.
Classified as ‘Southern Montane Wet Temperate Forest’ by experts Harry George Champion and SK Seth, the Sholas are found in the upper reaches of the Nilgiris, Anamalais, Palni hills, Kalakadu, Mundanthurai and Kanyakumari in the states of Tamil Nadu and Kerala.
Equally critical to some species, such as the Hodgson’s bushchat wintering away from Mongolia, is the protection of terai grasslands in Uttar Pradesh, Bihar, and the northeastern States.
India’s conservation community expects the Environment Ministry, which released the status report at the global conference of the Convention on the Conservation of Migratory Species of Wild Animals at Gandhinagar, Gujarat, to secure a future for birds.
Coursers and floricans need help with their delicate habitat, as do neglected small birds such as the Green Munia that is widely trapped.
Bird diversity makes India, Kerala in particular, a birdwatching destination.
That variety must be protected not just for cultural reasons, but to improve the health of forests, wetlands, open country habitat and high mountains.

In U.S. trade action, an Indian counter-strategy

The United States’s annual exercise of designating developing, and least developed countries has assumed importance for India this year: it has been dropped from the list of developing countries. Agreement on Subsidies and Countervailing Measures (ASCM) of the World Trade Organization (WTO).
Under the WTO rules, any country can “self-designate” itself as a developing country. In fact, the WTO does not lay down any specific criteria for making a distinction between a developed and a developing country member.
World Bank uses per capita incomes to classify countries.
United States Trade Representative (USTR) employed an arbitrary methodology to exclude India from list of designated developing countries.
India was removed from the Generalised System of Preferences.
USA: Brazil, China and India, have performed much better that those in the developed world and therefore they should no longer enjoy the slew of benefits that they have as developing country members of the organisation.
India would then lose the ability to use the special and differential treatment
(S&DT). S&DT lessens the burden of adjustment that developing countries have to make while acceding to the various agreements under the WTO.
Besides, when the WTO finalises an agreement in a specific area, developing countries are allowed longer implementation periods.

S&DT has been particularly beneficial for India in two critical areas

Implementation of the disciplines on agricultural subsidies
Opening up the markets for both agricultural and non-agricultural products

WTO Agreement on Agriculture (AoA)

developing countries, spending on price support measures and input subsides taken together cannot exceed 10% of the total value of agricultural production
developed countries are allowed to spend only 5% of their value of agricultural production.
The issue of market access, or the use of import tariffs, is one of the important trade policy instruments.
It has some key provisions on S&DT, which the developing countries can benefit from.
Over the past two years, the government of India has been extensively using import tariffs for protecting Indian businesses from import competition.

Lending a helping hand

Chinese netizens question whether India has struck the right balance in protecting its domestic population from the deadly disease and dousing the flames of a neighbour whose house is on fire.
Many contrast New Delhi’s arguably overcautious response — initially banning all export of face masks, suspending e-visas, sending a delayed message of empathy at the highest level to the distressed Chinese.
Chinese Internet users have showered praise on a retailer from Japan, which donated one million masks to the city of Chengdu.
The Japanese also avoided fire-walling their borders.
Despite the initial damage, there may still be an opportunity for India to recover some of its soft power erosion.
The key would be to follow the precedent of 2003, when George Fernandes, then Defence Minister, travelled to Beijing to express India’s full support to the Chinese people, during the SARS outbreak.

That visit reminded people of Dwarkanath S. Kotnis, an Indian surgeon who had died in China, where he had gone in 1938 as part of a five-member medical team to assist Chinese revolutionaries at the time of the Sino-Japanese war.

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