Indian healthcare needs urgent reforms: The Lancet

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London: Indian healthcare system needs urgent reforms across several key challenges if the country is to achieve the government’s vision of assuring health for all, says a paper in The Lancet.

The paper, authored by professor Vikram Patel from London School of Hygiene & Tropical Medicine and colleagues, has documented India’s progress on major health indicators in the past decade but also its many deficiencies.

Key health indicators for Indian states

“The health time-bomb ticks on due to the rising burden of non-communicable diseases. There are widespread inequities in health outcomes that are apparent in the large morbidity and mortality differentials across socio-economic status, caste, class, sex, and geographic location,” Patel said.

The most disturbing indicator of the deficiencies of the Indian healthcare system is the observation that health care costs are driving millions into poverty.

The authors argue not only for more resources but for an integrated national healthcare system, built around a strong public primary care system with a clearly defined supportive role for the private and indigenous sectors.

The system should address acute as well as chronic health care needs and should be cashless at the point of service delivery, the authors said.

According to the paper, India continues to lag behind regional neighbours especially on health indicators like mortality rates for children aged under five years, with India recording 27 percent of all neonatal deaths and 21 percent of all child deaths in the world.

The paper calls for strengthening the country’s weak primary health system.

“Second is the challenge of skilled human resources, where an overall shortage was further compounded by inequitable distribution of skilled workers,” the paper said.

“Also, India needs to better harness and regulate its large private sector” in 2014, more than 70 percent of outpatient care and 60 percent of inpatient care was provided in the private sector.

“However, lack of regulation has led to corruption across the sector, with consequent poor quality of care and impoverishment of patients,” it added.

According to the authors, dismally low public spending on health has crippled the public sector and created large barriers in quality and access.

Gaps in the availability of health professionals in India

The total expenditure on health in India fell from 4.5 percent of gross domestic product (GDP) in 2004-05 to 4.0 percent of GDP in 2013-14.

Real expenditure and government expenditure on health per head from 2004 to 2014

With India spending as little 0.1 percent of its GDP on publicly funded drugs, close to two-thirds of the total out-of-pocket expenditure on health was incurred on drugs, often used irrationally.

Out-of-pocket expenditures on health per episode of inpatient and outpatient care in India

“Only a radical restructuring of India’s healthcare system will assure healthcare for all Indians,” Patel said.(IANS)

(Picture courtesy: www.thelancet.com)

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New Reforms and Alternative Markets Likely To Benefit Farmers

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New reforms will benefit farmers who are reeling under the Covid-19 crisis. Pixabay

The Modi government in order to double the income of farmers by 2022 announced a slew of measures last week, and it is widely expected that these reforms will benefit farmers who are reeling under the Covid-19 crisis. Post Coronavirus as state reopens farmers might benefit.

IANS spoke to Ashok Dalwai, chairman of the Committee for Doubling Farmers’ Income, on the issue of strategic reforms initiated by the government and their importance to the farm sector.

He said the alternative market provided to the farmers will give them more earning power. The reforms will unshackle the agriculture value chains by deregulating the essential commodity trade and introducing a Central law to ease inter-state farm trade, effectively overriding the Agricultural Produce Market Committee (APMC) mandis that have shown resistance to change in the past.

“We are not ending the APMC, but reforming it. Till now APMC was regulated by the state governments, now the private sector can establish its own APMC which will give an alternative market to farmers,” Dalwai said.

He said the way the telecom sector provided options to the consumers to choose the operators of their choice, in the same way the private AMPC will give farmers the choice to sell their produce at a better price anywhere in India. “The proposed amendment to the Essential Commodities Act of 1955 will ensure seamless movement of farm produce not only inter-state, but also within the state. Anyone having a central license can buy and sell anywhere,” Dalwai said.

Farmers
Ashok Dalwai says Alternative markets might help corona struck farmers. Pixabay

Dalwai said many states have already adopted the reforms and more will join in the future. “The new law related to APMC will be definitely adopted by the state governments and the Centre will provide the framework for inter-state trade of agricultural produce. If a farmer in UP wants to sell his produce to a market in Karnataka, he does not need to go there. He can do so online. The way e-NAM works for APMC mandis, e-platform will work for such farmers.”

He said the amendment to the Essential Commodities Act has been initiated with the sole purpose to provide better prices to the farmers. The government has also decided to free certain categories of agricultural products such as cereals, pulses, oilseeds, onions, and potatoes from the government’s control and lend more predictability to even export policies.

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On the question of challenges due to Covid-19 with regard to doubling farmers’ income, Dalwai said, “The farmers have not been impacted due to the pandemic. There will be no problem in achieving the target of doubling farmers’ income by the year 2022.” (IANS)

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Wolrd Bank Chief Asks India to Undertake Financial Reforms

It has made progress in terms of monitoring of assets, the bankruptcy process and deepening of the banking system

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The Indian financial sector has made quite a bit of progress. Pixabay

India must undertake financial reforms in three key areas — sound regulations for non-banking financial companies (NBFCs), allow private sector banks in a big way in the banking sector and deepen capital market to aide growth — World Bank group President David Malpass said during a media interaction on Saturday.

Malpass, who is on a three-day visit to India, earlier met Prime Minister Narendra Modi, Finance Minister Nirmala Sitharaman and members of the Niti Aayog and discussed financial sector reforms with them as well.

“We (Malpass and Modi) discussed the ways in which the financial sector can move forward. The Indian financial sector has made quite a bit of progress. It has made progress in terms of monitoring of assets, the bankruptcy process and deepening of the banking system.

“I am looking forward to encouraging progress in three primary areas — to allow growth of the banking sector, including the private sector; allow and encourage deepening of capital market bonds, mortgages; and the third is regulations for NBFCs which have grown in importance in the Indian financial system, but entails some risks.

India, Financial, Reforms
Malpass, who is on a three-day visit to India, earlier met Prime Minister Narendra Modi, Finance Minister Nirmala Sitharaman and members of the Niti Aayog and discussed financial sector reforms with them as well. Pixabay

“Having sound regulations for NBFCs, which is vital to India’s overall growth, will help India’s financial sector. Prime Minister Modi has the goal of a $5 trillion economy. That’s a powerful vision that needs to be assisted by innovations in the financial sector,” Malpass said during the media interaction.

The NBFCs have caused credit squeeze in the financial sector. Default in IL&FS bonds sparked a liquidity squeeze that spread to other NBFCs. It led to credit squeeze, over-leveraging, excessive concentration and massive mismatch between assets and liabilities. The government has since been observing the sector quite closely.

Malpass also called for more reforms to support growth.

“My prescription is that openness to reforms and innovations, and improvements in the government structures will allow for faster growth. India has undertaken important reforms in the last few years,” he noted.

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Replying to a query as to whether demonetisation has caused lower growth in India, the World Bank chief said, “Economists made lots of forecasts… They were saying India has been affected by the global environment and has slowed from the higher past growth rates and it is very much related to the slowdown in global growth.”

Recently the World Bank sharply cut India’s growth forecast for the current fiscal to 6 per cent, down from the 7.5 per cent forecast it made in April.

Malpass said the main policy challenge for the country is to address the sources of softening private consumption and the structural factors behind weak investment.

The World Bank President said that stronger courts, modern land management and land permits and enforcement of contracts will benefit India.

India, Financial, Reforms
We (Malpass and Modi) discussed the ways in which the financial sector can move forward. Pixabay

He also said that the possibility of setting up fast track courts for dispute resolution should be considered.

To modernise land management, India could digitise land records, which will facilitate quick transactions, he said.

Malpass also said that global trade uncertainty, Britain’s plans of leaving the European Union and the low investment rate in the world were among the factors affecting growth.

“I think what is to be done is to have better growth programmes country by country,” he said.

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Malpass said the World Bank will continue with the $6 billion lending target for India. Ninety-seven projects are currently being executed with loan assistance from the World Bank in India.

“The World Bank right now has 97 projects in India with a commitment of $24 billion. We expect the programmes to continue,” he said.

Praising the recent corporate tax cut, Malpass said, “India has taken a good step with the recent cut in corporate tax rate which will add to its growth.”

The government recently cut the effective corporate tax rate from 35 per cent to 25 per cent and those not availing any other incentive will have an effective tax rate of 22 per cent. (IANS)

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Government Plans Slew of Reforms in Mining Sector

This would be a major reform that would allow companies such as Tata, Vedanta, JSW to commercially sell out

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Instead, a new hybrid mining lease agreement would be framed under which companies would be free to use extracted mineral both for captive use. Pixabay

The government plans a slew of reforms in the mining sector, including giving a big push to commercial mining to help attract investment and improve mineral production in the country.

As part of this, highly placed sources said the government would discontinue the practice of offering mining rights for mineral resources, including coal, to companies for captive use. Instead, a new hybrid mining lease agreement would be framed under which companies would be free to use extracted mineral both for captive use of end use plants (power, steel, cement etc) and commercial sale in the open market.

This would be a major reform that would allow companies such as Tata, Vedanta, JSW to commercially sell out from their captive iron ore mines for higher gains. State-owned SAIL has already been permitted to commercially sell iron ore from its captive mines.

A high level committee headed by NITI Aayog vice chairman and having top representation from ministries of finance, mines, coal and environment, has suggested that all mines hence forth be auctioned for commercial production. For companies taking mines largely for captive use, 50 per cent of production from those mines would be permitted to be sold in the open market under the new hybrid lease agreement.

Government, Reforms, Mining
As part of this, highly placed sources said the government would discontinue the practice of offering mining rights for mineral resources, including coal, to companies for captive use. Pixabay

Sources said the government has accepted these recommendations and necessary changes in mineral laws would be made to allow the reform measures to take shape.

“Captive mining rights do not result in optimal extraction of mineral resources, making the activity uneconomic. Often companies with captive leases are forced to contain production as extra production would cause loss of revenue to them in the absence of commercial selling right for surplus production. Thus, a hybrid agreement will allow full potential of mineral block to be realised and also help both the Centre and the state to increase their earnings,” said a former head of Coal India Ltd asking not to be named.

The high level committee has suggested that changes in grant of mineral rights with the option to do both captive and commercial mining may be applied prospectively for all exploration and mining activities. In addition to extraction of main mineral, the hybrid model will also allow leaseholders to extract other minerals found in their mine lease area on payment of 10 per cent of the quoted revenue share for the main mineral.

For existing captive mines allocated before the auction mechanism was made mandatory for grant of mineral leases, the high level committee has suggested the companies can use surplus mineral in their new end-use units formed under a joint venture agreement with a minimum 26 per cent shareholding.

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Mining has been identified as a critical activity that needs a big push to help other capital intensive and employment generating industries. The sector is braving a slowdown that has seen declining investment and production. (IANS)

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