Primary care facilities in India are not well prepared to provide high-quality obstetric and newborn care, and facility capacity is worst in States with the worst health outcomes, a latest study has said.

The Indian government will need to increase investment in the health system, in providers and in research to harness the full benefit of its public health infrastructure. Research on regionalisation is a priority as this may offer an innovative approach to ensuring quality services for mothers and newborns, according to the study “Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services’’ by Jigyasa Sharma, Devaki Nambiar and others.

The impact of regionalisation strategies on facility overcrowding, performance incentive structures for front-line workers, as well as equity in service access should be important considerations of such research.

Over the past decade, India’s health system has operated in an extremely resource-constrained environment: from 2004 to 2014, government health expenditure has remained approximately around 1% of country’s gross domestic product. 

“Improving quality of care and strengthening public health infrastructure is integral to India’s path to universal health coverage: without an explicit focus on quality, a push towards universal coverage is unlikely to lead to better health for mothers and newborns.’’ The study says.

The aim of the study was to assess input and process capacity for basic delivery and newborn care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across States.

The researchers used data from the nationally representative 2012–2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 States and Union Territories in India. It covered 8536 Primary Health Centres and 4810 Community Health Centres.

About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. While in CHCs, capacity was slightly higher in urban areas, gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these States receiving scores in the lowest third of the facility capacity index.

Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and emergency service availability are urgently required, the study has said.

Increased coverage of facility-based births has not successfully translated to desired improvement in health outcomes for mothers and newborns. Under India’s National Rural Health Mission (NRHM, now called the National Health Mission or NHM), a variety of interventions were introduced through architectural improvements in the fund flow and design of services: increased number of maternal care facilities, particularly primary health centres (PHC) and community health centres (CHC); a strengthened supply chain for essential medicines, equipment and supplies; and Janani Suraksha Yojana, a financial incentive programme to increase institutional deliveries.

Following the launch of NRHM in 2005, institutional deliveries in rural areas have more than doubled, and a declining trend in maternal and newborn mortality has been noted, although strong causal evidence linking NRHM efforts to improved health outcomes for mothers and newborns is lacking. Annual decline in neonatal mortality between 2005 and 2015 was faster than in the preceding years; however, the rate of decline is not sufficient to meet the 2030 SDG targets. Inadequate quality of care, including insufficient facility readiness, and low provider skill and clinical management capacity, as evidence from low/middle-income countries (LMIC) indicates, may explain why increased utilisation alone may not have resulted in the desired reduction in adverse intrapartum outcomes. Moreover, quality of care itself also affects utilisation.

Evidence indicates that the availability of a labour room and adequacy of essential equipment and laboratory services for childbirth at public health facilities have a significant effect on service uptake. Describing and improving quality of intrapartum care is relevant to increasing service uptake in India, where maternal and newborn services are underused despite the availability of primary healthcare in public health facilities free of charge, the study has said.

Public health facilities are a significant provider of care in India, especially for rural and vulnerable population segments. About 80.1% of all deliveries in rural India are facility based, of which about 70% are in public facilities. For urban areas, 89.5% of births are institutional, 47.4% of which are in public facilities. In the majority of India’s States, more facility-based deliveries happen at government health institutions than in private facilities. Additionally, quality of care in the public sector affects the poorest segment of the population the most, as the poorest wealth quintile is more heavily reliant on public health facilities than the richest, in both rural (58% vs 29%) and urban areas (48% vs 19%).

New Delhi : Applications are now open in India for the Rhodes Scholarships – widely considered to be the most respected post-graduate academic scholarships in the world. The Rhodes Scholarships are post-graduate awards supporting outstanding all-round students, to enable two to three years of study, depending on the academic route taken, at the University of Oxford, the oldest and amongst the most well regarded universities in the world.

The Rhodes Scholarships aspire to create ‘leaders for the world’s future’ and are achievement-based awards, open to students with proven intellectual and academic attainment of a high standard, who show exceptional character, leadership, achievement in extra-curricular activities and a commitment to service in the public good. Since Independence, there have been 217 Rhodes Scholars from India. This illustrious list includes prominent personalities such as Olympian Ranjit Bhatia, playwright Girish Karnad, and economist Montek Singh Ahluwalia.

Each year, five Indian Scholars are selected on the basis of their intellect, character, leadership, and commitment to service, to join Rhodes Scholars from around the world at the University of Oxford in a Rhodes Scholars class of approximately 100.

Winners of the Rhodes Scholarship emerge after a competitive application and selection process spanning over 6 months. The finalists are shortlisted based on applications and a preliminary interview and are then interviewed individually on their interests, achievements and goals before the independent selection panel makes its selection.

Applications for the 2019 Rhodes Scholarship are open to Indian citizens between the ages of 19 and 25 (as of October 1, 2019) who have received or are on the path to receiving at least a first class undergraduate degree. Applications may be submitted online on or before July 31, 2018.

The Rhodes Scholarships include all university and college fees for two to three years (depending on the academic route taken), an annual stipend, and travel expenses to the University of Oxford before the start of the programme and a return ticket following the course of study.

Studying at the University of Oxford will give the chosen Scholars access to world class academics in their field as well as an international alumni network that includes heads of state, Pulitzer Prize winning authors, Nobel Prize winners and Olympians.

To apply for the Rhodes Scholarships for India 2019, aspirants must submit an online application, which includes submission of academic transcripts, the names of six references, proof of age and an essay describing the proposed course of study at Oxford, general interests and activities, including activities demonstrating energy and drive, and future aims of the candidate, each as further described in the Rhodes Scholarships 2019 India Memorandum.

Outstanding applicants will be shortlisted for regional and final interviews with a panel consisting of eminent personalities who will recommend the final five Rhodes Scholars for 2019.

The Centre has launched the oxo-biodegradable sanitary napkins under the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP).

‘Janaushadhi Suvidha’ –the affordable sanitary napkins will now become available at over 3600 Janaushadhi Kendras functional in 33 States/UTs across India.

Launching the sanitary napkins, Minister of State for Chemicals and Fertilisers, Mansukh L. Mandaviya said that this is a special gift for all women on the eve of World Environment day, as this unique product would ensure affordability, hygiene as well as ease of use and disposal for them.

Janaushadhi Suvidha comes with a special additive, which makes it biodegradable when it comes in contact with oxygen after being discarded. This would ensure ‘swachhta, swasthya and suvidha’ for the underprivileged women and go a long way in the achievement of Prime Minster Narendra Modi’s vision of Affordable and Quality Healthcare for All, the Minister added.

The average price of sanitary napkins available in the market today is around Rs. 8 per pad, whereas now with the launch of the napkins at Rs. 2.50 per pad, will make the basic hygiene requirement aid for women affordable for the underprivileged sections.

According to the National Family Health Survey 2015-16, about 58 percent of women aged between 15 to 24 years use locally prepared napkins, sanitary napkins and tampons. Further, about 78 percent women in urban areas use hygienic methods of protection during menstrual period; only 48 percent women in rural areas have access to clean sanitary napkins.

NEW DELHI: A young man, all of 28 years, was aspiring to become a civil servant but abruptly and sadly ended his life on Sunday in the heat of the national Capital. Varun Subhash Chandran had failed to enter the examination centre, notified by the UPSC, in time on Sunday morning to take the preliminary exams of civil services. He was late only by four minutes.

This delay of four minutes weighed heavily on the mind and thought process of Varun and ultimately sniffed out his life as he committed suicide by hanging himself from a ceiling fan. The four minute-delay caused a young life to cease to exist and put a lid firmly on his aspirations and dreams. 

Apparently, he had wasted precious few minutes by going to a wrong examination centre and by the time he realized his mistake and rushed to the designated centre, the gates were closed. And after an hour or so he closed all the possibilities of life upon himself.

Let us ponder, what could have happened if was allowed entry to the examination centre by the supervising staff. The examination had not even begun, there were six minutes to go for that. Varun could have rushed to his seat and taken the prelims exam and his life could have been saved. 

This archaic regulation needs to be thrown out immediately. Closing the entry gates of the centre even before the exam has begun. The supervising staff could have taken a sympathetic view, could have imagined the plight of a youth who came running to make it in time. No candidate wants to be late for the all important exam but even if a candidate is allowed a late entry and is not granted any other relaxation or extra time, it is the candidate’s fate – he or she would have to complete the examination in the allotted time. The time wasted by late entry debits his or her own time to take on the paper.

Varun was attempting the UPSC prelims for the sixth time. He was aware of all regulations and stipulations but it was a stroke of bad luck that he could not enter the centre four minutes ago. There are many candidates who have to cover long distances but it was not so in case of Varun, the young life which was lost to a rule that could have shown only a bit of leniency in allowing him to take the exam. It would have been wholly his own fate – what if he could have cleared it and gone on to the mains section. He had failed to clear it in the past five attempts, the pressure on him was immense and he could not cope with it.

So far there has not been any official statement on Varun’s suicide for being four minutes late. Probably, all the wise men and women of vast experience and wisdom who are members of the UPSC can instruct the supervisory staff at examination centre to use their judgment on the spot in deciding upon such individual cases which would be negligible but would save a young life, offer yet another opportunity to an aspirant. By no means, it would have given Varun an extra edge or advantage over other candidates appearing in the civil services exam.

Last year, Lok Sabha Secretariat had conducted a prelims exam for assistants. One of the centres in South Delhi was located next to an under construction government school and candidates had a tough time in locating it. No rule was broken but supervisory staff and the security personnel allowed candidates entry moments before the examination began. Nothing was lost. Failure or success depends on an aspirant’s preparation and hard work, let him or her realize that. Surely, we are not turning into a police or military State and are not becoming stumbling blocks in building a value-based, purposeful, constructive and humane society. 

“Rules are rules, but bending them for a good purpose should be legitimate.” These were the last words of Varun Chandran who hailed from Karnataka and had come to Delhi to give wings to his dreams which now lay shattered. Nobody’s life will be affected by his suicide except his family’s who will never be come to terms with the loss of their young one. The news of his suicide managed to enter the pages of all newspapers and news portals but will it spur any rethink on rules? It is time that measures are in place so that another Varun does not take his own life. 

A unique new kind of warfare, the global trade war, is now on the horizon. The flashpoint is the slugfest between the world’s two largest economies, the U.S. and China  to ensure that their products remain cheap and affordable. This is the main aim of the battle, of which the first skirmish began in March this year when U.S. President Donald Trump raised tariffs by 25 per cent on imports of steel and aluminium from all over the world including 3 billion dollars worth of supplies from China. At the time, he had exempted the European Union and neighbours like Mexico and Canada. Those exemptions were withdrawn a week ago. To add to the belligerence, he has now threatened to levy 25 per cent tariff on goods worth 50 billion dollars imported from China. In turn, the Asian economic powerhouse has threatened to levy retaliatory tariffs on goods ranging from pork to soyabean being imported from the U.S.

The latest round of  talks between the two countries in Beijing has ended in a stalemate. Irked by the U.S. President’s tough public talk, China has threatened that all the decisions taken at this meeting will be revoked unless it is publicly stated that the proposed tariffs will not be imposed. 

During the negotiations, media reports say the Chinese government had agreed to buy more goods from the U.S. in a bid to curb the trade deficit. The focus was on energy and plans to buy liquefied natural gas from Alaska. In addition, China had agreed to lower technical barriers to trade that could potentially double agricultural exports to that country. Besides, it had even cut tariffs on consumer imports and were planning to remove curbs on foreign investment in energy and transport sectors. The Chinese authorities were perturbed that despite these offers, the Trump administration continued to make public threats about levying higher tariffs.

The rest of the world is watching the situation with concern as a trade war between the U.S. and China will have an impact on the entire world. In case the effort to slow down China’s growth succeeds, it will mean lower demand for goods now being imported from many other countries. For instance, some countries are exporting components to China that are used in products meant for shipment to the U.S. Others manufacture goods in the U.S. and supply to China, like in the case of automobiles, an item on which tariffs may be raised by the latter.

Not only that, the tariff war launched by the Trump administration can ultimately harm rather than help the booming U.S. economy. Many analysts have recalled that a similar hike in steel and aluminium tariffs in 2002 during the tenure of former President George Bush had to a steep rise in domestic steel and aluminium prices at the time. This in turn had led to the closure of many small businesses and job losses rather than job creation. In this context, one must point out that one of the reasons being given for this aggressive attitude by Donald Trump has been the need  to propitiate his blue collar constituency. This segment has seen many jobs go overseas due to closure of factories in the U.S. The strong action against China is thus seen as a retaliatory strike against the forces that took away those jobs.  Unfortunately, such policies are more likely to end in more jobs being lost than creating any new jobs.

As far as India is concerned, protectionist rise in tariffs is bound to hit its exports to the U.S as well as China. In the case of the U.S., it has already been marginally impacted by the increased levies on steel and aluminium exports as it supplies only two per cent of that country’s requirements. But in case the tariff war expands, it could be affected in a much bigger way. Currently, India is trying to benefit from the prospect of soyabean exports being scaled down from the U.S. by offering to supply this commodity to China. But such advantages can only be in the short run. In the medium and long term, higher tariffs will definitely mean a setback to the efforts to increase exports.

It would thus be in India’s best interests to join hands with other stakeholders like the European Union as well as other Asian countries to deal with the situation. For the time being, it may not be affected by the turmoil in the global economy. But it cannot remain untouched in case the current strains between the U.S. and China erupt into a full blown trade war. For the time being, however, it needs to closely monitor the situation and ensure that India’s economic interests are not compromised in any manner at all.

(Views expressed are personal.)

The World Health Organisation (WHO) has launched a new action plan on physical activity and health.

The WHO Global action plan on physical activity and health 2018-2030: More active people for a healthier world’’shows how countries can reduce physical inactivity in adults and adolescents by 15% by 2030. It recommends a set of 20 policy areas, which combined, aim to create more active societies through improving the environments and opportunities for people of all ages and abilities to do more walking, cycling, sport, active recreation, dance and play.

It also calls for support to, for example, training of health care workers and other professionals, stronger data systems, as well as use of digital technologies.

 Â“Being active is critical for health. But in our modern world, this is becoming more and more of a challenge, largely because  our cities and communities aren’t designed in the right ways,” said Dr Tedros Adhanom ghebreyesus, WHO Director-General. “We need leaders at all levels to help people to take the healthier step. This works best at city level, where most responsibility lies for creating healthier spaces.”

Worldwide, one in five adults, and four out of five adolescents (11-17 years), do not do enough physical activity. Girls, women, older adults, poorer people, people with disabilities and chronic diseases, marginalized populations, and indigenous people have fewer opportunities to be active. 

Regular physical activity is key to preventing and treating non communicable diseases (NCDs) such as heart disease, stroke, diabetes and breast and colon cancer. NCDs are responsible for 71% of all deaths globally, including for the deaths of 15 million people per year aged 30 to 70.

Dr Tedros added: “You don’t need to be a professional athlete to choose to be active. Taking the stairs instead of the elevator makes a difference. Or walking or using the bike instead of driving to your neighbourhood bakery. It’s the choices we make each and every day that can keep us healthy. Leaders must help make these choices the easy ones.” 
 
To support national efforts to implement the plan, WHO is launching an advocacy campaign to promote physical activity, Let’s Be Active: Everyone, Everywhere,Everyday.This new drive, launched at the Portuguese Football Association’s iconic Cidade do Futebol (City of Football), aims to encourage governments and city authorities to make it easier for people to be more physically active, and healthier.

Physical inactivity is more than a health challenge: the financial costs are also enormous. Globally, physical inactivity is estimated to cost US$54 billion in direct health care, of which 57% is incurred by the public sector and an additional US$14 billion is attributable to lost productivity. 

World leaders will meet later this year to take action on physical inactivity and other causes of NCDs, and mental disorders, when they take part in the Third United Nations General Assembly High-level Meeting on NCDs, being held on 27 September in New York.

The Centre has decided to widen the scope of the Indecent Representation of Women (Prohibition) Act to bring new forms of communication.

Speaking to reporters, Women and Child Welfare Minister, Maneka Gandhi said since the enactment of the Act, technological revolution had resulted in the development of new forms of communication such as internet, multi-media messaging, cable television, over-the-top (OTT) services and applications such as Skype, Viber, WhatsApp, Chat on, Snapchat, and Instagram among others necessitating the amendments.   

The enacted the Indecent Representation of Women (Prohibition) Act (IRWA), 1986 to prohibit indecent representation of women through advertisements, publications, writings, paintings, figures or in any other manner.  

Keeping in mind these technological advancements, it has been decided to widen the scope of the law so as to cover such forms of media on one hand and to strengthen the existing safeguards to prevent indecent representation of women through any media form on the other. Hence, the Indecent Representation of Women (Prohibition) Amendment Bill, 2012 was introduced in Rajya Sabha December, 2012 which referred the Bill to Department related Parliament Standing Committee for consideration.

Based on the observations made by Parliamentary Standing Committee and recommendation made by the National Commission for Women on the basis of consultation with civil society groups and likeminded individuals, WCD has proposed amendments in IRWA keeping in mind the recent technological advancement in the field of communications such as social media platforms, over the top services etc.

The reformulated Bill proposes following amendments in the parent Act:

Amendment in definition of term advertisement to include digital form or electronic form or hoardings, or through SMS, and MMS,

Amendment in definition of distribution to include publication, license or uploading using computer resource, or communication device or in

Insertion of a new definition to define the term publish. 

Amendment in section 4 to include that No person shallpublish or distribute or cause to be published or cause to be distributed by any means any materialwhich contains indecent representation of women in any form:

Penalty similar to that provided under the Information Technology Act, 2000

The Parliamentary Committee has also recommended creation of a Centralised Authority under the aegis of National Commission of Women (NCW). This Authority will be headed by Member Secretary, NCW, having representatives from Advertising Standards Council of India, Press Council of India, Ministry of Information and Broadcasting and one member having experience of working on women issues.

This Centralised Authority will be authorized to receive complaints or grievances regarding any programme or advertisement broadcasted or publication and investigate/ examine all matters relating to the indecent representation of women.

A coalition of civil society organisations in Tamil Nadu has demanded an immediate ban on Sterlite following the death of 15 protestors in police firing on May 22 at Tuticorin in Tamil Nadu.

‘Coordinating Committee for People’s Inquest into Thoothukudi Police Firing’ organised by People’s Inquest (PI) on June 2-3, 2018 at Thoothukudi and its suburbs, into the targeted kllings, has recommended that the plant should be dismantled and the area cleared.

As per the latest records, 15 protestors were killed and more than a hundred severely injured in protests against the Sterlite Copper plant. May 22, 2018, marked the 100^th day of protests against the Sterlite Copper plant. 

A memorial for those killed by the police should be created by the TN Government, an importantly, establish who ordered the shooting and killing and make them accountable as per the law, and action against those who were responsible for the killings, injuries and continuous unlawful search, assault and harassment of the people are some other major recommendations of the inquest.

The inquest was done by a 23-member committee comprising people from different walks of life and the objectives of the inquest were to ascertain the facts that led to the continued protests in Tuticorin over the years and particularly in the last 100 days, to ascertain the facts and circumstances of the incidents which lead to the police firing through gathering statements from eye-witnesses, family of the deceased, meeting the officials from Tuticorin district administration, Tuticorin district police department, representatives of the Anti-Sterlite protest committee and to ascertain who authorized the firing and under what circumstances.

Sterlite Copper started its operations in Tamil Nadu in 1996 by setting up a plant in Tuticorin district. Sterlite Cooper known as Sterlite Industrial India Ltd. is a a unit of Vedanta group that has setup smelter, refinery, acid plant, and copper road plant in the land allocated them in State Promotion Corporation of Tamil Nadu. There have been numerous complaints against the company of harming the environment and breaking the government environmental regulations. There are numerous reports which suggests that the company with help of its money power and political clout have gotten away with breaking laws.

The Thoothukudi Administration had called for a ‘peace meeting’, inviting the organisations and protesting villages’ representatives on May 20, 2018, prior to the community rally on May 22, 2018. It has been learnt from people’s testimonies that the administration used a selective approach in inviting the organisations and protesting villages’ representatives for the said meeting. People with whom the PI team interacted in Thoothukudi allege this to be a deliberate attempt of the administration to divide the anti-Sterlite movement. It has also been brought to the notice of the PI team that invitation sentto one such organisation (Makkal Adhikaram) was done to an individual who had no association with that organisation. 

The administration didn’t ensure that all organisations and individuals involved in anti-Sterlite movement are communicated with. The PI team observes that the district administration negotiating with only one set of the organisers made the bona fides of the administration suspect in the eyes of the people.

The People’s Inquest (PI) team observes with grave concerns about the absence of the District Collector (DC) in the above mentioned meeting. The meeting was led by the Thoothukudi Superintendent of Police (SP) along with the Sub Collector. As the head of the district administration, it was the DC who should have led the meeting and reached out to the people. This would have been more respectful to the people who have been protesting for close to 100 days. Role of the SP is solely towards maintaining law and order. Given that the protests were seen only as a law and order issue and the demands of the people overlooked, do raise doubts on the intentions of the district and state administration.

The PI team observes several gaps in Section 144 imposition. The administration was fully aware about the anti-Sterlite protests at District Collectorate on May 22, 2018 well in advance and despite that waited till its eve for imposing Section 144, which do appear only symbolic. Section 144 was imposed only at 8PM on May 21, 2018. As gathered from people’s testimonies, after the Section 144 imposition, announcements were not made by the administration in most areas, to reach the information to the people. People got to know about the same only through television news around 9:30 PM on May 21, 2018 and in the newspapers the next day. It is evident that these channels were too late to communicate to the people and wouldn’t have deterred the protesters who were entering into the 100th days of the peaceful anti-Sterlite protests. It is important to note, given that Section 144 was imposed in only two PS jurisdictions, there was no legal restriction on the protesters to walk for as many as 15 kilometres, to enable them to reach and assemble at the District Collectorate.

The PI team observes that there has been clear irregularity in the process through which Section 144 was imposed and implemented. The DC has abdicated all his responsibilities.

A Jaipur court has directed the Rajasthan police department to begin an investigation into cruelty carried out against the elephants used as a tourist attraction at Amer Fort.

This court order came after a complaint filed by Gauri Maulekhi, Trustee, People for Animals, and Government Liaison for Humane Society International/India.

The complaint filed at the Amer Court by Gauri Maulekhi asks to provide relief to the elephants under the Prevention of Cruelty to Animals Act, 1960. The approximately 103 elephants at Amer Fort carry tourists up and down a steep slope at Amer Fort. They are housed in Haathi Gaon, a concrete housing structure around 4 kilometres away.

The Animal Welfare Board of India (AWBI) has conducted multiple investigations in the past disclosing the conditions under which these elephants labor. They suffer from the blows of the ankush or bullhook, which is prohibited, and from beating, kicking, tethering, and insufficient diet and inadequate medical care. If the investigation finds the complaint made by the complainant valid, the police will be required to file a first information report and submit the investigation report to the court.

Gauri Maulekhi said; “We are happy with the order of the court. We are confident that our concerns will be proven in the police department’s investigation. This is a landmark order and we believe it is the beginning of the end of the torture that these elephants have suffered for so long.”

A recent report by the AWBI showed that many of these elephants used for foreign tourists suffer from tuberculosis (TB). In addition, most of the 103 elephants have open wounds, scars, are chained when not working and display stereotypical behaviour that entails repetitive movements for long durations of time like swaying side to side or back and forth due to suffering from lack of natural mental stimulation. The foreign tourists who frequent the elephant rides are often unaware of the cruelty behind them.

Humane Society International and its partner organisations together constitute one of the world’s largest animal protection organisations. For more than 25 years, HSI has been working for the protection of all animals through the use of science, advocacy, education and hands on programs. Celebrating animals and confronting cruelty worldwide. 

Jan Swasthya Abhiyan (JSA) – a conglomerate of health experts has described as `arbitary’ the constitution of a high level commission on health and has questioned its skewed composition.

Given the government’s recent initiative for an insurance based National Health Protection Scheme (NHPS), we are concerned that this is an exercise in preparing the ground such that the private sector would benefit the most from its rollout, a statement issued here has said.

That the formation of the committee with a mandate with wide-ranging consequences, has avoided media attention is also a matter of great concern. Jan Swasthya Abhiyan has lodged a strong protest against the constitution of this group and urges the government to revoke this committee.

Health is an important public policy matter and any committee constituted to frame policies or provide recommendations related to it should be representative of all interests and sections in the society. The Finance Commission is a constitutional body vested with specific powers related to financial devolution. It has no role in planning for health and should not be given any responsibility that would be an overreach of its powers, the statement said.

The fifteenth Finance Commission has constituted a High-Level Group “to examine the strengths and weaknesses for enabling balanced expansion of health sector”. Dr.Randeep Guleria, Director, AIIMS, New Delhi is appointed convenor with Dr. Devi Shetty, Chairman, Narayana Health City, Bengaluru, Dr. Dileep Govind Mhaisekar, Vice Chancellor, Maharashtra University of Health Sciences, Pune, Dr. Naresh Trehan, Medanta City, Gurgaon, Dr.Bhabatosh Biswas, Prof & HOD of Cardio Thoracic Surgery, R.G.Kar Medical College, Kolkata and Prof. K. Srinath Reddy, President of Public Health Foundation of India as members.

The roles and responsibilities assigned to the group are:

To evaluate the existing regulatory framework in the health sector and examine its strengths and weaknesses for enabling a balanced yet faster expansion of the health sector keeping in view India’s demographic profile;

To suggest ways and means to optimize the use of existing financial resources and to incentivize the state governments’ effort on fulfilment of well-defined health parameters in India; and

To holistically examine best international practices for the health sector and seek to benchmark our frameworks to these practices for optimizing benefits keeping in mind our local issues.

The JSA has said that the constitution of the group and its roles and functions raise many questions including who gave the Finance Commission the mandate.

Under the Constitution, Finance Commission has been given the responsibility to make recommendations to the government regarding the distribution of the net proceeds of taxes between the centre and the States and among the States, provision of grants in aid from the centre to the States. Nowhere in the Terms of Reference (ToR) of the fifteenth Finance Commission, are there any specific references related to regulation of health sector. Previously, a High-Level Expert Group (HLEG) on universal health coverage was constituted under the Planning Commission by the UPA government. This was justified since it came under the purview of the Planning Commission’s mandate. Health is a state subject and the formation of the group under the aegis of the Finance Commission is clearly an overreach by the centre on States’ powers, the JSA has said.

The composition of the group is highly problematic. Out of the five members, two are extremely prominent names in the field of private corporate healthcare. This is a form of ‘regulatory capture’ where entities who need to be regulated capture regulatory institutions. Further, a majority of the group are clinicians specialised in tertiary care, and there is an absence of other health professionals. There are no representatives from either the central or the state health ministries or their agencies in this group. Neither is there representation of civil society organisations, media, activist, legal or consumer groups. All the members are male, exhibiting a clear gender bias, the statement said.

The first point in the ToR is about evaluation of the existing regulatory framework for the expansion of the health sector. The term “health sector” has a discernible market connotation and it is not clear whether this “expansion” is aimed at strengthening of the existing public health delivery system or is it directed at further strengthening the corporate health care industry. It is also not clear whether the regulatory framework here refers to the Clinical Establishment (Registration and Regulation) Act, 2010 or similar state laws.

The second role assigned to the group is about incentivizing “the state government’s effort on fulfillment of well-defined health parameters” amounts to usurping the role of the central health ministry and it is unclear whether states will be consulted. Further, in the third point there are no clear indications whether the examination of the said “international best practices” are for the benefit of public health system or the private healthcare industry. There is also a mention of “our frameworks” and it is unclear whether this refers to the current regulatory framework which is the Clinical Establishment Act or a regulatory framework for health insurance or whether it refers to the need to revisit specific standards such as the Indian Public Health Standard (IPHS) or the National Accreditation Board for Hospitals & Healthcare Providers (NABH).