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Monday, September 24, 2018

New health paradigm

Pradhan Mantri Jan Arogya Yojana will ease burden on poor, be a catalyst for more changes in health sector.

Ayushman Bharat is a far-reaching initiative aimed at ensuring holistic healthcare services. Its first component of expansion of services with elements of promotive and preventive healthcare under comprehensive primary health through health and wellness centres was launched on April 14 from Chhattisgarh’s Bijapur district. Since then, 2,287 health and wellness centres have come up around the country.
Its second component, the health assurance mission addressing concerns of catastrophic expenditure by vulnerable families for secondary and tertiary care, the Pradhan Mantri Jan Arogya Yojana (PMJAY), will be unveiled on September 23.
It will provide a cover of Rs 5 lakh per family per year for inpatient care to 10.74 crore families at the bottom of the pyramid. This translates into more than 50 crore people, around 40 per cent of India’s population. The health conditions and surgical procedures, covered free, are encompassed in over 1,350 packages that include practically all secondary and tertiary conditions requiring hospitalisation, barring a few such as organ transplantation. The services will be provided by empanelled public and private hospitals.
Unlike private insurance schemes, PMJAY does not exclude a person on account of pre-existing illnesses. The size of the family is no bar. There is also no need for formal enrolment; families that are listed with defined deprivation criteria on the Socio Economic and Caste Census database are automatically enrolled. All that is required is a proof of identity, which could be Aadhaar or any other government-issued identity card.

All but a few states have agreed to be a part of the PMJAY. Most have chosen to run the scheme in the trust mode, which means that the state health agencies will directly implement the mission. A strong fraud control mechanism has been conceived. An audit system has been put in place. Thousands of Ayushman Mitras are being trained. At each facility, one of them will receive the beneficiary, check her eligibility and facilitate in-patient care. A system for patient feedback and grievance redressal is also in place. The system will be cashless and largely paperless.
The Yojana will be implemented in concord with state-level schemes, if they exist. An autonomous and empowered National Health Agency (NHA) has been established with corresponding state level health agencies (SHAs). A plethora of guidelines on every aspect of the scheme has been developed and pre-tested. A robust IT system has been put in place. An efficient claims management system is functional with payments to be made within two weeks.
One unique feature of the PMJAY is its national portability once fully operational. If a beneficiary from Jharkhand falls sick in Uttar Pradesh (UP), she is entitled to receive treatment in any of the empanelled hospitals in UP. Her home state will make the requisite payment for the services availed.
The service package rates are based on an extensive exercise to determine market-discovered estimates. The rates of all state schemes as well as the CGHS system were carefully studied. The cost of packages is modelled on quality care in a general ward. On the base rates, states can add upto 10 per cent as required. The base rates can further be augmented by 10 to 15 per cent each if the hospital is accredited, if it is located in one of the 115 aspirational districts or is running a specialty education course. If a state’s existing scheme has a higher rate for a specific package compared to the PMJAY, the former will apply.
PMJAY will herald a new era in healthcare for four reasons. First, it will dramatically improve provision of healthcare for the poor. It is now possible for a construction worker with an injured knee to have an implant for free, a rickshaw-puller with a heart attack to undergo a stent procedure and a farmer’s wife to receive full treatment for breast cancer.
Second, the PMAJAY will be a catalyst for transformation. It will be an enabler of quality, affordability and accountability in the health system. The empanelled hospitals have been tasked to follow the treatment guidelines. Patient outcomes will be monitored. Another impact of the PMJAY will be rationalisation of the cost of care in the private sector. With an increase in demand created, it is expected that private sector will move from a low volume-high return paradigm to a high volume-fair return (and higher net profit) model.
The earnings of public hospitals under PMJAY will be available for their upgradation and also for incentivising the provider teams as these funds will be deposited with the Rogi Kalyan Samitis. Up to 30 per cent of the overall public spending on the scheme may return to public sector institutions.
Third, the PMJAY is a poverty-reducing measure. Each year, six to seven crore people, above the poverty line, fall below it because of health-related expenses. PMJAY would reduce this number significantly. More than a third of the out-of-pocket expenditure (around Rs 5,000 per household) is due to inpatient hospitalisations. One out of eight families have to incur health expenditure of more than 25 per cent of the usual household expenditure each year. PMJAY will ease this burden on the poor.
Fourth, the scheme will create lakhs of jobs for professionals and non-professionals — especially women. It will give a boost to the health technology industry.
The implementation of a mission of this size, ambition and complexity is hugely challenging. High uptake, quality care, beneficiary satisfaction, efficient operations and fraud-controlled systems are the key metrices of its success. With highly competent and dedicated teams at the NHA and SHAs, backed by the highest political will and the goodwill of the people, the PMJAY is poised to deliver on its promise. There is also willingness to learn, improve and reform.
Source: Indian Express, 22/09/2018
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The law of happiness

Nations that ensure the rule of law are also home to happy people. Policy-making must strive for the larger satisfaction of the people with public institutions they have to regularly approach

Happiness has come to be accepted as a goal of public policy. And this discourse has given a fillip to a new narrative where the interconnections between law, governance and happiness are being searched. Why do these connections matter? Experiences from several nations confirm that the countries with higher GDP and higher per capita income are not necessarily the happiest countries and there exists a link between the state of happiness and rule of law.
The World Happiness Report (WHR) 2018, which ranked 156 countries, placed India at the 133rd place on the index of global happiness. While India’s performance on this can be attributed to several factors, there’s no denying the fact that there is an intrinsic relationship between law and people’s happiness. The WHRs, over the years, confirmed that people tend to have poor mental health, a low score of subjective well-being and poor perception about the governance and law and order, despite high income levels.
The curious question in this discourse is how the law is linked with happiness. In an environment in which laws are gradually becoming reactive, regulatory and penalising, this question needs some probing.
Jeremy Bentham said the object of the law should be the maximum happiness of the maximum number. Going by popular perceptions, laws and legal regimes are the distributors of unhappiness in many ways. We have about 3.3 crore cases pending in various courts in the country. How does unhappiness emanate from these cases? Each case is not a mere number — it involves tension, anxiety and deprivation to all those associated with it. A group of people — family members, relatives, friends and others of the parties involved — are necessarily affected because of such cases. If we presume that there are about 20 persons in each case belonging to one or the other parties, we get a number of about 64 crore. Interestingly, none of them would be in a state of happiness on account of being linked to the case. Inevitably, the criminal justice administration for these people is a source of unhappiness.
Moreover, not more than 30 per cent people approach the courts in India. There is a visible decline in civil litigation, which suggests that a large number of people in the country are living with unresolved conflicts. This too dents the state of happiness in general.
Criminal justice has far-reaching consequences for the lives of people — it brings difficulties when it does not act, it causes turbulence when it does. Millions of accused, victims, suspects, witnesses and others have poignant tales about the actions and inactions of the criminal justice administration. The satisfaction level of people is far too low in this country when it comes to the police and courts.
The relationship between crime and happiness offers some interesting insights. Vesna Nikolic, a noted victimologist, says that making people happy is the best crime prevention. Do happy people become victims less often than unhappy people, and if so, why? Do happy people commit crimes, or do people commit crimes in order to achieve happiness? The connection between crime and happiness is understandable from the experience of Bhutan, which introduced Gross National Happiness (GNH) as a measure of good governance. The data show that a great majority of the Bhutanese population are happy (of whom 41 per cent are extremely happy), and only 4 per cent reported being victimised by crime over the last 12 months. Further, the crime rate in Bhutan is extremely low. A negative correlation between crime/victimisation and happiness is observed.
The World Reports on Happiness in selected countries and their crime and victimisation data present remarkable trends. The impact of criminal victimisation on happiness is often negative. Analysis from six nations, namely, Finland, Denmark, Philippines, South Africa, India and Sri Lanka shows that at least one of the four crime variables share an inverse relation with the happiness score of the respective nation. This leads to the conclusion that individuals living in nations with high crime rates are less happy and satisfied than individuals living in nations with a comparatively lower crime rate.
Does rule of law make you happy? The countries scoring high on the Rule of Law Index, a measure used by the World Justice Project, are those who are higher on the index of happiness as well. Among these countries are Denmark, Sweden, Finland, Norway, the Netherlands and Austria. The fact that happiness ought to be part of the agenda to improve rule of law, and vice versa, is a new thrust in the emerging policy discourse in many jurisdictions. The institutionalisation of a happiness framework as a measure of achievement for policy goals is now being debated. Madhya Pradesh has set up a Happiness Department to achieve such objectives.
It is probably time to change the narrative — to shift the discourse of policy making towards the larger satisfaction of the people with the public institutions they have to regularly approach for various purposes.
The ideologies promoted by the government also have an effect on the overall satisfaction of the people. Besides poverty, unemployment and other issues of sustenance, the outlook of the government on religion, gender, sexuality, etc. also determine the contentment of the governed. For example, in India, increasing incidents of cow vigilantism, communal and gender bigotry, ultimately make the society intolerant and dissatisfied. It is, perhaps, time to turn the narrative of law, policy and development, towards building a happier society.
Source: Indian Express, 24/09/2018
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Ego Prevents You From Accepting Your Mistakes

Everyone makes mistakes. But if you perceive your mistake in the right way, despair can never arise. The reason for your sadness and despair is that you actually do not want to accept your mistake, but are compelled to do so. When you are caught red-handed and have to reluctantly admit it, you feel sad, depressed and you develop complexes. This occurs when you intend to defend your ego and not honestly own up. Your suffering is not because you did what you shouldn’t have done, but because the image you have created gets tainted. He who honestly accepts his mistake so that he can uproot it would never go into depression or inferiority. You ask for atonement for a wrongdoing and you perform it, too. But the next time you get a wrong desire, you feel, ‘let me fulfil it and later I shall ask for atonement and cleanse myself.’ Your focus remains on the deed and not on the impurity latent in your intention. Thus by falsely repenting and taking atonement, you try saving your image but not move towards transformation. There is no regret for your faulty state. You try covering up the mistake. In the name of repentance, you try defending your ego. If the list of your mistakes becomes long, your ego feels hurt and you think, ‘Am I really so bad that I became angry? I am not, it’s just that such a situation arose and I happened to act like that.’ You repent and become the ‘good’ person you think you are. This so-called repentance does not transform you but makes arrangement for you to stay the way you are. You keep repeating the same mistake but do not bring any change in your inner state. Ouspensky in his book ‘Strange Life of Ivan Osokin’ writes about Ivan Osokin who goes to a mendicant and says, ‘On the whole I am a good person. Yet mistakes have been committed. Walking through an unknown path, I fell in a pit. I am not the kind who would fall, but the path was unfamiliar, there was darkness of the night and a pit. May be someone pushed and I fell in the pit. If I get to relive the past and walk again, I want to prove that I would never fall in the pit.’ The mendicant said, ‘I make you 12 years younger.’ Osokin said, ‘You see, in 12 years I will become another person. I was wishing I could get another chance so I don’t repeat the mistakes I had committed in ignorance.’ Osokin returns to the mendicant after 12 years and confesses, ‘I seek forgiveness. The mistakes I had committed in the past were not because the path was not known. The mistakes were mine alone; because I have repeated the same mistakes. I have realised that I have been living exactly the way I had lived in the past.’ The mendicant said, ‘I knew it will recur. Because the mistakes are not in the action but in the intention.’ Not just Osokin but you too live a strange life; you live your life in exactly the same way as you have been living. Even as you age, you keep repeating the same mistakes, because the doer remains untransformed. You do the same things you did in the past and so you remain the same as you were. Life gives you many chances. But you cheat yourself by blaming the circumstances.

Source: Times of India, 24/09/2018 
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Saturday, September 22, 2018

Journal of Developmental Entrepreneurship

Volume 23, Issue 02 (June 2018)

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Editor’s Note — JDE, JUNE 2018
  • 1801002
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FINANCIAL CONSTRAINTS MATTER: EMPIRICAL EVIDENCE ON BORROWING BEHAVIOR, MICROFINANCE AND FIRM PRODUCTIVITY
  • 1850008
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FRAMING SECOND GENERATION GENDER BIAS: IMPLICATIONS FOR WOMEN’S ENTREPRENEURSHIP
  • 1850009
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EFFECTUATION AND OPPORTUNITY RECOGNITION IN THE RENEWABLE ENERGY SECTOR IN SOUTH AFRICA: A FOCUS ON ENVIRONMENTAL DYNAMISM AND HOSTILITY
  • 1850010
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EXPLAINING INFORMAL SECTOR ENTREPRENEURSHIP IN KOSOVO: AN INSTITUTIONALIST PERSPECTIVE
  • 1850011
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GROUNDING THE DREAM OF AFRICAN INNOVATION HUBS: TWO CASES IN KIGALI
  • 1850012
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SAUDI ARABIAN WOMEN IN ENTREPRENEURSHIP: CHALLENGES, OPPORTUNITIES AND POTENTIAL
  • 1850013
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Protecting persons with HIV/ AIDS

A law to safeguard rights and prevent discrimination

The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act of 2017 safeguards the human rights of people living with HIV and AIDS. The Ministry of Health and Family Welfare issued a notification to bring the Act into force from September 10.
The Act was born out of an urgent need to prevent and control the virus and syndrome. It has highlighted the necessity for effective care, support and treatment for HIV and AIDS. The Act spawns from the commitment to the global community under the Declaration of Commitment on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (2001) for enhanced coordination and intensification of national, regional and international efforts to combat the virus and syndrome in a comprehensive manner.
The statute aims to provide equal rights to persons with HIV and bring them into the mainstream. The Act gains importance as it makes it a legal obligation to protect the privacy of persons with HIV and AIDS.
The law addresses discrimination meted out to persons with HIV and AIDS. It fortifies the health and medical health-care system for them and introduces legal accountability along with formal mechanisms to inquire into complaints and redress grievances.
The Act lists various grounds on which discrimination against persons with HIV is prohibited. These include the denial, termination, discontinuation or unfair treatment with regard to employment, educational establishments, health-care services, standing for public or private office, and insurance.
The requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education is also prohibited.
The Act provides that every HIV infected or affected person below the age of 18 years has the right to reside in a shared household. The Act prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them. Section 37 makes such propagation of hatred punishable with a term of imprisonment which shall not be less than three months but which may extend to two years, with fine which may extend to ₹1 lakh.
As per the provisions of the Act, every person in the care and custody of the state shall have the right to HIV prevention, testing, treatment and counselling services.
Source: The Hindu, 21/09/2018
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Saving rivers


As a first step, the capacity of treatment plants along all rivers must be urgently expanded

The finding of the Central Pollution Control Board that the number of critically polluted segments of India’s rivers has risen to 351 from 302 two years ago is a strong indictment of the departments responsible for environmental protection. The data show that the plethora of laws enacted to regulate waste management and protect water quality are simply not working. The study also underscores the failure of many national programmes run by the Centre for river conservation, preservation of wetlands, and water quality monitoring. Tests of Ganga water indicate it has fared better in Uttar Pradesh; but then, the clean-up plan for the river has received dedicated Central funding of ₹3,696 crore over three and a half years, compared to ₹351 crore given to 14 States to conserve 32 rivers. The failed efforts to control pollution are all too evident in Maharashtra, Gujarat and Assam, which account for a third of the degraded river segments. Their problems are worsened by the poor infrastructure available in a large number of cities and towns located near rivers. It is notable that these results come from a CPCB audit that was carried out at the instance of the National Green Tribunal. Ideally, the Board should be reporting more frequently on pollution, and carrying out intensive measures through State Pollution Control Boards to eliminate pollutants, starting with sewage and industrial effluents.
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Representational photo of the Ganga
More river stretches are critically polluted: Central Pollution Control Board
 
Managing sewage requires steady funding of treatment plants for all urban agglomerations that discharge their waste into rivers, and also reliable power supply. The deficit between sewerage available and the volume generated along the polluted stretches was estimated by the CPCB last year at 13,196 million litres a day. Rapid urbanisation is widening the gap, since infrastructure planning is not keeping pace with growth in housing. Moreover, with low priority accorded to enforcement of laws by the SPCBs and Pollution Control Committees — something that is unlikely to change quickly — the immediate plan should be to expand the supply of treatment plants. Sustained civil society pressure on governments is vital to ensure that this is done in a time-bound manner. On the industrial side, the plan to bring all liquid effluent discharge from textile units and tanneries to zero has to be pursued vigorously, giving industries the assistance to help them choose the best technologies for the recovery of waste water for reuse. These measures are urgently needed to revive India’s many dying rivers, protect its agriculture, and prevent serious harm to public health from contaminated water. A 2013 World Bank study estimated that environmental degradation is costing India at least $80 billion a year, of which losses to rivers form a significant part. This is indeed a problem of catastrophic dimensions.

Source: The Hindu, 18/09/2018
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India cannot afford to have a weak tribunal to adjudicate on environmental issues

Unless immediate corrective action is taken, the National Green Tribunal which has till recently served as an institution to provide environmental justice, will increasingly become an institution to perpetuate environmental injustice. If this is to happen, it will be a sad day for both India’s environment and democracy.

India’s environmental jurisprudence has seen considerable development in the last few years. This is largely because of decisions taken by the NGT, which has played a pivotal role in making sure environmental laws are taken seriously. India’s environmental court, which started functioning in 2011, has, over time, become an institution which many countries want to replicate.
But the last few months have seen a massive decline in public confidence in the NGT. The first wake-up call was in July when the new chairperson of the NGT commented that around 50% of the petitions before the tribunal were filed by “blackmailers”. Nothing could be more distressing because this comes from an institution that was created to protect the rights of the people. Recently, the decision of the chairperson of NGT to rehear 18 cases, which were reserved for judgment, has raised concerns about both propriety as well as legality.
The NGT, over the last two months, seems to have evolved four approaches to deal with litigations. First, dispose of existing cases. Second, form committees, comprising mostly people who were responsible for the problem, and outsource even adjudicatory functions. Third, refuse to entertain matters on the ground that the government has approved the project or other hyper-technical grounds. And finally, rehear cases which were earlier reserved for judgment.
One is not expecting the NGT to always give judgments in favour of those who approach it for protecting the environment. Rather, the cause for concern is the general reluctance of the tribunal to hear matters on merit, to consider the decision of the government as virtually sacrosanct and submissions of project proponents as cast in stone. It must not be forgotten that the NGT is not a special tribunal, but a specialised tribunal set up to adjudicate on complex environmental issues through the use of both judicial and technical expertise.
The decision of the tribunal must reflect the consideration of issues on merit, even if the final decision is to dismiss the appeal and application. Unfortunately, a series of orders were passed disposing of or refusing to hear appeals without consideration on the merits. An example is the appeal filed against the second airport in Mopa, Goa, where the locals opposed the project on grounds of social and environmental impact. The project entails the felling of more than 55,000 trees, loss of tiger habitats and destruction of water sources. This appeal was disposed of with directions to construct additional rainwater harvesting structures. Another appeal against a bio-ethanol plant in the No Development Zone of Kaziranga National Park, Assam, was dismissed on the ground that the appellants were a few days late.
Justice Adarsh Goel, on the day of his retirement from the Supreme Court in July, asserted that “if we cannot protect fundamental rights, wind up the Courts”. These words are very much applicable to the tribunals, including the NGT. The objective of the NGT is to protect the legal right to a clean environment, to provide a specialised remedy in the form an appellate forum against faulty decisions of the state, and provide compensation for those affected by environmental harm. At a time when India ranks lowest in the world in terms of environmental quality and more people die in India because of pollution than anywhere else in the world, the country cannot afford to have a weak institution to adjudicate on environmental issues.
The Supreme Court has held in numerous decisions that it is improper and undesirable to expose precious rights like the right of life and liberty to the vagaries of individual whims and fancies. In DTC versus DTC Mazdoor Congress 1991 Supp (1)SCC 600 , Justice PB Sawant wrote: “It is trite to say that individuals are not and do not become wise because they occupy high seats of power..There is only a complacent presumption that those who occupy high post have a high sense of responsibility. The presumption is neither legal nor rational. History does not support it and reality does not warrant it.”
Source: Hindustan Times, 22/09/2018
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