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Union Budget for 2018-2019 has promised a National Health Protection Scheme (NHPS), a publicly funded health insurance programme for half a billion citizens of the country. But no sufficient funds have been allocated for what Finance Minister Arun Jaitley said would be the world’s largest government-funded healthcare programme.

In the first phase, 1.5 lakh health and wellness centres are proposed to be set up across the country to provide comprehensive healthcare including free medicines and diagnostic services. But the Budget allocation for this is only Rs 1,200 crore. This works out to about Rs 80,000 per centre. If a centre receives 100 patients on weekdays which will make around 25,000 in a year, the average allocation per patient would be a little over Rs 3 which is much too insufficient even to cover the medicines and diagnostic services, leave aside the overhead expenses on running a centre.

It’s not that the government woke up only recently to the health problems of the people. Union Home Minister Rajnath Singh had observed in December 2014 — a few months after the present NDA government took office — that a major change in the health care system of India was needed. The country, he said, was at present having a fragmented healthcare system which was not at all enough to cater to the needs of the people, particularly the poorer sections of the society.

Addressing the 10th convocation of King George’s Medical University (KGMU) at Lucknow, he said, ‘if the primary healthcare centres are strengthened, almost 85 per cent of the burden on the major institutes like All India Institute of Medical Sciences, Sanjay Gandhi Post Graduate Institute of Medical Sciences and King George’s Medical University can be brought down.’ he added that the Government of India was working to bring about this change.

But the Government had, apparently, other priorities more pressing than the poor man’s health. A parliamentary panel report on health and family welfare released last year pointed out that in India there is just one government doctor for every 10,189 people, one government hospital bed for every 2,046 people and one State-run hospital for every 90,343 people. (Needless to say that most of these facilities are concentrated in urban areas.) With a doctor-patient population ratio worse than Vietnam, Algeria and Pakistan, the shortage of doctors is one of the biggest ailments afflicting the country’s health management system, the panel noted.

Meagre budgetary allocation for health services is the major factor affecting healthcare system, particularly in the rural and suburban areas. But more than that it is the mismanagement born out of indifference of the ruling classes that is plaguing the health delivery system. According to the findings of the Comptroller and Auditor General (CAG) in his report on reproductive and child health under the National Rural Health Mission for the year ended March 2016, the picture that emerges in several States is one of inability to absorb the funds allocated, shortage of staff at Primary Health Centres (PHCs), Community Health Centres (CHCs) and district hospitals, lack of essential medicines, broken-down equipment and unfilled doctor vacancies. In the case of Uttar Pradesh, the CAG found that about 50 per cent of PHCs it audited did not have a doctor, while 13 States had significant levels of vacancies.

A serious effort in this direction has of late been made by the Delhi Government by opening ‘Mohalla Clinics’ for providing free primary healthcare services to the people in the capital. The effort has been lauded by former United Nations Secretary-General Kofi Annan. In a letter to Delhi Chief Minister Arvind Kejriwal, Annan wrote, ‘we understand that this initiative is proving very successful and we commend you on this impressive achievement.’ Annan wrote the letter in his capacity as the Chair of ‘The Elders’, an organisation of independent global leaders founded by anti-apartheid icon and former President of South Africa Nelson Mandela. Dr Kenneth E Thorpe, Chair of Department of Health Policy at the Rollins School of Public Health, USA, remarked after visiting ‘Mohalla Clinics’ during one of his visits to India that these Mohalla Clinics ‘are definitely an important addition to India’s health sector.’

Politicians in power and government servants mostly patronise private nursing homes even for minor and routine ailments. Services in government-run hospitals, dispensaries and health centres will improve substantially if the government stops, by enacting a law or by evolving a convention, reimbursement of expenses incurred by these classes on meeting their health needs in private nursing homes. But the health insurance programme enunciated in the budget is only meant to help further private operators because there is nothing the budget to strengthen Government-run hospitals and dispensaries.

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Chief Minister Shivraj Singh Chouhan’s fascination for holding panchayats may have declined but his enthusiasm for making promises has not. He has now promised to create an atmosphere of happiness in the State and would pay Rs 10 lakh to whoever is willing to submit a project to achieve this. This is only natural that he should think of spreading happiness all around after having taken care of the problems of different segments of society. That he did by holding panchayats of those segments.

Within months of his having taken over as Chief Minister in November 2005, Chouhan held a kisan panchayat at his residence where he made as many as 35 promises aimed at redressing each and every grievance of the farmers. Chouhan is never tired of calling himself a ‘kisan-putra’ and the fact that the first panchayat he held was of the farmers shows his overwhelming concern for the agricultural community. If the farmers are still restive and agitating violently for the redress of their grievances and committing suicide almost regularly, it is only too bad.

Having taken care of the problems of farmers, Chouhan paid attention to other sections. So far he has held nearly two scores of panchayats covering almost every segment of society. The panchayat of Bais (house-maids) was the twenty-first such panchayat held at the CM’s residence. Chouhan declared at the outset that a housemaid would no more be called as Bai (as is the custom) but ‘Behen’ if she is younger and ‘Didi’ if she is older. The Bais would be issued photo identity cards and the Government would spend up to Rs 20,000 if a Bai fell ill. This facility would be extended to her husband, son, daughter, mother-in-law, father-in-law and widowed and deserted daughter also.

The other promises made by Chouhan included: free text-books to their children in addition to the monthly cash payment to the children; 45 days’ maternity leave and 15 days’ paternity leave to the husband while the Government would pay the wages of both for these periods; Rs 1000 cash payment to the Bai for nutritious diet during maternity. There were some more promises like insurance cover against death or accident and provision of pension.

He made similar promises with variations according to their specific needs to different sections such as agricultural labourers (including financial help for cremation if an agricultural labourer or his/her dependant died), kotwars (land, new cycles, new bright uniforms every year and immunity from prosecution), industrialists (international markets would be made available to the small scale sector for its products), the disabled, the poor belonging to the general category, and the women.

After solving the problems of the people segment-wise, Chouhan decided some time back to set up a Department of Happiness to spread happiness throughout the State. The Minister of Happiness, incidentally, is Lal Singh Arya against whom there is a non-bailable arrest warrant in a murder case. He waited for nearly two weeks for the police to arrest him but the police could not find him. Then he managed to get a stay order from the High Court. Now the Chief Minister has promised Rs 10 lakh to whoever can tell him how to spread happiness all around.

The Electoral Bonds scheme, notified by the Union Government on January 2, is a clever step towards emaciating the opposition parties. Neither will it lead to greater transparency in the funding of political parties (as claimed by Finance Minister Arun Jaitley) nor will it check the flow of black money into the electoral process. Even Election Commission has expressed apprehensions at the move. The scheme was mischievously included in the 2017-2018 budget proposals.

According to the notification, only the State Bank of India (SBI) can issue the Electoral Bonds  in the denominations of Rs 1000, Rs 10,000, Rs one lakh, Rs ten lakh and Rs one crore. A total of 53 branches of SBI have been authorised to sell the Bonds – one branch in the capitals of all the States and Union Territories – more than one branch in some States. An individual or body can purchase these Bonds from the designated branches after fulfilling the KYC (Know Your Customer) requirements. However, the Bonds will not carry the name of the purchaser.

The byer can donate these Bonds to a political party which is registered with the Election Commission and has received not less than one per cent of the votes in the last Lok Sabha or Assembly election. The party can encash the Bonds only by depositing these in its bank, registered with Election Commission, within 15 days after the issuance of the Bond. If not deposited within 15 days, the amount of the Bond will go to the Prime Minister’s Relief Fund.

Jaitley told Lok Sabha on January 2 that ‘the element of transparency is that the balance sheet of donors will reflect that they have bought a certain amount of Bonds and political parties will also file their returns (with the Election Commission) that will reflect the extent of Electoral Bonds received.’ The Finance Minister also said that ‘political funding needs to be cleansed up. A very large part of donation coming to political parties by the donors, quantum and source is not known….Electoral Bonds (will) substantially cleanse the system.’

The Election Commission was not amused when Jaitley had announced the Electoral Bonds scheme in his budget proposals. Its objection mainly was that it might lead to the use of black money in electoral politics. In his keynote address at a conference of Association for Democratic Reforms (ADR) some time back, Election Commissioner O P Rawat observed that ‘the recent amendments in the election and income tax laws make it clear that any donation received by a political party through an Electoral Bond has been taken out of the ambit of reporting in the Contribution Report which political parties have to submit to the EC. Implications of this step can be retrograde as far as transparency is concerned. Furthermore, where contributions received through Electoral Bonds are not reported, a perusal of contributions reports will not make it clear whether the party in question has taken any donations in violation of Section 298 of the Representation of the People Act, which prohibits political parties from taking donations from Government companies and foreign sources.’

Election Commission had expressed the apprehension that abolition of relevant provisions of the Companies Act of removing a cap of 7.5 per cent of profit for political donations can lead to money laundering by setting up of shell companies for diverting funds for donations to political parties.

The January 2 notification says: ‘the information furnished by the buyer (of Electoral Bonds) shall be treated confidential by the authorised bank and shall not be disclosed to any authority for any purposes, except when demanded by a competent court or upon registration of a criminal case by any law enforcement agency.’

That, of course, is the official position. Unofficially, the SBI is all but part of Finance Ministry. In the corruption-ridden system that we have, an unscrupulous Finance Minister can always get the information as to who purchased Electoral Bonds of what amounts and to  which parties’ accounts have these been credited. Next is carrots and sticks approach. 


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Outright Perilous!

An egoist as the head of the government is bad enough. An egotist is a nuisance as his constant chant of I…, I…., I….. jars on the listeners’ years. But when he loses touch with the reality and starts believing his imaginary achievements to be his real achievements, that’s outright perilous.

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