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1st December 2020 – Editorials/Opinions Analyses

Contents

  1. A misguided policy that cuts deep into patient safety
  2. Is a person’s address public information?

A MISGUIDED POLICY THAT CUTS DEEP INTO PATIENT SAFETY

Context:

On November 20, the Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry to regulate Indian systems of medicine, issued a gazette notification allowing postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.

Relevance:

GS Paper 2: Social Sector & Social Services (health, education, human resources – issues in development, management);

Mains Questions:

  1. Is allowing Ayurvedic doctors to perform surgery legally and medically tenable? 15 marks
  2. There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals. Discuss the statement in context of allowing Ayurvedic doctors to perform surgery. 15 marks
  3. India needs its Ayurveda graduates, including surgeons, to improve the common man’s access to decent health care. Comment. 15 marks

Dimensions of the Article:

  • What is the issue?
  • Health Status in India
  • Significance of allowing Ayurvedic practitioners to formal training
  • Issues related to this decision
  • Way Forward

What is the Issue?

The Central Council of Indian Medicine issuing amendments to the Indian Medicine Central Council (Post Graduate Ayurvedic Education) Regulations, 2016,

  • to allow postgraduates students in Ayurveda undergoing ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures.

This was immediately opposed by many allopathic professionals, with the Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy.

Health Status in India

  • Poor doctor-population ratio: India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000.
  • Poor distribution of doctors: In addition, there is a huge skew in the distribution of doctors working in the Urban and Rural areas with the urban to rural doctor density ratio being 3.8:1.
  • Poor condition in rural areas: Consequently, most of rural and poor population is denied good quality care leaving them in the clutches of quacks. It is worth noting that at present 57.3% of personnel currently practicing allopathic medicine does not have a medical qualification.
  • Health expenditure:
    • General Government expenditure on health as percentage of GDP in 2019-20 was 1.6% (up from 1.5% in 2018-19.
    • Out-of-Pocket Expenditure (OOPE) as a percentage of Current Health Expenditure fell down to 58.7% in 2016-17 from 60.6% in 2015-16.
    • Population with health insurance coverage: About 14% of the rural population and 19% of the urban population had health expenditure coverage.
  • Availability of basic infrastructure:
    • India has 8.5 hospital beds per 10,000 citizens, one doctor for every 1,456 citizens (WHO’s prescribed norm is 1:1000) and 1.7 nurses per 1,000 people (WHO’s prescribed norm is 3:1000).
    • Lack of adequate number of ventilators in hospitals needed for patients with severe COVID-19 infection.
    • Availability of limited accredited diagnostic labs delays testing and consequent understanding of disease progression.
  • Uneven distribution of healthcare workforce: Most of the workforce practice in metropolitan or tier I or tier II cities, creating personnel deficiencies in small towns and villages.
  • Denial of healthcare: Private hospitals are reportedly denying treatments to the poor along with the cases of overcharging patients despite accounting for about 62 percent of the total hospital beds as well as ICU beds and almost 56 percent of the ventilators.

Significance of allowing Ayurvedic practitioners to formal training

  • It will address the poor doctor-population ratio in India and improve human resources in providing health facilities.
  • Theses Ayurvedic practitioners can work in rural areas, which is facing shortage of doctors.
  • Today, private health facilities are much costly due to demand-supply mismatch. The poor people can’t afford this costly health facility. Allowing Ayurvedic doctors in surgery will reduce the health expenditure.
  • It will reduce out of pocket expenditure which is very high in India.
  • Several countries have been using mid-level care providers, such as nurse practitioners, to enhance the access to healthcare, though with strict safeguards around training, certification, and standards. India can also use it health workforce.
  • Ayurveda graduates including surgeons are a large workforce in search of an identity. India needs them. If they are creatively and properly trained, they can play important roles in our health-care system.
  • Moreover, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course.

Issues related to allowing Ayurvedic practitioners to formal training

  • The basic requirement of medical practice is the safety of the patient. Surgery is a branch of medicine in which poor training can have dramatic and disastrous results.
  • The well-trained surgeon must have a good knowledge of the structure of the human body in health and disease. This is one branch of medicine where knowledge can only be acquired through apprenticeship — that is, the learner needs to be guided by an expert.
  • The surgeon needs to know when not to perform surgery, a skill commonly called clinical judgement. These skills are difficult to teach and difficult to master.
  • Errors in surgery can be devastating. Data from the United States suggests that up to 4,000 surgical errors occur each year despite well-considered controls on who can perform surgery.
  • In India, the Consumer Protection Act serves as an incentive to modern medical practitioners to provide high quality health care. Even this legal mechanism is not accessible to the poor. It is quite clear that there is no shortcut to safe surgical outcomes.
  • Modern medical training consists of a basic degree during which the fundamentals of the functioning of humans in health and disease, and techniques to diagnose illnesses are taught. It is impossible for Ayurveda to incorporate surgical techniques while ignoring all the other domains of modern medicine and still perform surgery safely and effectively.
  • Surgical facilities manned by graduates of Ayurveda will be patronised only by the very poor who do not have the resources to access modern medical care. This will further entrench the existing grossly unequal access to health care.

Way Forward

There is a shortage of trained medical personnel in rural areas. The only way to address this is to greatly increase the number of government medical colleges. This will take a few years, but it is a safe and effective policy. Safety of patients should not become a victim of misguided policies based on poor understanding of what safe surgery requires.


IS A PERSON’S ADDRESS PUBLIC INFORMATION?

Context:

Recently, in a case involving activist Saket Gokhale, the Bombay High Court ordered the Ministry of Information and Broadcasting to remove Mr. Gokhale’s contact details from its website.

Relevance:

GS Paper 2: Important aspects of governance; Transparency and accountability (institutional and other measures);

Mains Questions:

  1. Only information bearing a nexus to public activity should be available to the public. Discuss. 15 Marks
  2. The disclosure of addresses of citizens in the public domain plays a crucial role in boosting public confidence in governance systems and ensuring efficiency while also combating corruption in its various forms. Analyse. 15 marks
  3. What is Right to Information Act? Assess the role of Right to Information Act to bring transparency and accountability in governance. 15 Marks

Dimensions of the Article

  • What is the Right to Information Act?
  • Exemptions under RTI Act
  • Whether a person’s address is public or private information.
  • Way Forward

What is Right to Information Act?

The Right to Information (RTI) Act was enacted by parliament in 2005 to empower citizens, promote accountability and transparency in the working of the government and contain corruption.

  • Despite challenges in RTI act, people have used it fiercely and owned the law like no other.
  • In the unequal battle of trying to hold power to account, it offers sense of hope for the human desire for dignity, equality, & the capacity to enforce these to some extent.
  • RTI addresses the issue of constitutional rights and empowers people to demand answers – basis of democracy. It encourages a culture of asking questions in ordinary people.
  • It can help us escape from policy paralysis, and build a more informed, equitable and robust decision-making process.
  • Beside good governance RTI has helped in the development process as well:
    • effective delivery of socio-economic services, awareness and realization of entitlements
    • Guarantee of income and Food Security: Reduction in leakages and corruption in social welfare schemes, better scrutiny, allocation of resources, effective delivery of services
    • Human Capital: Education and Health Care: Schemes like SSA, National Rural Health Mission are better implemented

Exemptions under RTI Act

  • Section 24 of RTI says that RTI is not applicable to the intelligence and security organisations specified in the Second Schedule with only exception for information on allegations of corruption and human rights violations.
    • Second Schedule includes 26 intelligence and security agencies under its ambit. Some of them are IB, RAW, Cabinet Secretariat, BSF, NSG etc.
    • Recently, Strategic Forces Command (SFC) which forms part of the National Command Authority (NCA) has been added to this schedule.
  • Exemption to certain Information under Section 8 of RTI
    • National security or sovereignty
    • National economic interests
    • Relations with foreign states
    • Law enforcement and the judicial process
    • Cabinet and other decision making documents
    • Trade secrets & commercial confidentiality
    • Individual safety
    • Personal privacy

“Public authority” according to Section 2(h) of Right to Information Act, 2005 includes:

  • Any authority or body or institution of self-government established or constituted
    • By or under the Constitution (or)
    • By any other law made by the Parliament or State Legislature (or)
    • By notification issued or order made by the Central Government or a State Government
  • Bodies owned, controlled or substantially financed by the Central Government or a State Government
  • NGOs substantially financed directly or indirectly by the Central Government or a State Government.

Whether a person’s address is public or private information:

  • The address of people’s residence or office has never been considered private under Indian law.
    • The government telecom service providers used to supply telephone directories to everyone containing the names, telephone numbers and addresses of every subscriber in the city.
    • Electoral voter lists include the addresses of all voters in each and every ward. These lists are now available online in a digital format on the website of the Election Commission.
    • Land records, containing details of ownership, are open for public inspection across the country and play a crucial part in ensuring confidence in the volatile land markets in India.
    • All FIRs in cognisable cases must be displayed on the website, according to a Supreme Court judgment. These would display the names and addresses of the complainants and the accused.
    • Many of the new transparency initiatives such as the Jan Soochna Portal in Rajasthan make available the details of all beneficiaries of all welfare schemes administered by the State government.

Way Forward

The rationale for such disclosures is quite simple. As has been demonstrated repeatedly by grassroots activists working on the Mahatma Gandhi National Rural Employment Guarantee Scheme and the Public Distribution Scheme, access to information about beneficiaries, including addresses, is critical to weeding out ‘ghost beneficiaries’ created by officials looking to pilfer funds or rations. In all of these cases, the disclosure of addresses of citizens in the public domain plays a crucial role in boosting public confidence in governance systems and ensuring efficiency while also combating corruption in its various forms.

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