Editorials/Opinions Analysis For UPSC 9 September 2024

Contents:

1. Policy Paralysis: A Weakened Public Health Sector in India
2. India Needs Consistent Engagement with ASEAN on Trade and Security
3. Building on Success: The Impact of the Swachh Bharat Mission
4. PresVu: Eye Drops to Reduce Dependency on Reading Glasses
5. The Use of Artificial Intelligence in Warfare: Navigating Ethical Boundaries and Global Norms

Policy Paralysis: A Weakened Public Health Sector in India

Context: India’s public health system is facing a crisis marked by inadequate policy focus on primary care, limited access to healthcare services for the underprivileged, and a growing emphasis on privatized healthcare models. Over the past decade, public health policies have not adequately addressed the real needs of the population, resulting in poor outcomes in both preventive and curative care. This editorial discusses the policy shortcomings that have weakened India’s public health sector, with an emphasis on primary care and public health infrastructure.

Relevance: General Studies Paper II and III, Governance and Healthcare

Mains Question: Analyze the causes of the weakened public health sector in India. What policy reforms are required to address the health needs of vulnerable populations while ensuring comprehensive access to healthcare services?

• Current Crisis in Public Health Policies:
  • India’s public health system is plagued by policy paralysis, with a growing disconnect between the needs of the population and the policies implemented by the government. Recent public health initiatives have not adequately focused on the “felt needs” of the population, including diseases of poverty like tuberculosis, malnutrition, and waterborne diseases.
  • Public health policies have become increasingly dependent on expert-driven decisions, leaving out the real experiences and needs of people, particularly the poor and vulnerable. These needs include better sanitation, access to clean water, and prevention of common infectious diseases.
• Primary Health Care: The Forgotten Sector:
  • India’s focus on primary healthcare has declined in recent years. The National Health Mission (NHM), launched in 2005, and the National Rural Health Mission (NRHM) in 2013 initially aimed to strengthen primary care services across rural India. These programs emphasized the need for community-based healthcare and the role of Primary Health Centers (PHCs) and Community Health Centers (CHCs).
  • However, subsequent government policies have focused on secondary and tertiary care services, leading to a reduction in the importance of primary health services. Data from NHM shows that India has about 1,53,655 sub-centers, 25,308 PHCs, and 5,396 CHCs, which are crucial for delivering primary care, especially in rural areas. However, the system’s capacity has remained underutilized.
• Commercialization of Health Services:
  • India’s health sector has gradually shifted towards privatization, with the government promoting insurance-based models, such as the Ayushman Bharat scheme. However, such models often benefit the secondary and tertiary healthcare sectors, while leaving primary care underfunded.
  • The Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat targets the poorest of the poor, but its coverage is limited. With only 2.5 crore people enrolled out of the targeted 50 crores, the scheme has not reached its full potential. Moreover, it primarily covers hospitalization, leaving preventive healthcare services underfunded.
• Public Health Infrastructure and Challenges:
  • The last significant health policy reforms were aimed at transforming Sub-Centers (SCs) and PHCs into Health and Wellness Centers (HWCs) under the NHM 2015 initiative. The goal was to establish 1,50,000 HWCs, with only 17,000 established by 2019. Despite these efforts, the rural health infrastructure remains weak, and gaps in staffing, resources, and accessibility persist.
  • Health outcomes in India remain poor compared to global standards. Maternal mortality and infant mortality rates continue to be high, especially in rural areas where access to healthcare is limited. India’s maternal mortality rate (MMR) was 103 per 100,000 live births in 2017-19, while the infant mortality rate (IMR) stood at 28 per 1,000 live births in 2020, highlighting the need for significant improvements in healthcare access and quality.
• Issues of Inequality in Healthcare Access:
  • India’s public health sector faces deep inequalities, particularly in rural areas where poor infrastructure, lack of trained healthcare professionals, and inadequate facilities hinder access to quality healthcare. Rural areas are home to 70% of India’s population, yet receive less than 25% of the country’s health expenditure.
  • Data from the National Sample Survey (NSS) indicates that out-of-pocket healthcare expenditures continue to be a significant burden for families, with healthcare expenses pushing nearly 7% of the population into poverty every year.
• The Role of Private Healthcare:
  • The increasing role of private healthcare has led to an imbalance in the health system. While private hospitals cater to the middle class and wealthy, public healthcare institutions remain underfunded and overburdened. The health insurance schemes launched by the government cover mainly curative treatments, making preventive care and health promotion activities a “luxury” for the poor.
  • The private sector accounts for nearly 70% of healthcare services in India, but its focus on profit-driven models leaves the majority of the population dependent on an ailing public health system.

Conclusion: India’s public health sector is in dire need of reform, with a focus on strengthening primary healthcare, reducing inequalities, and addressing the felt needs of vulnerable populations. Policy reforms should prioritize preventive healthcare, upgrade public health infrastructure, and ensure that both rural and urban areas receive adequate healthcare services. The National Health Mission and Ayushman Bharat, while well-intentioned, need to focus more on preventive services and widen their scope to cover essential primary care needs. A stronger public health system, with better resource allocation and equitable access, is essential for improving health outcomes and reducing the burden of disease in India.

India Needs Consistent Engagement with ASEAN on Trade and Security

Context: Prime Minister Narendra Modi’s recent visit to Brunei and Singapore highlights India’s renewed focus on its “Act East” policy. This visit underscores the importance of consistent engagement with ASEAN nations on matters of trade, security, and strategic cooperation. While India has historically enjoyed strong ties with ASEAN, recent years have seen a decline in engagement, particularly after India’s withdrawal from the ASEAN-led Regional Comprehensive Economic Partnership (RCEP). Modi’s visit is seen as an attempt to reset these ties and focus on the growing strategic and economic importance of Southeast Asia in India’s geopolitical vision.

Relevance: General Studies Paper II – International Relations

Mains Question: Discuss the strategic and economic significance of India’s engagement with ASEAN. How can India ensure more consistent engagement with ASEAN countries on issues of trade, security, and regional cooperation?

• India’s Act East Policy:
  • Prime Minister Modi’s visit to Brunei and Singapore represents India’s commitment to its “Act East” policy, which focuses on strengthening ties with Southeast Asian nations. Modi’s visit to ASEAN countries is the first such outreach by an Indian Prime Minister since 2018, highlighting the need for more frequent diplomatic engagement.
  • India has long-standing ties with ASEAN, but recent years have seen a decline in active engagement, particularly after India’s decision to opt out of the RCEP trade agreement in 2019. This decision left a gap in India’s regional trade relations, especially as ASEAN continued to integrate economically with other major global economies like China and the EU.
• Strategic Importance of ASEAN:
  • ASEAN’s centrality in the Indo-Pacific region makes it a crucial partner for India in its quest for greater influence and stability in the region. Modi’s visit comes at a time when India seeks to balance its relationships with China and the U.S. while promoting regional security and economic partnerships.
  • Singapore, a key ASEAN member, is strategically important for India’s semiconductor supply chain, and Modi’s visit included discussions on expanding cooperation in this sector. Singapore’s advanced electronics manufacturing capabilities make it an essential partner for India’s ambitions in semiconductor manufacturing and technology development.
• Bilateral Cooperation on Trade and Technology:
  • Modi’s discussions in Brunei included defense cooperation and space technology, with the renewal of space cooperation agreements. Brunei’s strategic location and its hosting of an ISRO station make it an important player in India’s regional space ambitions.
  • Singapore’s role in global electronics and semiconductor manufacturing is critical for India’s push to reduce dependency on China. Modi’s visit also focused on investment in rare earth minerals, de-risking supply chains, and mitigating the impact of U.S.-China trade tensions.
• Trade Decline and Need for Reset:
  • India’s trade with ASEAN has grown over the past decade, but trade with specific countries like Brunei has declined. The drop in Foreign Direct Investment (FDI) from Singapore to India further signals the need for renewed efforts to strengthen economic ties.
  • The signing of the 2009 ASEAN-India Trade in Goods Agreement (AITIGA) and the 2005 Comprehensive Economic Cooperation Agreement (CECA) with Singapore are critical frameworks that need updating to address modern trade challenges. India’s exit from RCEP has created trade gaps that need to be filled through stronger bilateral agreements with ASEAN nations.
• Geopolitical and Security Cooperation:
  • India’s engagement with ASEAN is not limited to trade. Regional security issues, including the South China Sea, Myanmar, and the Quad grouping, are important areas where India and ASEAN can cooperate. India’s commitment to ASEAN’s centrality in the Indo-Pacific security architecture remains strong.
  • Modi’s visit also reinforces India’s role in balancing Chinese influence in the region, particularly in defense and space cooperation with ASEAN nations like Singapore and Brunei. India must continue to leverage its strategic partnerships to enhance security cooperation and regional stability.

Conclusion: India’s engagement with ASEAN is vital for both economic and strategic reasons. Prime Minister Modi’s recent visit is an important step toward revitalizing ties with Southeast Asia, but consistent engagement is key to ensuring long-term benefits. Updating trade agreements, focusing on technology partnerships, and enhancing regional security cooperation are essential steps in strengthening India-ASEAN relations. In an increasingly multipolar world, ASEAN represents a critical partner for India’s Indo-Pacific strategy and its efforts to create a balanced regional order.

Building on Success: The Impact of the Swachh Bharat Mission

Context: The Swachh Bharat Mission (SBM), launched in 2014, has been a transformative sanitation program that aimed to eliminate open defecation and improve access to clean sanitation across India. This editorial discusses the long-term benefits of SBM, its role in achieving India’s sanitation goals, and the importance of sustained intervention to maintain these gains.

Relevance: General Studies Paper II – Governance and Paper III – Public Health, Sanitation.

Mains Question: Evaluate the impact of the Swachh Bharat Mission in improving public health and sanitation in India. How can sustained intervention and policy expansion ensure that sanitation goals are achieved in the long term?

• Overview of Swachh Bharat Mission:
  • SBM’s Achievements: Since its launch in October 2014, the Swachh Bharat Mission has built around 11 crore household latrines, making significant progress in reducing open defecation. According to a recent study published in the journal Nature, SBM has averted 60,000-70,000 infant deaths annually by reducing waterborne diseases and improving sanitation.
  • Open Defecation-Free Status: Open defecation leads to contamination of water sources and the spread of diseases like diarrhoea, which disproportionately affect children. The mission’s success in reducing open defecation has contributed to improved public health outcomes, as noted in the study.
• Impact on Infant Mortality and Child Health:
  • The National Family Health Survey (NFHS) data shows a decline in households without access to toilets, from 55% in 2005-06 to 39% in 2015-16. This percentage dropped further to 19% in the 2019-21 survey, driven by the large-scale construction of toilets under SBM.
  • The reduction in open defecation has had a direct impact on reducing diseases that lead to infant and child mortality. By improving sanitation access, SBM has contributed to lowering infant mortality rates, particularly in rural areas where access to clean water and sanitation is often limited.
• Addressing Malnutrition and Stunting:
  • The Nature study highlighted the link between improved sanitation and reductions in stunting (low height-for-age) and wasting (low weight-for-height) in children. Poor sanitation and contaminated water contribute to malnutrition and recurrent infections, which hamper children’s growth.
  • By addressing these issues, SBM has the potential to positively affect nutrition outcomes. The mission’s success could be further enhanced through integration with programs like the Jal Jeevan Mission, which aims to provide clean drinking water to all households by 2024.
• Expansion and Challenges:
  • While SBM has made significant strides in building sanitation infrastructure, there are still challenges in maintaining the status of open defecation-free (ODF) areas. Questions have been raised about the sustainability of the ODF status and the need for continuous behavior change campaigns to ensure that people continue using the toilets.
  • The Modi government has implemented complementary schemes like Jan Dhan and digital payments, which have helped facilitate financial inclusion and improved access to services. However, other programs like the Soil Health Card and Pradhan Mantri Fasal Bima Yojana have seen mixed success, demonstrating that sustained intervention is key to long-term program success.
• The Role of Technology and Digital Payments:
  • Digital payments and financial inclusion have played a critical role in the success of SBM. By providing subsidies and direct benefits to households through platforms like UPI, the government has ensured that households receive the financial support needed to build and maintain toilets.
  • Additionally, technology has been leveraged to track toilet construction and usage, ensuring accountability and transparency in the program’s implementation.
• The Road Ahead:
  • The success of SBM shows that sustained intervention is necessary to achieve large-scale social change. The expansion of sanitation programs, combined with access to clean water and continued health and hygiene education, will be crucial in ensuring that the gains of SBM are maintained.
  • As India aims to achieve universal sanitation and clean water access by 2024, integrating SBM with other programs like Jal Jeevan Mission and focusing on community-based behavior change campaigns will be essential.

Conclusion: The Swachh Bharat Mission has been a transformative initiative that has significantly improved public health and sanitation in India. By building millions of household toilets and promoting the importance of sanitation, SBM has averted thousands of infant deaths and reduced the spread of waterborne diseases. However, sustained efforts are needed to ensure that India remains open defecation-free, with continued investments in sanitation infrastructure, clean water access, and public health education. The success of SBM serves as a model for future government initiatives, demonstrating that sustained intervention can drive long-term change and improve the lives of millions.

PresVu: Eye Drops to Reduce Dependency on Reading Glasses

Context: Entod Pharmaceuticals, a Mumbai-based company, recently announced that the Drug Controller General of India (DCGI) has approved their new eye drop called “PresVu.” This product is designed specifically to reduce dependency on reading glasses for individuals suffering from presbyopia, a common age-related vision condition that affects a large portion of the population above 40. This innovative eye drop offers an alternative to traditional interventions like glasses or LASIK surgery.

Relevance: General Studies Paper II and III, addressing developments in healthcare and pharmaceutical innovations, public health, and technological advancements in medicine.

Mains Question: How can pharmaceutical innovations like PresVu contribute to improving quality of life for patients with presbyopia? Discuss the role of healthcare innovations in addressing age-related conditions.

• What is Presbyopia?
  • Presbyopia is a common condition related to aging, typically starting after the age of 40, where individuals experience difficulty focusing on close objects. It is caused by the natural loss of elasticity in the eye’s lens.
  • Glasses, specifically reading glasses, have been the most common solution for presbyopia, with LASIK surgery offering another alternative. However, not everyone opts for surgical intervention, making new medical innovations important for improving quality of life.
• What is PresVu?
  • PresVu is a prescription-only ophthalmic solution developed by Entod Pharmaceuticals. Its active ingredient is pilocarpine, a compound that has been used in eye treatments for decades. Pilocarpine works by contracting the iris muscles and reducing pupil size, allowing people to see near objects more clearly.
  • Entod claims that PresVu has “advanced dynamic buffer technology,” which adjusts the pH levels of the solution to enhance its effectiveness and comfort.
• How PresVu Works:
  • Pilocarpine, the active ingredient in PresVu, stimulates the muscles in the eye to contract, which results in improved near vision by focusing better on nearby objects. This reduces the need for reading glasses for those with presbyopia.
  • The mechanism involves improving the depth of focus and allowing individuals to see clearly at different distances.
• Innovation in Eye Care:
  • The approval of PresVu by DCGI marks a significant advancement in non-invasive treatment options for presbyopia. It offers a pharmaceutical alternative to corrective lenses and LASIK surgery.
  • While pilocarpine has traditionally been used to treat other eye conditions, such as glaucoma, this is the first time it has been marketed for presbyopia in India, showing how existing medications can be repurposed for new conditions.
• Regulatory Approval and Market Impact:
  • The approval of PresVu comes as the first of its kind in India for presbyopia. By offering a non-invasive solution, it is expected to become an attractive option for people who want to reduce dependency on reading glasses without opting for surgery.
  • According to Entod Pharmaceuticals, the company has already filed for patents, indicating that PresVu could have significant market potential both in India and internationally.
• Global Comparisons:
  • The United States Food and Drug Administration (FDA) approved a similar eye drop in 2021, which further demonstrates the growing global interest in pharmaceutical interventions for presbyopia. As a non-surgical treatment, such eye drops could have widespread appeal, particularly for individuals seeking less invasive solutions.

Conclusion: The development and approval of PresVu in India mark a promising step forward in treating age-related vision issues like presbyopia. By offering a non-invasive, easy-to-use alternative to reading glasses or surgical interventions, pharmaceutical innovations like PresVu have the potential to improve the quality of life for millions of individuals. With regulatory approval and advancements in eye care, the future of non-surgical solutions for presbyopia looks promising, bringing enhanced accessibility to vision correction across the globe.

The Use of Artificial Intelligence in Warfare: Navigating Ethical Boundaries and Global Norms

Context: With the rise of Artificial Intelligence (AI) in military technology, countries are grappling with the potential of AI-enabled warfare. A global summit in Seoul is addressing the responsible use of AI in the military domain, focusing on shaping international norms and ethical guidelines. India, although actively engaged in discussions around AI in civilian use, has maintained a “watch-and-wait” stance when it comes to AI in warfare. This article examines the growing integration of AI into military operations, the associated ethical dilemmas, and the emerging global frameworks to regulate its use.

Relevance: General Studies Paper III – Science and Technology and Security

Mains Question: Discuss the potential risks and ethical challenges posed by the use of Artificial Intelligence in warfare. How can global frameworks ensure the responsible use of AI in military applications?

• AI in Military Operations:
  • AI is becoming a significant player in modern warfare, with applications ranging from intelligence gathering, surveillance, target identification, and even autonomous weapon systems. Nations are increasingly integrating AI into their defense strategies, raising concerns about the ethical use of AI in war.
  • Case Study – Israel and Gaza: The Israeli Defense Forces (IDF) have reportedly used AI-based programs like “Lavender” and “The Gospel” to identify and target militant groups. These AI systems are designed to process vast amounts of intelligence data and assist in decision-making.
  • Case Study – Ukraine Conflict: Ukrainian forces are reportedly using drones powered by AI, including systems capable of identifying and striking targets autonomously. AI in the Ukrainian conflict reflects how the technology can be a game-changer in real-time battlefield operations.
• Global Diplomacy on AI in Warfare:
  • The summit in Seoul on Responsible Use of Artificial Intelligence in the Military Domain (REAIM) marks a crucial step toward establishing global frameworks on AI arms control. Co-hosted by several countries, including Kenya, the United Kingdom, and the United States, the summit brings together technologists, international organizations, and policymakers.
  • REAIM builds on previous efforts to regulate military AI, such as the initial global discussions held at the UN General Assembly (UNGA) in 2023. One of the primary objectives is to shape international norms for the responsible deployment of AI systems in military operations.
• Emerging Frameworks:
  • Several initiatives are underway to regulate AI’s use in warfare, including guidelines from NATO and the U.S. to ensure responsible AI use by their armed forces. NATO’s 2024 strategy identified six key principles for responsible military AI, emphasizing transparency, accountability, and human oversight.
  • The U.S. also released its national guidelines in 2020, accelerating efforts to create a responsible AI framework for military use. AI-enabled systems like drones and autonomous vehicles are already in use in combat zones, demonstrating the urgency of formalizing these frameworks.
• Ethical Dilemmas and Risks:
  • The use of AI in warfare presents several ethical challenges, particularly concerning the autonomy of AI systems to make life-and-death decisions without human intervention. This raises questions about accountability in the event of unintended consequences, such as civilian casualties or misidentification of targets.
  • Critics argue that the narrative around AI in warfare being a “waste management problem” diverts attention from the core issue—how to mitigate the risks of AI taking control over human decision-making in combat. The focus needs to shift toward enhancing safeguards and ensuring human involvement in the decision loop.
• India’s Stance on AI in Warfare:
  • India has been actively involved in discussions on AI in civilian use, but its approach to AI in military applications has been more cautious. While countries like the U.S., China, and Israel are pushing ahead with AI-driven military technologies, India has maintained a more reserved approach, opting to observe the evolving norms before making significant investments.
  • However, as global frameworks for AI arms control continue to develop, India will need to engage more actively to ensure that its defense strategy aligns with emerging ethical and operational standards.
• The Way Forward:
  • The REAIM process is a critical moment for global diplomacy in military AI. As AI technology advances, countries will need to work together to ensure that AI’s integration into defense systems does not lead to unintended global security risks.
  • India’s participation in these discussions is crucial for shaping global norms that balance the benefits of AI in warfare with the need for responsible use. As AI continues to transform military operations, the establishment of a comprehensive global framework will be vital in preventing the misuse of AI in combat.

Conclusion: The use of Artificial Intelligence in warfare presents both opportunities and significant ethical challenges. While AI can enhance military efficiency and reduce human error, it also risks creating scenarios where autonomous systems operate without human oversight, leading to unintended consequences. Global summits like REAIM are essential for establishing international norms that ensure the responsible use of AI in military applications. As the technology evolves, countries like India must actively participate in shaping these frameworks to balance innovation with ethical responsibility, ensuring that AI is used for the betterment of global security, not its detriment.