BBC News – India healthcare: Will the ‘world’s largest’ public scheme work?

Soutik Biswas, India correspondent

New Delhi-India, 4 February 2018. On the face of it, it is difficult to not warm to India’s newly announced flagship health insurance scheme, designed as a safety net for millions of people who struggle to afford quality medical care.

India has an abysmal record in public health. It presently spends a little over 1% of GDP on public healthcare, one of the lowest levels in the world.

Poor health and steep costs alone are responsible for pushing 3-5% of the population below the poverty line. Rural households source more than a quarter of their health expenses by borrowing or selling assets.

India’s disease burden – borne mainly by the poor – is higher than in many emerging economies. Quality state-run hospitals are few and far between, primary care facilities are poor and private clinics are prohibitively expensive.

The insurance scheme announced in the federal budget, dubbed “Modicare” after Prime Minister Narendra Modi by his supporters, would cover more than 500 million Indians and provide 500,000 rupees ($7,825; £5,520) in medical coverage for each family annually.

The government estimates that the premium for insuring each family would come to around $17 (£11.93), and the scheme will cost $1.7bn in federal and state funds. Finance Minister Arun Jaitley has said it will be the “world’s largest government-funded healthcare programme”.

The scheme seeks to cover the poorest of Indians, some 29% of Indians live below the poverty line, and the lower middle class, the two most vulnerable groups. They hold irregular jobs or are jobless, have few assets and are saddled with high-interest informal debt as well as having to pay for their own healthcare.

So to provide such people with decent publicly-funded medical treatment is indisputably a step in the right direction.

“The programme is bold and recklessly ambitious”, K Sujatha Rao, former health secretary and author of a magisterial book on India’s health system, told me. “Our health sector has been ignored for a long time. But the big challenge is implementation.”

That is, indeed, the biggest worry.

Federal healthcare schemes and similar publicly-funded medical insurance schemes, more than a dozen Indian states have adopted such schemes since 2007 providing secondary and tertiary care hospitalisation, albeit with much lower coverage, don’t have a very inspiring record.

Nine of 13 studies assessing such schemes reported no reduction in out-of-pocket expenses by people covered by insurance. An assessment of a publicly funded health insurance scheme for the poor launched in 2008 covering some 130 million people found that it had not “provided any significant financial protection” for poor households.

Illegal payments

One such study is of a publicly financed health insurance scheme for the poor in the central state of Chhattisgarh. It found that 95% of the insured who used private hospitals and 66% of the insured who went to government hospitals were still spending on treatment from their pockets.

In state hospitals, where treatment is supposed to be largely free, patients ended up buying consumables and medicines from private pharmacies because the hospitals simply didn’t have enough supplies. Also, illegal payments had to be made sometimes to doctors and nurses.

Private hospitals, according to study author Sulakshana Nandi simply told patients that they could not afford to provide treatment at the government-mandated rates under the scheme and asked them to pay the difference.

India’s private healthcare system is largely unregulated, opaque and often unscrupulous. It can also overcharge with impunity, leading to increasing conflict with patients.

Many believe that private facilities are actively hostile towards the poor and do not allocate enough of the mandated cheap beds for them.

“The good thing is that health is now becoming a political imperative, but we are still sleepwalking into delivery architectures without serious regulatory capacity,” says Pratap Bhanu Mehta, chief of India’s Ashoka University.

Game changer?

Furthermore, quality private healthcare is mainly available in big cities and towns, and it is difficult to see how some of India’s poorest of the poor living in remote areas and insured under the scheme will be able to reach any of these facilities.

What many miss is that the poor are actually impoverished by outpatient costs rather than hospitalisation expenses. Diagnostic tests, doctor follow-ups, basic medicines (statins for heart disease or diabetes control and psychotropic drugs for mental health, for example) and post-operative home care are expensive.

So just covering hospitalisation expenses may not help, one southern state, for example, provides free drugs to poor patients until a year after a surgical procedure, something that the federal scheme can adopt.

If implemented properly, the massive healthcare programme will be a game-changer for the poor. But, going by past experience and India’s spotty record in public delivery and weak regulation, the government will have to put in a lot of effort make it work.


The Tribune – Chief Khalsa Diwan executive expels Chadha

G S Paul, Tribune News Service

Amritsar-Panjab-India, 5 February 2018. The executive body of the Chief Khalsa Diwan (CKD) today formally accepted the resignation of Charanjit Singh Chadha and terminated his primary membership from the over century-old religious educational organisation.

The development paves the way to block Chadha officially from taking part in any CKD affair. However, the executive’s decision will be placed before the general house meeting scheduled for Tuesday to get its approval.

Of the total 29 existing executive members (barring Chadha and his deceased son Inderpreet Singh Chadha), 25 members attended today’s meeting, led by officiating president Dhanraj Singh.

Chadha’s son Harjeet Singh and another relative Navpreet Singh were also present in the meeting as part of the executive body. “The decision was taken while abiding by the Akal Takht directions which were acceptable to all”, said Harjeet Singh.

Dhanraj Singh said the members unanimously agreed to the directions of Akal Takht Jathedar Giani Gurbachan Singh and also followed the CKD constitution. Chadha’s resignation was accepted and his primary membership was cancelled.

The executive body has authorised Dhanraj Singh for any financial transactions related to the CKD. He said the fresh election for the president and other office-bearers would be conducted within two months.

Regarding the woman principal in question who was allegedly spotted with Chadha in the controversial video clip, Dhanraj Singh said, “She is on leave since the incident was reported. A three-member committee was constituted to investiagte the matter, its report is awaited”.

After submitting his resignation, Chadha had appeared before the five high priests* at the Akal Takht on January 23. Jathedar Giani Gurbachan Singh had imposed a two-year restriction on him from appearing on any social, religious and political stage.

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Den Haag Transvaalkwartier
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Man in Blue – Anti-Sikh riots: BJP files complaint with Delhi Police against Congress leader Jagdish Tytler

New Delhi-India, 5 February 2018. The BJP filed a complaint with the Delhi Police against senior Congress leader Jagdish Tytler in connection with the 1984 anti-Sikh riots.

BJP national secretary R P Singh met the Additional Police Commissioner, New Delhi, and filed a complaint which was based on purported video clips concerning the Congress leader.

The video clips were released in a press conference by Delhi Sikh Gurudwara Management Committee president Manjit Singh GK.

“It has been requested in the complaint that since the accused can leave the country any time hence he should be arrested immediately and prosecuted under IPC sections 302, 147/149 and 120-B,” R P Singh said in a statement.

Earlier, Manjit Singh GK said that they would send copies of the video clips to various authorities and demanded arrest of the Congress leader.

The Hindu – When two people get into wedlock, no one should interfere, says Supreme Court

Chief Justice Dipak Misra says no third party has the right to harass a couple, in reference to honour killings

Krishnadas Rajagopal

New Delhi-India, 6 February 2018. Two adults are free to marry and “no third party” has a right to harass or cause harm to them, said Chief Justice of India Dipak Misra, speaking against honour killings on Monday.

“When two people get into wedlock, no one should interfere. Neither parents, society, khap or panchayat… no one at all,” said Chief Justice Misra, leading a three-judge Bench that upheld the fundamental right of two people who wish to marry and live peacefully.

‘Honour killing’

When activist Madhu Kishwar brought up the issue of Ankit Saxena, a young man who was allegedly murdered by his lover’s parents, the Chief Justice said, “We are not into that. That is not before us”.

Ms Kishwar said “honour killing” was “too soft a word” for such crimes against young people. “They should be called hate crimes”, she submitted.

But the Chief Justice repeated that no one has any individual, group or collective right to harass a couple.

A senior counsel, who represented the khap panchayats, objected to them being portrayed as “inciters” of honour killings.

“Just don’t be,” the Chief Justice replied.

The counsel said such panchayats were age-old traditions and they did encourage inter-caste marriages now. He argued that the objection of khaps to marriages between people from the same gotra was upheld in Section 5 of the Hindu Marriage Act of 1955.

The Section said, “Sapinda should be removed by five degrees from the father’s side and by three degrees from the mother’s side.” He said only 3% of honour killings were linked to gotra. The remaining 97% were due to religion and other reasons.

Marriage within the same gotra led to genetic deformity in children, the counsel argued.

“We encourage inter-caste marriages. In Haryana, because of the skewed gender ratio, we get women from other States,” the counsel said.

Freedom of adults

But the Chief Justice said the court was not concerned about khap panchayats either. “We are not writing an essay here on traditions, lineages, etc. We are only concerned with the freedom of adults to marry and live together without facing harassment,” he said.

The counsel for khaps agreed that “custom is not above human lives”.

The court is hearing a petition filed by Shakti Vahini, an NGO, to make honour killing a specific crime.