📰 India gives food aid, defence equipment to Mozambique
Mozambique has been fighting terrorism in its northern region
•India handed over two Fast Interceptor Craft (FIC) and other self defence equipment to Mozambique to assist in its capacity building as the Central African nation battles growing terror threats. Naval ship INS Kesari entered Port of Maputo in Mozambique to deliver 500 tonnes of food aid as well as the defence equipment, under the eight edition of Mission Sagar by the Navy to assist friendly foreign countries in the region.
•These deployments were conducted in solidarity with India’s extended Maritime Neighbourhood and highlights the importance accorded by India to these special relationships, the Navy said on Sunday. 500 tonnes of food aid has been shipped by INS Kesari to support the efforts of Government of Mozambique to cope with ongoing drought and concurrent challenges of pandemic, it stated.
•“India also remains committed to supporting the capacity building efforts of the armed forces of Mozambique. To this end INS Kesari is carrying two Fast Interceptor Craft and self defence equipment to be handed over to the armed forces of Mozambique,” the Navy said.
•The equipment will be useful be useful as Mozambique is hit by terrorism in its North, a defence official said. Terrorist group Islamic State, also known as Da’esh, and its affiliates have rapidly spread in Central Africa.
•A recent United Nations report on the threat of Da’esh had sounded an alarm on the rapid expansion of the terror group in Central Africa and especially in northern Mozambique. For instance, in August 2020 fighters of Ahl al-Sunnah wa al Jamma’ah (ASWJ) affiliated to Da’esh had briefly captured the strategic port of Mocimboa da Praia in the northernmost province of Cabo Delgado of Mozambique near the Tanzanian border.
•Of late, capacity building has been a major focus area in India’s engagements with Indian Ocean littoral states, with hardware and equipment supplied to many countries. This also helps in tackling common maritime challenges in the region. This has been a major theme of discussion at the second edition of the Goa Maritime Conclave last month which brings together countries in the Indian Ocean Region.
•INS Kesari, a Landing Ship Tank (Large) had undertaken similar mission in May-June 2020 to provide humanitarian and medical assistance to Maldives, Mauritius, Seychelles, Madagascar and Comoros, including deployment of medical assistance teams of the Indian Navy in multiple locations. Since May 2020, ships have been deployed to 15 friendly countries under SAGAR missions, the Navy said.
•These deployments, spanned over 215 days at sea, have delivered a cumulative assistance of more than 3,000 MT of food aid, over 300 MT Liquid Medical Oxygen (LMO), 900 oxygen concentrators and 20 ISO containers. Navy’s cumulative effort to make this happen amounts to 215 days of deployment at sea, with the ships traversing close to 40,000 nm and an investment of close to a million man-hours, the Navy said.
•Separately, INS Sudarshini which is on deployment to Gulf region as part of Navy’s efforts towards familiarising friendly navies on various facets of operations and training on board sail training platforms visited Port Sahid Bahonar, Bandar Abbas in Iran on December 22 on a three day visit.
•Iranian Navy trainee officers designated to undergo sail training visited the ship for a familiarisation tour of the ship. “Practical knowledge on subjects of seamanship, sail arrangement, rope work and the technicalities of sail training were shared. Hands-on practical knowledge and experience on sail rigging of both sides was also imparted during this visit,” the Navy added.
The Gulf Cooperation Council’s interests directly impinge on the outcome of the discussions
•While Iran is engaged in negotiations in Vienna on matters relating to the U.S.’s re-entry into the Joint Comprehensive Plan of Action (JCPOA) and the relaxation of the sanctions, two parties absent at the talks are watching developments very closely — Israel and the six states of the Gulf Cooperation Council (GCC) — whose interests directly impinge on the outcome of the discussions.
•Israel, in public remarks, has focused on Iran’s progress towards weaponisation while ignoring its own nuclear weapons’ capability. Serving and retired security officials have been mobilised to urge immediate and harsh military action on Iran. Unlike Israel’s theatrics, the GCC countries have been pursuing a more low-key but more constructive an approach to regional challenges — diplomatic engagement with Iran. This is largely because the U.S.’s credibility as the GCC’s security partner was severely dented when President Donald Trump failed to protect their interests in the face of Iranian attacks on their assets in 2019. U.S. standing in the region reached rock-bottom during its chaotic withdrawal from Afghanistan in August this year.
GCC engagement with Iran
•The UAE had first reached out to Iran in July 2019, when its senior officials visited Tehran to discuss maritime security. Following the U.S. assassination of Iranian general Qassem Soleimani in January 2020, the UAE and Saudi Arabia had called on the U.S. to reduce regional tensions, recognising that more conflict would bring the GCC states in the direct line of an Iranian retaliation. The GCC countries’ estrangement from the U.S.’ security partnership has been further encouraged by President Joe Biden’s avowed disengagement from the region in favour of containing China in the Indo-Pacific.
•Since April this year, Saudi Arabia and Iran have had five meetings in Baghdad – mainly to rebuild confidence between them, re-establish diplomatic ties, and address specific areas of conflict, Yemen and Syria. Given the hostility of over a decade, no major success has been announced so far, but talks are ongoing.
•The revival of the nuclear talks with Iran from November and the Israeli sabre-rattling through the Vienna negotiations have pushed the GCC states to take “their destinies in their in their own hands”, as noted by the Abu Dhabi-based commentator, Raghida Dergham. On November 23, Iran’s chief negotiator, Bagheri-Kani, visited Abu Dhabi, possibly to seek the UAE’s good offices to facilitate an agreement with the U.S.
•Soon thereafter, the UAE’s influential national security adviser, Sheikh Tahnoun bin Zayed, visited Tehran on December 6. Reports say that Iran may have sought the UAE’s help to facilitate financial transactions once the sanctions are eased. Trade ties are already flourishing: in 2021-22, Iran’s imports from the UAE are expected to reach $12 billion.
•UAE officials have also made some significant public statements relating to Iran. Anwar Gargash, Foreign Affairs Adviser to the UAE President, said at a conference in Washington in early December that states should “avoid vacuum and escalation” with adversaries and rivals. The message from the UAE is that this is “the era of crisis management and conflict resolution” and it would pursue rapprochement among the regional states.
•The UAE’s ties with Israel are a part of this approach. The visit of Prime Minister Naftali Bennett to Abu Dhabi on December 13 took place a week after Sheikh Tahnoun’s visit to Tehran. In 10 months of 2021, UAE-Israel trade has reached $875 million, besides the $1 billion UAE stake in Israel’s Tamar gas field. Six flights a day from Israel to Dubai are bringing in several thousand Israeli businessmen and tourists to the UAE. The UAE is making it clear that in its regional partnerships it does not have a zero-sum approach.
•From Vienna, instead of hard news, we have seen public posturing by the U.S. to camouflage its own responsibility for the present imbroglio. Iran’s insistence that the U.S. return to the JCPOA, remove the sanctions it had imposed under the rubric of ‘maximum pressure’, and give some assurance that a future U.S. administration will not withdraw from the agreement makes complete sense. But the polarised political environment in the U.S., Mr. Biden’s weak political position in Congress, and the pervasive hostility to the Islamic Republic make it impossible for the U.S. to accept Iran’s demands. What we are, therefore, left with is the U.S. delegation placing on Iran the onus of possible failure of the talks by blaming it for being hardline, irrational and not seriously interested in a positive outcome. In this situation, unless there is a real change in the U.S.’s approach, it seems unlikely that Vienna will deliver an agreement. What does this mean for the Gulf?
•More U.S. sanctions and more Israeli aggressiveness are well past their use-by date. The harshest U.S. sanctions on Iran have failed to bring Iran back to the negotiating table or brought about regime change. In fact, as China buys more Iranian oil and the UAE pursues trade ties, the death knell of the ‘maximum pressure’ regime is already being sounded. U.S. and Israeli commentators are also speaking out about the operational difficulties involved in an effective strike on Iran’s nuclear programme and the harmful implications this could have for Israel itself and the region, while even providing an impetus to the weapons programme that Iran has so far rejected. To avoid the possibility of a military attack, the Iranian spokesman in Vienna has just said that Iran will not enrich uranium beyond 60%, even if the talks fail.
Regional security architecture
•In this background, there are two possible scenarios for regional security. In the absence of a nuclear deal, it is likely that Israel will push for a “normalisation” of ties with more Arab states so that it builds a coalition of regional states against Iran. However, it is difficult to see how this can be achieved. There is already widespread popular opposition to this initiative across West Asia. Again, since Iran will not be intimidated into serving the U.S./ Israeli agenda, it will only aggravate regional instability and portend conflict.
•A more useful framework for the region would be an inclusive security arrangement. The first steps in bringing Iran into this architecture have already been taken through the several rounds of the Saudi-Iran dialogue, the UAE-Iran engagements, the Baghdad conference in August that brought together all the regional states, and the recent Saudi effort to build a security consensus among the GCC states at the recent Riyadh summit. This summit has accepted “strategic integration”, common foreign policies, and a joint defence agreement. But given the divisions within the GCC and the positions of Qatar, Kuwait and Oman, such a consensus will only emerge if Iran is integrated into the security framework.
•Israel’s inclusion will be more difficult – its domestic politics has been framed for decades on the basis of hostility towards Iran. But the valuable results of a more accommodative approach to the region, already apparent in the positive results yielded by normalisation with the UAE, could over time help Israel’s leaders see the benefits of deeper integration with the West Asian neighbourhood.
•Perhaps, this is what former Prime Minister Ehud Barak had in mind when he wrote recently that Iran’s ability to pursue its nuclear programme despite the severest U.S. sanctions is “a new reality [that] requires a sober assessment of the situation, decisions and actions and not hollow public threats”.
📰 Prevention is better than cure
There are several compelling reasons for extending outpatient health care coverage
•Outpatient (OP) health care, mainly comprising doctor consultations, drugs, and tests, can be called ‘the elephant in the room’ of Indian public health care policy. Over the past two decades, initiatives announced to extend health care coverage to the indigent sections have come under criticism due to their near-exclusive focus on hospitalisation (inpatient, IP) care. This owes to the fact that OP expenses have the majority share in total out-of-pocket (OOP) expenditure on health. As per the government and various representative surveys, the catastrophic impact of OP expenses on Indian households is disproportionately greater than IP expenditure.
The need for coverage
•There are, however, other compelling reasons for extending OP care coverage. First, IP care comprises high-impact and unavoidable episodes that are less prone to misuse than OP care, for which demand is considerably more sensitive to price and is thus more prone to overuse under health insurance. This logic, among other reasons, has led to IP insurance schemes being prioritised. However, while a price-sensitive demand for OP care entails that it could be misused under insurance, it also means that OP care, which includes preventive and primary health care, is the first to come under the knife when there is no insurance. In India, where there are many public IP insurance schemes but no OP coverage, this incentive is further amplified. The mantra of ‘prevention is better than cure’ thus goes for a toss.
•Second, it defies economic sense to prioritise IP care over OP care for public funds. Healthcare markets are notorious for being imperfect. However, this is more so for preventive and primary care services which often come with externalities, elicit little felt need and demand, and must therefore be the primary recipients of public investment.
•Third, positive feedback in health systems could mean that greater investments in IP care today translate to even greater IP care investments in future, further diminution in primary care spending, and ultimately lesser ‘health’ for the money invested. None of these are conducive to the epidemiological profile that characterises this country.
•Some recent policy pronouncements by the Centre have conveyed an inclination to expand healthcare coverage with little fiscal implications for the government. A corollary is that private commercial insurance has been proposed for extending OP care coverage nationwide. Little thought has gone into the many reasons why this could prove detrimental, if not a resounding debacle.
•This has to do with the reasons why OP care insurance has not caught on in India yet: under-regulated OP practices and the lack of standards therein; the difficulty to monitor OP clinical and prescribing behaviours and the concomitant higher likelihood of malpractices; low public awareness of insurance products and a low ability to discern entitlements and exclusions; and the high frequency of OP episodes and thus a giant volume of claims all embedded in a context characterised by low incomes and a high disease burden. All these entail tremendous (and largely wasteful) costs and administrative complexity, and it would be of little help even if the government was to step in with considerable subsidies. Add to it the inexperience that a still under-developed private OP insurance sector brings.
Back to the basics
•It is important to note a few caveats at the outset. First, significant improvements in healthcare are implausible without significant fiscal and time commitments. Second, there is no ‘perfect’ model of expanding healthcare — the emphasis must be on finding the best fit. Third, implementing even such a best fit could involve adopting certain modalities with known drawbacks.
•For India, wisdom immediately points to successful countries that are (or were, at one point) much closer to its socioeconomic fabric, such as Thailand, than countries like the U.S. which we currently look to emulate. The remarkable decline in OOP expenditure that Thailand recorded was achieved on the back of a universal, tax-financed, public sector-predominant model of OP care.
•The focus must be on expanding public OP care facilities and services financed mainly by tax revenues. Now, the sparse number and distribution of public facilities offers various modes of rationing care, and their expansion is likely to result in a considerable spike in demand. Systematic, judicious, and tiered copayments on certain OP services that are prone to overuse may be needed, as also a standard benefit package. Contracting with private players based on objective and transparent criteria would also be called for, with just enough centralised supervision to deter corruption while preserving local autonomy. To deter supply-side malpractices, low-powered modes of provider payment, such as capitation, may be considered for private providers wherever possible.
📰 The elderly are assets, not dependents
Proof of a truly developed country lies in the way it not only nurtures its young but also cares for its elders, equally
•In the past few decades, concerns about “population explosion” have given way to joy about a “demographic dividend”. The latter is expected to give a push to economic growth due to the lower dependency ratio which results from having a larger proportion of the population in the working-age group. The “Asian Tigers” — countries such as South Korea, Taiwan, Hong Kong and Singapore — as also China, have exemplified the benefits.
NFHS-5 data
•The larger youth population is also expected to give an impetus to innovation and entrepreneurship. Not surprisingly, then, the young are in focus, with many programmes to facilitate their education, entrepreneurship, sports training, etc., but also well-being. This is as it must be, not just from an economic viewpoint, but especially from the perspective of health. Poor health, like inadequate education, could well nullify the demographic advantage. Of concern is data from the latest National Family Health Survey (NFHS)-5, which indicates that while much progress has been made, the metrics for infant and child health continue to be dismal, with some being even lower than what they were five years ago.
•Yet, even as we pay attention to the young, there is both need and benefit in also looking at the other end of the spectrum. Life expectancy in India has risen from 50 (1970-75) to 70 years (2014-18); as a result, the number of elders (those over 60 years) is already 137 million, and expected to increase by 40% to 195 million in 2031, and 300 million by 2050. While one perspective would look at them as dependents (and, therefore, a drag on the economy), a rather different view would look at them as a potential asset: a massive resource of experienced, knowledgeable people. Converting them from dependents to productive members of society depends on two primary factors: their health and their capabilities.
Changing health-care needs
•Generally, the elderly population needs more medical attention of a diverse range. As per the first ever Longitudinal Ageing Study in India (LASI), 11% of the elderly suffer from at least one form of impairment (locomotor, mental, visual and hearing). It is estimated that 58 lakh Indians die from noncommunicable diseases (NCDs) in India annually, and cardiovascular disease (CVD) prevalence is estimated to be 34% amongst 60-74 yearolds, rising to 37% in those above 75 years. As we move to a demographic where the growth rate of elders far exceeds that of the young, perhaps the biggest challenge that the country would face is to provide a range of quality, affordable, and accessible health and care services to the elderly. They require an array of specialised medical services at home including tele or home consultations, physiotherapy and rehabilitation services, mental health counselling and treatment, as well as pharmaceutical and diagnostic services. These needs are particularly evident now, with elders being advised to stay indoor as a precaution against the novel coronavirus epidemic.
•As per the 2016 Healthcare Access and Quality Index (HAQ), India improved its HAQ score from 24.7 in 1990 to 41.2 in 2016. However, we still are significantly below the global average of 54 points, ranking at the spot of 145 out of 195 countries. The low HAQ worsens even further in smaller cities and rural areas where basic quality health-care services are very inadequate. Factors such as familial neglect, low education levels, socio-cultural beliefs and stigma, low trust on institutionalised health-care services and affordability exacerbate the situation for the elders. Inequity in health-care access compounds the problems for the elderly, who are already, physically, financially and at times psychologically restricted in understanding, responding to, and seeking medical care for various ailments. Consequently, most of them live their years in neglect.
Inadequate schemes
•Health care of the elderly has, sadly, been greatly neglected. An overwhelming proportion of the elders are from the lower socio-economic strata (including many who are destitute). They are unable to afford the cost of health care and slip into ever poorer health. The vicious cycle of poor health and unaffordable health costs is further accelerated by their inability to earn a livelihood. As a result, not only are they economically unproductive but are dependent on support from family or others. This, and poor physical health, adds to their mental and emotional problems. The Government does have schemes that cover the elderly and seeks to take care of these issues, but they are completely inadequate.
•Despite Ayushman Bharat, the Government’s health insurance scheme for the deprived, and private health insurance, a NITIAayog report indicates that 400 million Indians do not have any financial cover for health expenses. One can be sure that a very large number of elders are among the uncovered. Both the Centre and States have pension schemes for the elders, but these provide but a pittance — as low as ₹350 to ₹400 a month in some States. Even this is not universal.
•A 2007 law requires States to ensure earmarked facilities for elders in every district hospital, headed by a doctor with experience in geriatric care. Yet, a status report filed by the Government in the Supreme Court of India in 2019 stated that 16 States and Union Territories (‘of 35’) did not have a single ward/bed dedicated to elders.
Opportunities in challenges
•Given the range of diverse challenges, can India take care of its aging population? The success of the COVID-19 vaccination strategy gives hope: a seniors-first approach led to over 73% of elderly population receiving at least one dose and around 40% being doubly vaccinated by October 2021.
•Considering the demographic trends, India should reimagine its entire health-care policy for the next few decades, with an elderly prioritised approach. As senior citizens require the most diverse array of health-care services, the creation of adequate services for them will benefit all other age-groups. Apart from legislating pro-elderly health care and insurance policies, India needs to aggressively take certain measures, while finding opportunities amidst this challenge.
•India needs to rapidly increase its public health-care spending, and invest heavily in the creation of well-equipped and staffed medical care facilities and home health-care and rehabilitation services.
•Presently, India has a major deficit in infrastructure and skilled medical care resources, with 1.3 hospital beds, 0.65 physicians, and 1.3 nurses for every 1,000 people. Over the next decade, we have the potential to add more than 3 million beds, 1.54 million doctors and 2.4 million nurses. We need to accelerate implementation of programmes such as the National Programme for Health Care of the Elderly (NPHCE). The Ayushman Bharat and PM-JAY ecosystems need to be further expanded and similar, special health-care coverage schemes and services need to be created for senior citizens from the lower economic strata. The National Digital Health Mission has tremendous potential to expand medical consultations into the interiors of the country. However, this requires a digital literacy campaign for senior citizens.
•These essential steps will help to convert elders into a massive resource for socio-cultural and economic development, giving an altogether different perspective to “demographic dividend”. After all, the proof of a truly evolved and caring nation lies in the way it not only nurtures its young but also how it cares for its aging population.
📰 A chance to tap India’s high equity in Myanmar
Though there are challenges, the momentum gained from the Indian Foreign Secretary’s recent visit must not be lost
•The short visit to Myanmar (December 22-23) by India’s Foreign Secretary Harsh Vardhan Shringla had a clearly-etched mandate: to deepen cooperation with an important neighbour. His mission succeeded to a large extent, but challenges remain.
•The Indian delegation took a special flight to Naypyitaw and Yangon. It certainly eased logistics for the officials, but was fully utilised as it also carried one million India-made vaccine doses, as a gift to the people of Myanmar.
Regional dimensions
•Mr. Shringla followed India’s calibrated middle-path position. Not the West’s reflexive policy of condemnation, threats and sanctions against the military regime, but a position reflective of regional realities. It is no easy task.
•Since the military coup on February 1, 2021, the international community has stayed divided on how to address the derailment of Myanmar’s transition to democracy. For a decade, the country’s ‘hybrid democracy’ based on power-sharing between the military and elected representatives ran well enough. But an overwhelming electoral victory of the National League for Democracy (NLD) led by Daw Aung San Suu Kyi in November 2020, unnerved the military leadership. It apprehended that armed with a new mandate, the NLD would move fast to clip the Army’s wings. The Tatmadaw (Myanmar’s military) moved faster, seizing power in violation of the Constitution and putting down the Opposition with an iron hand. The results have been disastrous for democracy, economy and the people’s well-being, especially as the political crisis coincided with COVID-19 ravaging the ‘Golden Land’.
•Global dismay was evident in the western sanctions, but others such as Russia saw the opportunity to strengthen ties with the new rulers. China regretted the loss of Daw Suu Kyi as a valuable ally but took urgent steps to stabilise and expand cooperation with the military regime. The Association of Southeast Asian Nations (ASEAN) first showed creativity through its ‘Five-Point Consensus’ formula, but later its unity stood damaged once Myanmar’s top leader Senior General Min Aung Hlaing (picture) refused to cooperate in the formula’s implementation.
•In this highly polarised and complex situation, Mr. Shringla has succeeded in holding substantive discussions with the top State Administrative Council (SAC) leadership and political parties including the NLD in Naypyitaw as well as Senior General Min Aung Hlaing and the representatives of civil society in Yangon. India’s position, as conveyed to Myanmar, is similar to and supportive of ASEAN: release of political prisoners; resolution of issues through dialogue; cessation of “all violence”; and full cooperation with ASEAN. In recent years, India has assisted Myanmar through capacity-building programmes for strengthening the transition to democracy. This assistance remains available, but it is not an offer of mediation by India in the military-NLD conflict. This burden will have to be borne by ASEAN.
•That India’s position carries confidence is reflected in an unusual interactive meeting Mr. Shringla held with a select group of Myanmar-based foreign Ambassadors.
Bilateral concerns
•Myanmar’s military is responding as it can. India’s principal concerns pertaining to border security and stability in its neighbourhood were clearly conveyed, especially the noticeable escalation of activities of anti-India insurgent groups. By handing over five cadres of the Manipur People’s Liberation Army to Indian authorities before the Shringla visit, the military government demonstrated its desire for cooperation. It also renewed the previous pledge that its nation’s territory would not be allowed to be used for any activities inimical to India.
•The second issue — the outcome of Myanmar’s instability — is that of refugees. Several thousands of Myanmar people have sought shelter in Mizoram. This will only be reversed by a political settlement in Myanmar, through dialogue. This issue too was taken up seriously, despite the understandable reiteration later of known positions in the regime’s formal take on discussions last week.
•Economic cooperation has always been a major agenda item in all bilateral discussions with Myanmar. This visit was no exception, with the usual emphasis on “people-centric socio-economic developmental projects”. Central to this is India’s long-delayed commitment to “expeditious implementation” of mega initiatives such as the Trilateral Highway and Kaladan projects. Unfortunately, no revised deadlines were announced. These projects continue to be the Achilles heel of the relationship.
Protocol departure
•Still, India continues to have high equity in Myanmar, which it must now carefully leverage. It is reflected in the special gesture made by Senior General Min Aung Hlaing (who is Chairman of the SAC and Prime Minister) to receive Mr. Shringla and hold detailed discussions in Yangon. This is unusual. The Myanmar establishment is highly protocol-conscious. My innings as Ambassador in Yangon saw three visits by the Indian Foreign Secretary (i.e., two different office-holders), but they were not received by the regime’s highest dignitary. The protocol departure for Mr. Shringla revealed current political realities which should be carefully factored in by those who wrongly argue that China is the only friend Myanmar has.
•Also, though the request for the Indian Foreign Secretary’s call on Daw Suu Kyi was not acceded to, as was expected, it should be underlined that New Delhi made the request. There are other ways to pursue the matter as India has done in the past. A quiet approach then resulted in a rare call by this writer on Daw Suu Kyi in January 2003 when she was still under house arrest. Projecting the request this time around may yet produce results.
Back home, the steps to take
•Both the Government and the Opposition in Myanmar seem to understand India’s sober approach. India can leverage the gains of this visit and keep up the momentum by inviting Myanmar’s Foreign Minister at an appropriate time as well as other important stakeholders such as leaders of political parties, civil society and think tanks to India for deliberations with their counterparts here. The single goal should be to put Myanmar back on the path of becoming “a stable, democratic and federal union”.
