📰 India’s second COVID-19 wave too saw penury: study
Hunger Watch-2 finds income dip and hunger, despite no national lockdown.
•India’s second wave that didn’t see a national lockdown like in the first failed to significantly alleviate economic distress and hunger among the poor, according to a survey of 6,500 respondents in 14 States.
•The survey, Hunger Watch–2, was commissioned by the Right To Food Campaign and The Centre for Equity Studies from December–2021 to January 2022 to evaluate economic distress following the second wave. The same organisations had conducted a similar survey, Hunger Watch–1, in October-December 2020 to measure the fallout of the first wave.
•66% of the respondents to the second survey said their income had decreased as compared to pre–pandemic period. This proportion was larger among urban households, among households earning less than ₹3,000 per month and among Muslim households. Only 34% of the overall sample reported that their household’s cereal consumption in the month preceding the survey was ‘sufficient’ and 79% of the households surveyed reported some form of food insecurity.
•Food insecurity is worse among urban households. 87% of Muslim households reported some form of food insecurity compared to 77% Hindu households, the report noted.
•The first survey had reported similar numbers suggesting that the absence of a national lockdown didn’t automatically improve the odds of the poorest accessing adequate work and nutrition. Over two thirds of the respondents, for instance, reported that in October 2020, the quantity of food they were able to consume was less than what it was before the lockdown. Seven out of 10 respondents reported a worsening nutritional quality of diets.
•In 2020 too, the survey found, those belonging to socially vulnerable groups such as Dalits, Adivasis and Muslims as well as households with single women, aged, disabled were worse off. These households reported higher decline in consumption of food.
•Only half of those interviewed ate eggs, milk, fresh foods and fruits less than 2–3 times a month. More than 25% ate dark, green, leafy vegetables and pulses fewer than three times a month whereas 41% reported that the nutritional quality of their diet had deteriorated compared to pre-pandemic levels. This proportion was higher among the urban than the rural households.
‘PDS is providing relief’
•The PDS is providing relief, the report underscored. While 84% of the households had a ration card, over 90% of those who were eligible said they received some food grains. However, other schemes weren’t effective. A quarter of households with eligible members said they could not avail the Mid–Day Meal Scheme or the Integrated Child Development Services provisions.
•For both surveys, more than 70% of those interviewed were from rural India. While 64% were Hindu, 18% were Muslim and 71% of the respondents were women. Both male and female working members reported spending approximately 18 days working in the month prior to the survey.
•Non-agricultural casual labour was a prominent source of employment in rural and urban areas. 18% of all households reported that a child that was in school before the pandemic had dropped out.
India has an opportunity to reset its trade ties with others, one accord at a time
•A little over two years after it turned its back at the last minute on a major multilateral trade agreement it had spent years negotiating, India last week announced the signing of a Comprehensive Economic Partnership Agreement with the United Arab Emirates (UAE). The free trade pact is a tacit acknowledgment that India needs to strengthen its trade ties with existing partners by lowering tariff walls and obtaining more favourable access for its exports in order to boost trade and economic output. With the COVID-19 pandemic having thrown into sharp relief the public health and economic vulnerabilities of an increasingly interconnected world, a reflexive urge to turn inward was evident in the last two years as nations imposed tight travel and entry restrictions in a bid to protect their populations. And ironically, even as India sought to promote atmanirbharta or self-reliance, the pandemic also depressed domestic consumption demand, dragging down overall economic output. Exports on the other hand have rebounded strongly, with growth outpacing even the pre-pandemic levels. It is in this backdrop that the Government’s renewed push to negotiate its bilateral free trade agreements is a welcome change in tack and signals that India is keener to strengthen trade ties with individual partner countries on equitable terms rather than be tied into multilateral pacts that do not necessarily address its key concerns.
•That the accord was finalised in less than six months’ time, from the start of negotiations in September, is a testimony to the strength of the bilateral ties and the recognition that there is more to gain from a deepening of the relationship. The UAE is already India’s third-largest trading partner with bilateral trade in 2019-20 valued at $59 billion. While India’s exports amounted to about $29 billion in the pre-pandemic fiscal year ended March 2020, the UAE supplied India with $10.9 billion worth of crude oil in that period and counts New Delhi as its second-largest trading partner. The two partners now aim to leverage the free trade deal to lift bilateral merchandise trade to $100 billion over the next five years. While the fine print of the tariff concessions on both sides is yet to be spelt out, India has made it clear that a range of exports including textiles and jewellery are set to benefit from a zero-duty regime once the accord is formally operationalised by May. Two-way investment flows and remittances — a major source of foreign exchange earnings for India given the large Indian workforce in the UAE — are also expected to receive a fillip. With multiple other FTAs in the pipeline, India has a fresh opportunity to reset its trade ties with the international community, one accord at a time.
📰 The Union Budget lacks the ‘power’ to transform services
While clean energy is a priority, providing power has not been linked with policy making in the development sector
•India’s Union Budget 2022-23 demonstrates a clear intent to prioritise investments in clean energy and sustainable development, in line with the country’s promises made at COP26 in Glasgow last year. The Budget is also an opportunity to turn the spotlight on policy conversations — since it sets the tone for reflecting on policies, schemes, and how they are implemented on the ground. Electricity and development sectors need a more integrated approach to achieve the vision set forth in instruments such as the Union Budget that guide policy implementation at other administrative levels.
A reduction
•While the health sector witnessed a 16% increase in estimated Budget allocations from last year, medical and public health spending was reduced by 45% for 2022-23. The education sector also witnessed an 11.86% increase in allocations. Interestingly, despite the push for digital education, which now includes the e-Vidya programme (to boost online learning), last year’s revised allocation saw a reduction of 35%. And despite these increases in estimates, health and education continue to share only about 2% each of budgetary allocations annually.
•Budget estimates demonstrate intent, but the proof of the pudding lies in the actual expenditure which reiterates the need for greater attention to be paid to our health and education sectors. While the health sector was allocated ₹74,602 crore in 2021-22, the Government exceeded its spending by over ₹5,000 crore more (₹80,026 crore) on health, signalling a spike in demand, likely propelled by the ongoing COVID-19 pandemic. Given this scenario, a less than ₹1,000 crore increase in the Budget Estimate (₹86,606 crore) in 2022-23 when compared with last year’s Revised Estimates (₹85,915 crore) appears incongruent with the Government’s aim of providing quality public health care at scale.
•Greater allocation of funds is welcome, even if marginally, but as our research on health and education policy documents at the national and State levels indicate, the aim of providing better health care gets stymied, in the absence of electricity and when power provisioning is not linked to desired outcomes.
The role of reliable energy
•It is widely recognised that the availability of reliable electricity supply can improve the delivery of health and education services; 74% of the targets of the Sustainable Development Goals are interlinked with universal access to reliable energy. Despite this, 44% of schools and 25% of India’s health sub-centres and primary health centres remain unelectrified. For the Government’s proposed energy transition to succeed, these critical facilities require energy access first. These statistics only refer to the presence or absence of an electricity connection. Its reliability in terms of the number of hours that electricity is available steadily without any voltage fluctuations also plays a significant role in delivering services.
•The lack of integration of electrification requirements in development sector policy documents may be partly due to lack of information about electricity and development linkages, poor coordination mechanisms between the sectors and departments, and poor access to appropriate finance. Even while electricity is considered, it is to the limited extent of being a one-time civil infrastructure activity rather than a continuous feature necessary for the day-to-day operations of these services. Departmental budgetary allocations are quite telling in terms of the extent to which electricity is prioritised by these departments; many do not even have line items to account for recurring electricity connection charges and maintenance expenditure. We must remind ourselves that while electricity is invisible and taken for granted when available, its absence is felt when it is not provided.
Think multiple policies too
•Our research on development and electricity policies also demonstrates that integration need not only be at the level of a single policy. Sometimes, multiple policies can complement each other to achieve the larger sectoral objectives. For example, in Assam, the Energy Vision document that lays out the electricity and development outcomes is to be applied in tandem with the Solar Energy Policy 2017 that operationalises this vision via an action plan. To successfully integrate electricity provisioning and maintenance, policy frameworks should include innovative coordination and financing mechanisms. These mechanisms, while developing clear compliance mandates, must also allow sufficient room for flexibility to respond to local contexts. Such flexibility can be embedded in funds (such as untied funds) to provide local decision-makers with some authority to mitigate policy implementation barriers.
•A successful policy outcome might be dependent on several invisible aspects that do not get the attention and the funding necessary to aid in successful policy delivery. Electricity is one of them.
This deepens exclusion
•Many development policies that have objectives to improve health and education services require facilities to have access to reliable electricity as a prerequisite to qualify for benefits. This, unfairly, puts the onus of acquiring reliable electricity supply on individual facilities rather than their departments. Such requirements result in facilities and schools that are already deprived of electricity to continue to be excluded from other assistance.
•Providing reliable electricity for health centres and schools should be the responsibility of centralised decision-making entities at the State or national level. Individual facilities should not be burdened with the responsibility to meet the eligibility criteria for policies or programmes.
•It must also be noted that integrative policies are useful but insufficient to achieve intended developmental outcomes. For policies to become transformative, instruments that operationalise them must be in place. This is when budgetary allocations, institutional structures, finance, information and coordination mechanisms come into play.
•Allocation of funds is a must to set up a robust data governance mechanism as it is critical for integrative action and evidence-based policymaking. However, as India has witnessed with other cross-sectoral and centralised statistical, planning, and implementation data governance, diverse contexts must support oversight mechanisms that ensure data credibility.
Systemic gaps
•Finance is largely unavailable to ensure reliable electricity supply to schools and health facilities. Some directives, such as those governing the use of untied funds, need to be more flexible in allowing these facilities to prioritise providing reliable and sustainable electricity. The provisioning of reliable electricity, in turn, improves the delivery of health and educational services. Departmental silos in public administration have resulted in linkage gaps between critical “supply” departments (such as electricity and water) and “demand-generating departments” (such as health and education). This gap is accentuated when coordination mandates are not met with sustained finance to support human resources and common activities.
📰 Drafting a new Constitution is impossible
That the Centre is suppressing the powers of the States is not reason enough for a new statute
•Recently, the Chief Minister of Telangana said India needs a new Constitution, as, according to him, governments at the Centre over the years have been suppressing the powers of the States. Being a citizen and a constitutional head of state, he was not wrong in exercising his fundamental right to express his views freely. Nor was what he said wrong: Central governments have indeed been suppressing the powers of the States in various ways. The Supreme Court, in judgments such as S.R. Bommai v. Union of India (1994) and Govt. Of NCT of Delhi v. Union of India (2018), has castigated governments at the Centre for this.
•But the question is, can the people of India give themselves a new Constitution? Noted jurist Fali S. Nariman, in a lecture titled ‘The Silences in Our Constitutional Law’, delivered in 2005, rightly said, “We will never be able to piece together a new Constitution in the present day and age even if we tried: because innovative ideas — however brilliant, howsoever beautifully expressed in consultation papers and reports of commissions — cannot give us a better Constitution. In Constitution-making there are other forces that cannot and must never be ignored — the spirit of persuasion, of accommodation and of tolerance — all three are at a very low ebb today”. We can add a few more forces which cannot be ignored today, such as casteism, nepotism and corruption.
Nation first
•This article highlights a few events that took place while India’s Constitution was drafted to argue how these events may never take place in the present scenario. The first is the appointment of B.R. Ambedkar as chairman of the Drafting Committee. Granville Austin, in his book The Indian Constitution: Cornerstone of a Nation, wrote that Ambedkar was originally elected to the Assembly as a member from Bengal, but lost his seat during Partition. He was subsequently elected from the Bombay Presidency at the behest of the Congress high command. This shows that the biggest party then had an accommodative spirit, which seems lacking today. Ambedkar was fighting to ensure rights for the depressed classes and, in his own words, he came to the Assembly to “safeguard the interests of the Scheduled Castes”. But he was trusted for his passion and talent and elected chairman of the Drafting Committee by the Constituent Assembly, which was dominated by the Congress. The result is the Constitution we see today, which safeguards the rights of majority and minority communities. Today, when caste and nepotism play a pivotal role in electing even a ward member, consensus over a new Constitution would be impossible.
•It took two years, 11 months and 18 days to draft the present Constitution. During this period, the members read the constitutions of other nations, consulted constitutional experts, drafted the Constitution, debated it, redrafted it and approved it. During Constituent Assembly debates, if five minutes were wasted one day, the House would assemble five minutes earlier the next day and sit until night to complete pending work. This showed value for time, and value for work done for the nation. Now, all we see is ruckus and noise in Parliament, with little debate or discussion taking place on Bills. During Constituent Assembly debates, dissenters and hard-core critics were tolerated and their suggestions, if found apt, were accommodated. If their suggestions were not found apt, there would be a healthy debate. Now, Bills are passed without allowing Opposition members to express their views completely, let alone accommodating their suggestions.
•Third, the members of the Constituent Assembly emerged from the clutches of colonial rule. They knew the sufferings that they and the nation had undergone under foreign rule and were determined to frame a Constitution, and spelled out fundamental rights, which allow every individual a right to live their life with liberty and dignity and challenge the state’s arbitrary decisions before an independent judiciary. Today’s leaders seem to lack that spirit. Members of the Constituent Assembly chose the nation first; today’s leaders tend to choose their party first.
•Fourth, the Constitution states that India is a “Sovereign Socialist Secular Democratic Republic”. It protects the rights of every section of society. On the other hand, today’s leaders give priority to particular ideologies and castes. Given this, drafting a new Constitution will be a chaotic exercise and will shut the voices of some sections, especially the vulnerable.
•Fifth, and most importantly, an unelected body was trusted by the Constitution framers to declare the law. The purpose behind choosing an unelected body was that, by its nature of being not answerable to anyone except the Constitution, the judiciary can adjudicate disputes in an independent, free, fair and impartial manner. Today, leaders may choose to become judges as well as rulers. For instance, through the Constitution (Thirty-Second Amendment) Act, 1973, a proviso to clause 5 of Article 371D was inserted which gave power to the Andhra Pradesh government to modify or annul any order passed by the Administrative Tribunal, constituted to deal with service matters in which the government is a party. This Tribunal replaced the High Court. When the government is party to the litigation and when the Tribunal is exercising the powers of the High Court, how can the government be given power to override the decisions of the Tribunal? Fortunately, the Supreme Court declared this proviso as unconstitutional in P. Sambamurthy v. State of A.P. (1986). There are other such examples.
A strong Centre
•Before independence, India comprised over 550 princely States, suffered from the problems created by Partition and faced a looming economic crisis. Thus, the Constituent Assembly’s members tilted towards a strong Centre with a blend of cooperative federalism. It is true that the governments at the Centre abuse their powers to cripple Opposition-ruled States, but that does not call for creating a new Constitution. It calls for seeking mandate from the people to elect regional parties in general elections so that States can have dominance in the Union, besides approaching the Supreme Court under Article 131 whenever the need arises to resolve conflicts between the Centre and State.
•The Chief Minister should remember that if he could become the Chief Minister of Telangana, it is only because of the present Constitution, as despite the Assembly of united Andhra Pradesh rejecting the resolution in 2013 to bifurcate Andhra Pradesh, it was Parliament, which by exercising powers conferred under Article 3 of the Constitution, carved out the two States.
📰 A reductionist approach
Population-level interventions are missing in India’s approach towards tackling non-communicable diseases
•Population health is more than just the health of all individuals. Suicide rates are an example of the distinction between population and individual health, as Johan Mackenbach discusses. While every individual case of suicide has its own unique aetiology, population rates of suicides tend to display remarkable stability over time, ceteris paribus. While individual and population health are inexorably linked, the causes, and thus the interventions required to address them, tend to be different. Trying to improve population health with merely individualistic strategies is foredoomed to failure and inefficiency.
Individualistic policy measures
•In the previous decade, the government acknowledged that the focus of Indian public health remained near-exclusively on maternal and child health and infectious diseases for too long. The peg was proposed to be moved over to non-communicable diseases (NCD) and chronic illnesses, whose rising prevalence portends huge economic and productivity losses. What followed were a set of essentially individualistic policy measures in the form of enhanced NCD screening and management infrastructure, wellness and lifestyle interventions, patient referral mechanisms, and so on. The question is, what becomes of the array of population-level determinants of NCDs that are deeply intertwined with social, economic, and political dimensions? To reflect the enhanced policy attention to NCDs in contemporary times, population-level representative surveys seem to be embracing an expanded set of indicators including blood pressure and blood sugar. But where are the true population-level interventions?
•A case from the Netherlands can help draw an apt analogy. In 2007, the Minister of Health of the Netherlands expounded their ideas on improving population health by exploring the inter-relationships between health and other related sectors such as economy, housing, social cohesion and environment. Soon, however, the reductionist tendencies of organised medicine came into play, turning it into a paradigm of personalised preventive medical care, backed by health insurance and dominated by healthcare professionals. A natural extension of this has characterised the Indian approach to NCDs too. With Health and Wellness centres, publicly financed health insurance schemes, and vertical NCD control programmes, the entire initiative to address NCDs has been subsumed into a largely biomedical paradigm with scarce vestiges of the social sciences. The private sector has come to complement this with a large array of self-tests, over-the-counter products, and lifestyle-change gimmicks. This is while overarching public interventions, which could also help raise much-needed revenue for health, such as sin taxes, attract hesitancy.
•This reductionist approach rides the crest of an undue reliance on medical and healthcare professionals for all public health solutions, and a policy myopia that fails to appreciate that tackling NCDs warrants action across a range of sectors besides health. The bigger menace is that this approach is entrenched in political and public health tradition. This even reflects in the way it impacts our research priorities for NCDs, which remain concentrated on lifestyle and individual-level NCD determinants and solutions.
A flawed perception
•In under-resourced systems in particular, what is readily actionable gets actioned and what isn’t so is softly swept under the rug. The elusive nature of social determinants has traditionally drawn funders and policymakers towards the better defined, easily actionable, albeit short-lived and inefficient technocratic solutions to mass health issues. These technocratic approaches have resulted in a flawed perception that social action for health is a high-order initiative reserved for affluent countries. The reverse is only true. Developing settings like India can gain far greater health for every rupee spent, by investing in social determinants. The same makes for a strong ethical case as well, by ensuring equitable distribution of such gains.
•For India, NCDs will be a long-drawn challenge. With projected losses due to NCDs in the order of multiple trillions by 2030, the case for investing in inter-sectoral, population-based, socially embedded approaches is ripe. This requires a total galvanisation of different departments and sectors to the importance of population health. The push for digitisation must be mobilised to generate enough evidence for resolute action on social health determinants. Government policy pronouncements will need to enshrine actionable points and explicit mandates to address social health determinants. And political circles will have to outgrow the predominantly biomedical paradigm of health.
