📰 THE HINDU EDITORIAL 📰
The state’s domain - The proposal to allow the private sector to run district hospitals has its risks
The potential of India’s district hospital system to dramatically expand access to quality secondary and tertiary health care has never really been realised. The majority of patients today use the facilities created mostly by for-profit urban hospitals. That asymmetry could potentially be offset, though only in small part, through the proposal of the NITI Aayog and the Union Health Ministry to allow private entities to use the premises of the district hospitals to provide treatment for cardiac and pulmonary diseases and cancer. Viewed in perspective, a quick scaling-up of care for such non-communicable diseases is possible under the arrangement, because there are 763 functional district hospitals, with just five States led by Uttar Pradesh accounting for over 42% of the facilities. Yet, contracting out services in a virtually unregulated and largely commercial private system is fraught with risks. One major concern in such an arrangement is to ensure that the bulk of health spending, whether from government funds, subsidy or private insurance, goes into actual care provision, and that administrative expenditure is capped under the contract. Moreover, in consonance with the goal to provide health for all under the National Health Policy, care should be universal, and free at the point of delivery. A market-driven approach to providing district hospital beds for only those with the means would defeat the objective.
Providing 50 or 100 beds in a district hospital may expand access to care, but such arrangements do not offer a cure for the larger problem of the growing non-communicable disease burden. Lifestyle choices and social determinants, such as tobacco and alcohol use, and environmental pollution, are often linked to such diseases. Controlling the epidemic, therefore, requires other policy approaches too. Given the already high prevalence of cardiac and pulmonary conditions, some arising from diabetes and hypertension, and cancers, having more beds for treatment is a necessity. It is incongruous, however, to opt for contracts of 30 years, given the move towards achieving universal health coverage and, aspirationally, a single-payer government-led model that mainly relies on public facilities. Strong oversight is also necessary to ensure that ethical and rational treatment protocols are followed in the new facilities, and procurement and distribution of drugs are centralised to keep costs under control. Ultimately, the success of such systems depends on medical outcomes on the one hand, and community satisfaction on the other. Both dimensions must find place in a contract, and be assessed periodically. A provision for audits, penalties and cancellation of contracts is essential. Given the recourse to tax funds for viability gap funding and use of public infrastructure, the operations should be audited by the Comptroller and Auditor General.
Spanish steps: Madrid pulls out all the stops ahead of the secession vote in Catalonia
Ahead of the controversial October 1 referendum on secession in Catalonia, the Spanish government’s awkward move of tightening the purse-strings could prove politically costly. There is cause for concern that Prime Minister Mariano Rajoy's meddling with the financial priorities of Barcelona will play into the hands of the separatists. A veteran of many a crisis, Mr. Rajoy recently issued instructions to the regional government to ensure that not a single euro earmarked for development activities is diverted to the vote. The decision requiring weekly certification follows a judicial declaration that all expenditure towards the vote were unconstitutional. Recourse to such seemingly stringent measures has predictably drawn flak from Catalan leaders, who were already embittered that the province is being denied its due share of the overall tax revenues. Madrid’s mainstream political parties are opposed to the long-standing demand of Catalonia for independent statehood. Riding on the overwhelming support in the national parliament, Mr. Rajoy’s centre-right coalition is determined to block the proposed independence referendum. The government is even contemplating the invocation of Article 155 of the constitution to exercise direct authority over the north-eastern region in the event of a worst-case scenario. The country’s constitutional court is widely expected to rule that any referendum, as well as secession from the union, is violative of the constitution.
But that is where legalese ends and politics inevitably takes over. After holding several symbolic independence votes across many municipalities over the past decade, Catalan nationalists sense that what once seemed a distant dream could one day be turned into reality. The economic and social upheaval following the bursting of the Spanish housing bubble after the 2007-8 financial crisis, local problems were deflected on to the national stage. The 2015 election of the regional government, with a known pro-independence bent, might have been a reflection of this shift in perception. A perception among Catalan youth that the national government is clamping down on democratic expression could only strain the already delicate equation between Madrid and Barcelona. Recent history casts a remarkably sobering light on how much politicians can count on rational arguments to hold sway over popular sentiment. Britain’s vote to leave the European Union is just one example. Mr. Rajoy has earned a reputation for exercising caution to a fault during his premiership. His conciliatory tone, for instance, on Catalonia’s fiscal autonomy, a demand he had rejected some years ago, may yet open a window. The call issued by the opposition socialist leader, Pedro Sánchez, for more federal powers could similarly soothe tensions. Madrid must look to expand this spirit of accommodation.
📰 THE HINDU EDITORIAL 📰
The boycott ban: Maharashtra’s law criminalising social ostracism is a template for other States
Maharashtra’s new law prohibiting the social boycott of individuals, families or any community by informal village councils is a step in the right direction, given the pervasive nature of the problem. The progressive legislation, which received Presidential assent recently and was gazetted earlier this month, targets the pernicious practice of informal caste panchayats or dominant sections using ostracism as a means of enforcing social conformity.The Maharashtra Protection of People from Social Boycott (Prevention, Prohibition and Redressal) Act, 2016, may serve as a template for similar legislation in other States. The Act lists over a dozen types of actions that may amount to ‘social boycott’, which has been made a criminal offence punishable with imprisonment up to three years or a fine of ₹1 lakh or both. The practices it prohibits range from preventing the performance of a social or religious custom, denial of the right to perform funerals or marriages, cutting off someone’s social or commercial ties to preventing access to educational or medical institutions or community halls and public facilities, or any form of social ostracism on any ground. The law recognises the human rights dimension to issues of social boycott, as well as the varied forms in which it occurs in a caste-based society. Its progressive sweep takes into account discrimination on the basis of morality, social acceptance, political inclination, sexuality, which it prohibits. It even makes it an offence to create cultural obstacles by forcing people to wear a particular type of clothing or use a particular language.
This is not the first law of its type. Bombay enacted a law against excommunication in 1949, but it was struck down by the Supreme Court in 1962 after the Dawoodi Bohra community successfully argued that it violated the community’s constitutional right to manage its own religious affairs. One hopes the latest Act will not be vulnerable to legal challenge. Article 17 of the Constitution and the Protection of Civil Rights Act outlaw untouchability in all its forms, but these are legal protections intended for the Scheduled Castes. In reality, members of various castes and communities also require such protection from informal village councils and gatherings of elders who draw on their own notions of conformity, community discipline, morality and social mores to issue diktats to the village or the community to cut off ties with supposedly offending persons and families. The case of a mountaineer from Raigad is somewhat notorious. He had conquered Mt. Everest but could not escape a social boycott in his village because his wife wore jeans and did not wear a mangalsutra. It is not a proud moment for a country when special legislation is required to prohibit social discrimination, ostracism and practices repugnant to human dignity. Yet, given the prevailing circumstances, any legislative assault on abhorrent social practices ought to be welcomed.
The state’s domain - The proposal to allow the private sector to run district hospitals has its risks
The potential of India’s district hospital system to dramatically expand access to quality secondary and tertiary health care has never really been realised. The majority of patients today use the facilities created mostly by for-profit urban hospitals. That asymmetry could potentially be offset, though only in small part, through the proposal of the NITI Aayog and the Union Health Ministry to allow private entities to use the premises of the district hospitals to provide treatment for cardiac and pulmonary diseases and cancer. Viewed in perspective, a quick scaling-up of care for such non-communicable diseases is possible under the arrangement, because there are 763 functional district hospitals, with just five States led by Uttar Pradesh accounting for over 42% of the facilities. Yet, contracting out services in a virtually unregulated and largely commercial private system is fraught with risks. One major concern in such an arrangement is to ensure that the bulk of health spending, whether from government funds, subsidy or private insurance, goes into actual care provision, and that administrative expenditure is capped under the contract. Moreover, in consonance with the goal to provide health for all under the National Health Policy, care should be universal, and free at the point of delivery. A market-driven approach to providing district hospital beds for only those with the means would defeat the objective.
Providing 50 or 100 beds in a district hospital may expand access to care, but such arrangements do not offer a cure for the larger problem of the growing non-communicable disease burden. Lifestyle choices and social determinants, such as tobacco and alcohol use, and environmental pollution, are often linked to such diseases. Controlling the epidemic, therefore, requires other policy approaches too. Given the already high prevalence of cardiac and pulmonary conditions, some arising from diabetes and hypertension, and cancers, having more beds for treatment is a necessity. It is incongruous, however, to opt for contracts of 30 years, given the move towards achieving universal health coverage and, aspirationally, a single-payer government-led model that mainly relies on public facilities. Strong oversight is also necessary to ensure that ethical and rational treatment protocols are followed in the new facilities, and procurement and distribution of drugs are centralised to keep costs under control. Ultimately, the success of such systems depends on medical outcomes on the one hand, and community satisfaction on the other. Both dimensions must find place in a contract, and be assessed periodically. A provision for audits, penalties and cancellation of contracts is essential. Given the recourse to tax funds for viability gap funding and use of public infrastructure, the operations should be audited by the Comptroller and Auditor General.
Spanish steps: Madrid pulls out all the stops ahead of the secession vote in Catalonia
Ahead of the controversial October 1 referendum on secession in Catalonia, the Spanish government’s awkward move of tightening the purse-strings could prove politically costly. There is cause for concern that Prime Minister Mariano Rajoy's meddling with the financial priorities of Barcelona will play into the hands of the separatists. A veteran of many a crisis, Mr. Rajoy recently issued instructions to the regional government to ensure that not a single euro earmarked for development activities is diverted to the vote. The decision requiring weekly certification follows a judicial declaration that all expenditure towards the vote were unconstitutional. Recourse to such seemingly stringent measures has predictably drawn flak from Catalan leaders, who were already embittered that the province is being denied its due share of the overall tax revenues. Madrid’s mainstream political parties are opposed to the long-standing demand of Catalonia for independent statehood. Riding on the overwhelming support in the national parliament, Mr. Rajoy’s centre-right coalition is determined to block the proposed independence referendum. The government is even contemplating the invocation of Article 155 of the constitution to exercise direct authority over the north-eastern region in the event of a worst-case scenario. The country’s constitutional court is widely expected to rule that any referendum, as well as secession from the union, is violative of the constitution.
But that is where legalese ends and politics inevitably takes over. After holding several symbolic independence votes across many municipalities over the past decade, Catalan nationalists sense that what once seemed a distant dream could one day be turned into reality. The economic and social upheaval following the bursting of the Spanish housing bubble after the 2007-8 financial crisis, local problems were deflected on to the national stage. The 2015 election of the regional government, with a known pro-independence bent, might have been a reflection of this shift in perception. A perception among Catalan youth that the national government is clamping down on democratic expression could only strain the already delicate equation between Madrid and Barcelona. Recent history casts a remarkably sobering light on how much politicians can count on rational arguments to hold sway over popular sentiment. Britain’s vote to leave the European Union is just one example. Mr. Rajoy has earned a reputation for exercising caution to a fault during his premiership. His conciliatory tone, for instance, on Catalonia’s fiscal autonomy, a demand he had rejected some years ago, may yet open a window. The call issued by the opposition socialist leader, Pedro Sánchez, for more federal powers could similarly soothe tensions. Madrid must look to expand this spirit of accommodation.
📰 THE HINDU EDITORIAL 📰
The boycott ban: Maharashtra’s law criminalising social ostracism is a template for other States
Maharashtra’s new law prohibiting the social boycott of individuals, families or any community by informal village councils is a step in the right direction, given the pervasive nature of the problem. The progressive legislation, which received Presidential assent recently and was gazetted earlier this month, targets the pernicious practice of informal caste panchayats or dominant sections using ostracism as a means of enforcing social conformity.The Maharashtra Protection of People from Social Boycott (Prevention, Prohibition and Redressal) Act, 2016, may serve as a template for similar legislation in other States. The Act lists over a dozen types of actions that may amount to ‘social boycott’, which has been made a criminal offence punishable with imprisonment up to three years or a fine of ₹1 lakh or both. The practices it prohibits range from preventing the performance of a social or religious custom, denial of the right to perform funerals or marriages, cutting off someone’s social or commercial ties to preventing access to educational or medical institutions or community halls and public facilities, or any form of social ostracism on any ground. The law recognises the human rights dimension to issues of social boycott, as well as the varied forms in which it occurs in a caste-based society. Its progressive sweep takes into account discrimination on the basis of morality, social acceptance, political inclination, sexuality, which it prohibits. It even makes it an offence to create cultural obstacles by forcing people to wear a particular type of clothing or use a particular language.
This is not the first law of its type. Bombay enacted a law against excommunication in 1949, but it was struck down by the Supreme Court in 1962 after the Dawoodi Bohra community successfully argued that it violated the community’s constitutional right to manage its own religious affairs. One hopes the latest Act will not be vulnerable to legal challenge. Article 17 of the Constitution and the Protection of Civil Rights Act outlaw untouchability in all its forms, but these are legal protections intended for the Scheduled Castes. In reality, members of various castes and communities also require such protection from informal village councils and gatherings of elders who draw on their own notions of conformity, community discipline, morality and social mores to issue diktats to the village or the community to cut off ties with supposedly offending persons and families. The case of a mountaineer from Raigad is somewhat notorious. He had conquered Mt. Everest but could not escape a social boycott in his village because his wife wore jeans and did not wear a mangalsutra. It is not a proud moment for a country when special legislation is required to prohibit social discrimination, ostracism and practices repugnant to human dignity. Yet, given the prevailing circumstances, any legislative assault on abhorrent social practices ought to be welcomed.
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