National Health Policy/National Health Scheme

o State of​ Public Health in India

▪ Fragmented​ nature of India’s health system
▪ poor regulation of private secondary and tertiary care services
▪ high primary health treatment costs
o National Health Policy/Scheme(2017)
▪ Targets
● To raise the level of​ public expenditure from 1.5% -> 2.5% over three
years
● Aims​ to provide​ free primary care and free drugs, diagnostics and
emergency care in public hospitals
▪ Twin purpose
● Achieving universal health coverage
● Saving people from high healthcare costs
▪
o Latest government public health initiatives
▪ Ayushman Bharat(Budget 2018)
● Opening health centres for diagnostics, care, distribution of essential
drugs
● public health insurance for poor peoples
o Challenges for universal health coverage schemes
▪ Transfer of resources to provinces
▪ Recruitment of health personals
▪ Purchase and distribution of medicines ​to chosen Centres
▪ Steady growth of for profit tertiary care- costly
▪ poor public health Infrastructure
▪ public infrastructure unable to compete private health infrastructure
▪ Focus on demand side of health-care finance(public health insurance schemes)
is not fruitful if the supply side, the public infrastructure is in poor conditions
● failures of earlier health schemes such as RSBY(Rastriya Swasthya Bima
Yojana) to reach the most vulnerable sections
● out of pocket expenditure despite health insurance scheme for poor
● misuse of earlier health insurance schemes(RSBY, Aarogyashri(AP)-
both cashless)
o eg- ​private hospitals doing unnecessary procedures of
patient(often dangerous) just to inflate bill to make quick buck
● over-reliance on private sector,​ limits the reach of scheme to poor, as
most of the private hospitals are in urban areas
●
o Health Insurance
▪ Currently​ covers only​ 1/6 of the population
▪ 1/6->60%
o Conclusion
▪ Reform of public health infrastructure
SC upholding passive Euthanasia for terminally ill patient or an person in permanent
vegetation state, where there is no hope of recovery.
o Basic Points
▪ Holds that ​right to die with dignity is a part of the basic right to life
▪ Says​ quality of life is as important as prolonging it
▪ also allows ‘living wills’(advance directives) with safeguards
▪ declare right to die with dignity fundamental right under A21
o Verdict allowing ​passive euthanasia​ and give legal status to ‘advance directives’(live
will).
o Core philosophy of judgement is that the ​right to dignified life (Article 21) extends up
to the point of having dignified death.
o Five member Constitution Bench
▪ A progressive and humane verdict that​ lays down as broad legal framework for
protecting the dignity of a terminally ill patient or one in a persistent
vegetative state (PVS) with no hope of cure or recovery.
▪ “​accelerating the process of death for reducing the period of suffering
constitutes a right to live with dignity​”
▪ All adults with the capacity to give consent “​have the right to self
determination and autonomy”​, and ​the right to refuse medical treatment is
also encompassed into it.
▪ Passive euthanasia was recognized by a two judge bench in Aruna Shanbaug
Case(2011),
▪ Living will, or advance directive​, a practice whereby a person, while in a
competent state of mind , leaves written instructions on the sort of medical
treatment that may or may not be administered in the event of her reaching a
stage of terminal illness.
▪ SC recognized that​ in such cases “individual interest has to be given priority
over the state interest”
▪ Until Now, ​Government​ submitted that it is in the process of introducing a law
to regulate passive euthanasia , but ​opposed the concept of advance directive
o the ground that it was liable to be misused.
▪ But ​SC has imposed stringent conditions regarding advance directives​, i.e. set
out strict guidelines that will govern when and how it is permitted. Has placed
multiple checks to prevent misuse of live will provisions/passive euthanasia
case, that involves decision by doctor ​ ​ Setting of internal medical board(of
Hospital)​ ​if board decides apply living will, the Hospital inform​ ​ District
Magistrate, who will verify living will​ ​ then appoints a Medical board which
decides on the case.
▪ ​Passive Euthanasia​ -> Essentially​ involves withdrawal of life support or
discontinuation of life preserving medical treatment so that a person with a
terminal illness is allowed to die in the natural course.
▪ It is inhumane to force anyone to live on life support endlessly. ​It is​ torture for
the person and the family and is known to push families into poverty and
debts.
▪ Distinguished passive euthanasia from suicides.
Uniform Civil law
o What it means?
o Why it is needed?
o Current condition​- separate Personal Laws/personal laws
o Etc
o

Farm distress?
o

Khap panchayats
o Honour killings, ​crimes committed in the name of defending the honour of a caste, clan
or family.
o Reasons of honour killing
▪ Caste system
▪ Entrenched social prejudices
▪ Feudal structures
▪ Patriarchal attitudes
▪
o Can not be eradicated overnight through las or judicial diktat.
o But ​stern law and order approach should be adopted to curb groups that seeks to
enforce such medieval notions.
o Recent SC’s judgment against khap panchayats
▪ Honour killing violates the liberty and dignity of individual’s(A21)
▪ No group or person has any right to interference between choices of adult
couples
▪ Providing protection to affected couples is responsibility of state
▪ Safe houses for couple under threat, ​at district level for their protections, 24
hour help line
▪ Court has also empowered the police to prohibit such gatherings and effect
preventive arrests​.
▪ Deciding what is permitted form of marriages under Hindu Law and what is
not, is the job of civil courts.
▪ Refuted defense provided by khaps that their objective is to just create
awareness about permissible marriages, including inter caste, and inter faith
ones and against sapinda and sagotra marriages.
o Requires ​preventive, remedial and punitive measures
o Requires a ​comprehensive law to curb such crimes ​and​ to prohibit interference in the
matrimonial choices of individuals

Land Decay/ Degradation

o Causes
▪ Pollution
▪ Mining
 ▪ Unsustainable farming
▪ Urbanization
▪ High Consumption urban lifestyles
o Problems
▪ Land decay
▪ Food security
▪ Water pollution

Fake news and related issues

-Read Political Issues sections

National Health Protection Mission(Ayushman Bharat Scheme)

o Background
▪ Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
● is a​ Centrally Sponsored Scheme
● It is an​ umbrella of two major health initiatives
o Health and wellness Centres
o National Health Protection Scheme.
● Health and wellness Centres
o Under this ​1.5 lakh existing sub centres ​will bring health
care system closer to the homes of people
o These centres ​will provide comprehensive health care,
including for non-communicable diseases and maternal
and child health services.
● National Health Protection Scheme(​AB-PMJAY​)
o provides ​a defined benefit cover of Rs. 5 lakh per
family per year.​ This cover will take care of almost ​all
secondary care and most of tertiary care procedures​.
o ​no cap on family size and age​ in the scheme.
o also include pre and post-hospitalisation expenses.
o A defined​ transport allowance per hospitalization​ will
also be paid to the beneficiary.
o Benefits of the scheme are ​portable across the country
o The beneficiaries ​can avail benefits in both public and
empanelled private facilities.
o is an ​entitlement based scheme with entitlement
decided on the basis of deprivation criteria in the
SECC database​.
● One of the core principles of Ayushman Bharat -​ National
Health Protection Mission is to ​cooperative federalism and
flexibility to states to implement scheme.
● will target about​ 10 crore poor and vulnerable f​ amilies
● reduce out of pocket health expenses of poors
o objectives of scheme
▪ foundation for a universal health coverage system
o States have statutory responsibility of Public health
 o a move toward Universal Health Coverage
▪ a SDG 2030
o Challenges
▪ proper implementation

# MeToo Campaign and Sexual Harassment at Workplace

o Background – What it is ?
▪ Women from different fields opening/complain on social media about sexual
harassment faced by them at workplace at some point of time in their life.
▪ Complains have been ​made against number of famous personalities,
politician, journalists etc.
o Sexual Harassment at Workplace (Prevention, Prohibition and Redressal) Act -its
weakness
▪ Justice Verma Committee, termed the Sexual Harassment Bill “unsatisfactory”
and said it ​did not reflect the spirit of​ the ​Vishakha guidelines​ — framed by the
Supreme Court in 1997 to curb sexual harassment at the workplace.
o Justice Verma Committee and its recommendation
▪ panel ​formed in the aftermath of the Nirbhaya gangrape case
▪ The panel ​proposed State-level employment tribunal to deal with complaints.
▪ The report noted that ​an internal complaints committee as laid down
under the then proposed law would be “counter-productive”​ as​ dealing
with such complaints in-house could discourage women from filing
complaints.
▪ ​Instead, the committee​ proposed forming an employment tribunal​ to
receive and adjudicate all complaints.
▪ To ensure speedy disposal of complaints, the Committee proposed that the
tribunal should not function as a civil court but may choose its own procedure to
deal with each complaint.
▪ any “unwelcome behavior” should be seen from the subjective perception of the
complainant, thus ​broadening the scope of the definition of sexual harassment.
▪ an employer could be held liable if he or she facilitated sexual harassment,
permitted an environment where sexual misconduct becomes widespread and
systemic, where the employer fails to disclose the company’s policy on sexual
harassment and ways in which workers can file a complaint as well as fails to
forward a complaint to the tribunal.
▪ The company would also be liable to pay compensation to the complainant
▪ also made several suggestions to encourage women to come forward and file
complaints. For instance, it opposed penalizing women for false complaints
▪ also said that the time-limit of three months to file a complaint should be done
away with and a complainant should not be transferred without her consent.
o Way forward
▪
▪