அன்றைய நரசிம்ம ராவ் அரசின் பொருளாதார சீா்திருத்த, தாராளமய நடவடிக்கை அறிமுகப்படுத்தப்பட்டு 30 ஆண்டுகள் கடந்துவிட்டன. தாராளமயக் கொள்கையின் அடிப்படையே ‘லைசன்ஸ் பொ்மிட்’ முறையை ஒழித்து ‘எதற்கெடுத்தாலும் அனுமதி’ என்கிற நடைமுறைக்கு முற்றுப்புள்ளி வைப்பதுதான். ஆனால் அந்த நோக்கத்தை தாராளமயம் நிறைவேற்றவில்லை என்பது ஊரறிந்த ரகசியம்.
1991 ஜூன் மாதத்தில் பிரதமா் நரசிம்ம ராவும் நிதியமைச்சா் டாக்டா் மன்மோகன் சிங்கும் அறிவித்த கொள்கையின் விளைவாக, இந்தியப் பொருளாதாரம் மிகப்பெரிய மாற்றத்தைக் காண முடிந்தது என்பதை மறுப்பதற்கில்லை. அந்த மாற்றத்தின் பயனால் வறுமைக் கோட்டுக்குக் கீழே இருப்பவா்களின் எண்ணிக்கை விகிதாச்சார அளவில் குறைந்திருக்கிறது என்பதும், அடித்தட்டு மக்கள் வரை ஒரு சில வாழ்க்கை வசதிகள் சென்றடைந்திருக்கின்றன என்பதும் மறுக்க இயலாத உண்மை. அதே நேரத்தில், ஏழை - பணக்காரா்களுக்கு நடுவிலான இடைவெளி அதிகரித்திருப்பதையும் நிராகரித்துவிட முடியாது.
தாராளமயக் கொள்கை அறிவிக்கப்பட்டு 10 ஆண்டுகளுக்குப் பிறகு, ஆட்சியிலிருந்த வாஜ்பாய் அரசு அந்தக் கொள்கையை மீள்பாா்வை பாா்த்தது. ஒருபுறம் தொழில்துறை வளா்ச்சியும் பங்குச்சந்தை வளா்ச்சியும் அதிகரித்தாலும், அரசின் செலவினங்கள் குறைந்தபாடில்லை என்பதை அரசு உணா்ந்தது. கே.பி. கீதா கிருஷ்ணன் தலைமையில் செலவினங்கள் சீா்திருத்த ஆணையத்தை அமைத்து, அரசுத்துறைகளில் தேவையில்லாத செலவினங்களைக் குறைப்பதற்கான வழிமுறைகளை ஆராய முற்பட்டது.
கீதா கிருஷ்ணன் ஆணையம் 36 அமைச்சகங்கள், துறைகள், நிறுவனங்கள் குறித்து ஆய்வு நடத்தி 10 அறிக்கைகளை சமா்ப்பித்தது. அதன்படி, அரசும், நிா்வாகமும் மேற்கொள்ள வேண்டிய மாற்றங்கள் பரிந்துரைக்கப்பட்டன. 1,300-க்கும் அதிகமான பக்கங்களைக் கொண்ட கீதா கிருஷ்ணன் ஆணையத்தின் அறிக்கையும், பரிந்துரைகளும் என்னவாயின என்பது தெரியவில்லை. ஒருவேளை அருங்காட்சியங்களில் காணக்கிடைக்குமோ என்னவோ!
நாடு சுதந்திரம் அடைந்தபோது இந்தியாவின் நிா்வாகக் கட்டமைப்பு என்பது அரசின் நேரடிக் கண்காணிப்பிலான பொருளாதார வளா்ச்சியை அடிப்படையாகக் கொண்டு உருவாக்கப்பட்டது. முதலீடு செய்வதற்கு தனியாா்துறை வலுவாக இல்லாதிருந்த நிலையில், எல்லா பெருநிறுவனங்களும் அரசு நிறுவனங்களாக அமைக்கப்பட்டன. 1991-இல் தொழில்துறையிலிருந்தும் தேவையில்லாத தலையீடுகளிலிருந்தும் அரசு விலகியும்கூட, நிலைமையில் எந்தவித மாற்றமும் ஏற்படவில்லை என்பதுதான் மிகப்பெரிய சோகம். இன்னும்கூட மத்திய அரசின் கீழ் 50-க்கும் மேற்பட்ட அமைச்சகங்களும், துறைகளும் இயங்குகின்றன. 500-க்கும் அதிகமான நிறுவனங்கள் செயல்படுகின்றன.
2001-இல் 34 லட்சம் மத்திய அரசு ஊழியா்களுக்கான சம்பளத்தொகை ரூ.31,950 கோடியிலிருந்து ரூ.92,785 கோடியாக உயா்ந்தது. நிகழ் நிதியாண்டில் 35 லட்சம் மத்திய அரசு ஊழியா்கள் இருக்கிறாா்கள். அவா்களுக்கான ஊதிய ஒதுக்கீடு ரூ.2.54 லட்சம் கோடி. ஊழியா்களின் எண்ணிக்கை குறையவில்லை; ஊதியமோ அதிகரித்து வருகிறது. பிறகென்ன சீா்திருத்தம்?
கீதா கிருஷ்ணன் தலைமையிலான ‘செலவினங்கள் சீா்திருத்த ஆணையம்’ அறிக்கை தாக்கல் செய்த 5-வது ஆண்டில் பதவியிலிருந்த மன்மோகன் சிங் தலைமையிலான ஐக்கிய முற்போக்கு கூட்டணி அரசு, வீரப்ப மொய்லி தலைமையில் இரண்டாவது நிா்வாக சீா்திருத்த ஆணையத்தை அமைத்தது. அரசின் எல்லா நிலைகளிலும் தேவையற்றவை அகற்றப்பட்டு பொறுப்பேற்புடனும், திறமையுடனும் செயல்படும் நிா்வாகத்துக்கான பரிந்துரைகளை அளிக்க வீரப்ப மொய்லி ஆணையம் கேட்டுக்கொள்ளப்பட்டது. 2005 முதல் 2009 வரை அந்த நிா்வாக சீா்திருத்த ஆணையம் 15 அறிக்கைகளை சமா்ப்பித்தது. அந்த ஆணையத்தின் 3,500 பக்கங்களுக்கும் அதிகமான அறிக்கையில் பிரச்னைகள் குறித்தும், சீா்திருத்த நடவடிக்கைகள் குறித்தும் விவரமாகக் குறிப்பிடப்பட்டிருந்தது. என்ன பயன்? கீதா கிருஷ்ணன் ஆணையத்துக்கு ஏற்பட்ட அதே கதிதான் வீரப்ப மொய்லி ஆணையத்துக்கும் ஏற்பட்டது.
2014-இல் பதவியேற்றபோது ‘மேன்மையான நிா்வாகம், குறைந்த அளவு தலையீடு’ என்பது நரேந்திர மோடி அரசின் கொள்கையாக அறிவிக்கப்பட்டது. முன்னாள் ரிசா்வ் வங்கி ஆளுநா் பிமல் ஜலானின் தலைமையில் செலவினங்கள் மேலாண்மை ஆணையம் 2014 பட்ஜெட்டில் அறிவிக்கப்பட்டது. 2015-இல் விமல் ஜலான் ஆணையம் தனது அறிக்கையைத் தாக்கல் செய்தது. அதன் அடிப்படையில் என்ன நடவடிக்கைகள் எடுக்கப்பட்டன, என்ன மாதிரியான செலவினங்கள் மேலாண்மை பரிந்துரைக்கப்பட்டன என்பவை குறித்த எந்த விவரமும் இதுநாள் வரை வெளியிடப்படவில்லை.
இப்போது மீண்டும் 2021-இல், செலவினங்களைக் கட்டுப்படுத்தவும் நிா்வாக நடைமுறைகளை மாற்றி அமைக்கவும் தலைமைப் பொருளாதார ஆலோசகா் சஞ்சீவ் சன்யால் தலைமையில் சிறப்புக் குழு ஒன்று அமைக்கப்பட்டிருக்கிறது. தேவையில்லாத துறைகளை அகற்றுவது குறித்தும், நடைமுறைகளை மாற்றுவது குறித்தும் அந்தக் குழு பரிந்துரைக்கும்.
தாராளமயம் அறிவிக்கப்பட்டு 30 ஆண்டுகள் கழிந்தும்கூட எந்தவொரு பொருளாதாரச் செயல்பாட்டுக்கும் 60-க்கும் மேற்பட்ட ஒப்புதல்களும், தடையில்லாச் சான்றுகளும், நூற்றுக்கணக்கான விண்ணப்பங்களும், அனுமதிகளும் இன்னும்கூட தேவைப்படுகின்றன. 1991 பொருளாதார சீா்திருத்தத்தின் நோக்கம் நிறைவேறவில்லை. ஒப்புதல்களும் அனுமதிகளும் தடையில்லாத சான்றுகளும் இல்லாமல் போனால் கையூட்டுக்கு வழியில்லாமல் போய்விடுமே, என்ன செய்ய?
A hoarding in blue and white bearing the logo of the Kolkata Municipal Corporation (KMC) hangs outside an office located on the third floor of a building in Kasba. Unlike the dingy, cramped offices that define the KMC, this space, in a building referred to as the UCO Bank building, on Rajdanga Main Road, has a cheerful look. It is festooned with balloons in the official colours of the West Bengal government, blue and white. The hoarding lists in exhaustive detail the activities carried out by the civic body: ‘Urban Planning and Development’, ‘I&PR’ (Information and Public Relations), ‘Urban Management’, ‘Environment and Heritage Department’. And so on.
These are all not what they appear to be — signs of a celebration; they are, in fact, the only remains of an audacious vaccination racket that has been carried out from these premises. In charge of the scam was a stocky man aged 28, Debanjan Deb, who had been masquerading as an Indian Administrative Service (IAS) officer for about a year. The fact that Deb managed to dupe businessmen, officials and people and carry out a racket while posing as a government servant has left the Mamata Banerjee government red-faced, investigating officers astounded and the people scared.
Acts of deceit
Deb had mastered more than just the art of putting up a fake hoarding. He had learned to use government logos and letterheads, email from fake government accounts, and even create bank accounts that sounded official to those interacting with him. While Deb mostly masqueraded as the Joint Commissioner of KMC (the post was vacant then), he also sometimes posed as the Secretary of the Information and Cultural Affairs Department.
Deb looked like an official in every sense to an untrained eye. He used a Toyota Innova SUV, bearing the registration number WB06R-0999. The car was fitted with a blue beacon light, the symbol of power. It also had a flag, and logos and stickers representing the Government of West Bengal. Deb’s Salt Lake residence had an ‘IAS Officer’ plaque on the gate. A 50-m area around the house was declared as a ‘no vehicle zone’.
Deb’s social media profiles provide a glimpse of how he created and cultivated this fake identity. The bio of his Twitter account (@DebanjanDeb07) describes him as a ‘Public Servant’. He first posted from the account as a ‘public servant’ in October 2020. Among his initial posts was a photograph of him greeting the former Mayor of Kolkata and Chairman of the Board of Administrators, KMC, Firhad Hakim. Between October 2020 and April 2021, when he stopped tweeting, Deb posted several photographs with prominent personalities including Ministers and MPs of the Trinamool Congress. He retweeted information from the account of Egiye Bangla, the digital interface of the West Bengal government. Many of his posts were about RT-PCR tests carried out at different centres of KMC and other activities related to managing COVID-19 in the city. A few tweets were also about the Central government. He put up about 50 tweets and retweets between October 2020 and April 2021, each designed to give the impression that he is a government servant. On Instagram, Deb’s account describes him as a ‘Film Lover, Music Lover, Food Lover and an inveterate traveller’.
Blowing the lid off the scam
For months, Deb organised awareness drives on COVID-19 and distributed masks and sanitisers. He took bribes from businessmen. He operated the vaccination scam from the heart of the city — no one suspected anything amiss. His latest fake COVID-19 vaccination camp would have gone unnoticed too had it not been for Trinamool Congress MP Mimi Chakraborty. Deb and his team invited the actor-turned-politician to the ‘vaccination camp’ organised at the Kasba office where Chakraborty decided to take a vaccine shot. Deb did not miss the opportunity to sit next to her and be photographed. He seemed calm and composed — the videos and photos clicked at the event betray no emotion.
But Chakraborty grew suspicious when she did not get a message after receiving her shot. “I was told that I would receive it shortly. I immediately asked my office to enquire whether the people present at the site had received registration messages. The people present there said they had not received any such message,” she said. Chakraborty said she had agreed to go to the camp as she was told that people with disabilities were being vaccinated there. She brought the matter to the notice of the city police immediately. Deb was arrested the same evening.
“During the enquiry, several irregularities were noticed. It was revealed that the vaccination camp was running without any permission from the Kolkata Police, the Kolkata Municipal Corporation or any other government department. It also came to light that Deb is not an IAS Officer...,” reads the affidavit filed by the West Bengal government before the Calcutta High Court. Deb was detained and arrested on June 22. A couple of days after Deb’s arrest, Kolkata Police Commissioner Soumen Mitra broke his silence and described the actions of the accused as “inhuman”. “It can be nothing more than the workings of a distorted mind,” he said.
Once Deb was arrested, one of the biggest challenges for the investigators was to trace how he had procured COVID-19 vaccines. Once they recovered vials bearing the labels of ‘Covishield’ and ‘Sputnik V’, they began to examine whether the vaccines were genuine.
On hearing about the racket, hundreds of agitated people, who had been administered vaccines at the Kasba office, started to come forward claiming that they were feeling unwell. The KMC rushed a team of doctors on June 24 to check on these people. Scores of them came to get themselves checked, complaining of headache, body pain and general discomfort.
“I have been feeling unwell ever since I heard that the vaccines could be fake. I have headache and nausea,” said Kaushik Das, a security guard at the Kasba New Market area. Das and several others who queued up at the KMC health facility were also worried about how they would get their second dose as they had not received the vaccination certificate after their first dose.
The first list prepared by the civic body suggested that 102 people, mostly shopkeepers at the Kasba New Market area, not far from Deb’s office, were among the vaccinated. A medical officer of Borough XII, who was present at the camp, said that none of them had any serious symptoms. Most of them were suffering from panic attacks, he said.
Meanwhile, a team from the State Forensic Science Laboratory collected the vaccine vials from Deb’s office. The results came as a shock. The report of the forensic team said that the ‘Covishield’ labels had been pasted on glass vials of Amikacin Sulphate, used to treat serious infections caused by bacteria such as meningitis, while the ‘Sputnik V’ labels had been pasted on vials containing Triamcinolone Acetonide, which is used to treat inflammation, allergic reactions and various skin conditions.
The investigation turned a page when the police found that Deb had organised as many as six camps at his Kasba office between June 11 and June 22 and one camp at City College on Amherst Street on June 18. A total of 802 people had been administered these injections at these camps.
Fake accounts, orders, letters
How was Deb able to pull off such an outrageous operation? Not only did he organise seven ‘COVID-19 vaccination camps’ in the city in just 10 days but he also employed several people to work for him. Some of the people questioned claimed that they were recruited by the KMC and were paid regular salaries. A few of Deb’s employees said they took a test and even paid a bribe to Deb, who had posed as the Joint Commissioner of KMC, to get the job.
Some of the employees said that their salaries had been credited from an account called ‘WB FINCORP’, which appeared to be official but was not. The account was similar to the KMC hoarding outside Deb’s office at Kasba — it looked credible. The police have seized five accounts of Deb and two other accounts: M/s WB FINCORP and M/s KMC Planning & Development UPD Kasba.
The fact that Deb managed to open an account in the name of the KMC in a private bank surprised Hakim even more than his own photograph with the accused that Deb had tweeted. “How can someone open a fake account of the KMC with fake documents,” Hakim wondered. It turned out that Deb had used fake holograms of the KMC to get bank accounts in its name. For getting holograms for fake work orders, Deb had provided fake acceptance letters and approval letters from the ‘KMC’ to a businessman in the Dalhousie area.
As the investigation gathered pace, the police arrested some accomplices of Deb. Among those arrested was Kanchan Deb who had posed as a high-level official of the KMC. Kanchan is Deb’s cousin. Soon after his arrest, Kanchan spoke to the media about how he was unaware of the things that Deb had done. He also falsely claimed that he and his family got vaccinated at one of the vaccination camps organised by Deb. Another accused, Sarat Patra, was arrested for impersonating a medical officer and injecting people at one of the camps. Days later, Deb’s security officer, Aurobindo Baidya, was arrested. Deb had hired a private security guard who was instrumental in getting several people from the Sonarpur area to get vaccinated at the camps in Kasba.
By the end of June, the police had arrested nine people in connection with the vaccination scam. The Kolkata Police have set up a special investigation team comprising 17 members of the detective department. The investigation is being supervised by the Joint Commissioner of the Kolkata Police.
The obvious reason for Deb’s elaborate plan seems to be financial gains, said investigators. Deb, they said, was disposed towards criminal activities even during his college days. A Zoology teacher, who liked acting, said that Deb had once duped him on the pretext of securing a ‘technician card’ for him to get work in the Bengali film and television industry.
The son of a retired Deputy Collector of the State Excise Department, Deb graduated in Zoology from Charuchandra College in Kolkata. He later got admission for a Master’s course in Genetics at the University of Calcutta, which he never completed. According to his close friends and family, he appeared for the Civil Services Examination in 2014 and failed to crack it.
Once the scam was out in the open, several businessmen alleged that they had also been duped by him. Most of them had been promised tenders to supply COVID-19 essentials and other medicines to state-run facilities. Deb forged documents to make them appear as though they had been issued by the Government of West Bengal. He used fake stamps, fake seals and impressions, and operated from fake emails ids and bank accounts created in the name of the KMC. Not only in Kolkata but businessmen about 500 km north in Siliguri also said that Deb had taken money from them and promised to set up an office of the Tea Board in north Bengal.
“From the scrutiny of the bank account traced till date, it has been revealed that there has been a transaction of Rs. 2.80 crore (approx.) in the said accounts and a considerable portion of the said money have been found to be siphoned off in different accounts,” reads the affidavit filed by the Kolkata Police in the Calcutta High Court. The police also pointed out that Deb, using forged documents, had deposited a sum of Rs. 77,13,000 in the accounts. According to Atin Ghosh, MLA and member, Board of Administrators, KMC, Deb even took a little over a lakh to vaccinate about 100 employees of a non-governmental organisation.
A major embarrassment
The scam created ripples in the political circles in the State. While distancing her government from the issue, Chief Minister Mamata Banerjee described the accused as being “worse than a terrorist”. She said, “You should not publicise the names of cheats, thugs and impostors. If you don’t take his name and ask about the impostor, then I will respond.... How can someone display such audacity. This has nothing to do with the government.”
Deb’s duplicity brought major embarrassment to the State government. Days after his arrest, a bust of Rabindranath Tagore in Kolkata’s Taltala area, which was unveiled on February 26 this year, was located with the name of the impostor IAS officer on the plaque. The plaque had the names of a local MP, an MLA and a former Mayor of Kolkata, among others. The civic officials tried to cover his name with black ink. When that didn’t work, they finally destroyed the plaque on June 25 in the presence of several television news cameras.
The Opposition parties, particularly the Bharatiya Janata Party (BJP), had a field day as the controversy continued to make headlines for days. Party members hit the streets, clashed with the police during a march to the KMC, and organised a law violation programme in Kolkata, where several leaders courted arrest. BJP leaders wrote to the Union Health Ministry seeking its intervention in the issue. By the first week of July, the Enforcement Directorate had started a probe into the scam.
A number of writ petitions were filed before the Calcutta High Court demanding a probe by the Central Bureau of Investigation (CBI). The High Court said in its observation that the inquiry “does not show that there is any deficiency in the conduct of this investigation, the facts do not warrant investigation by the CBI”. In its July 9 order, the court said that Deb along with his collaborators have been “able to deceive a large section of innocent people, lure them to take vaccination from him at a serious risk to their lives”.
The story of Deb has had a snowball effect. In the last week of June and first two weeks of July, many impostors operating across the State were caught. They included a man claiming to be the CBI counsel, a youth claiming to be a CBI officer, and some pretending to be Crime Investigation Department officers and officers of the State Police. One of them even pretended to be a member of the National Human Rights Commission. All of them had a modus operandi similar to Deb’s — they spun their own webs of lies and operated fake social media profiles.
While investigations continue, the city police are busy keeping a watch on the roads and noting down the numbers of vehicles that have beacons on top.
India has a new Union Health Minister after the recent cabinet reshuffle. So, what does the new Health Minister need to learn from previous experience, and what unfinished tasks need to be taken forward? As citizens, how should we expect the Government to perform better on the public health front, given the lessons of the COVID-19 pandemic? If the Union Health Ministry acts upon the following health system lessons, this would not only enable improved handling of COVID-19, but would also have widespread positive impacts extending much beyond the COVID-19 situation.
Two States and a comparison
For any population, the availability of functional public health systems is literally a question of life and death. This is evident by comparing two States which currently have the highest number of COVID-19 cases in India — Maharashtra and Kerala. Their per capita gross State domestic product (GSDP), reflecting the overall economic situation in each State, is similar. However, their COVID-19 case fatality rates are hugely different — this being 0.48% for Kerala and 2.04% for Maharashtra, with the shocking implication that on average, a COVID-19 patient in Maharashtra has been over four times more likely to die when compared to one in Kerala.
A major reason for such critical divergence is likely to be the huge differences in the effectiveness of public health systems. Kerala has per capita two and a half times more government doctors, and an equally higher proportion of government hospital beds when compared to Maharashtra, while allocating per capita over one and half times higher funds on public health every year. Despite Maharashtra having a large private health-care sector, its weak public health system has proved to be a critical deficiency.
In contrast, robust government health-care services in Kerala have translated into: a more effective outreach, timely testing, early case detection and more rational treatment for COVID patients, which all together reduce fatality rates. Existing evidence from the COVID-19 pandemic provides a clear message: a neglect of public health systems can mean large-scale, avoidable losses of lives;hence, public health services must be upgraded rapidly and massively as a topmost priority.
Focus on public health
Talking of priorities, if the Rs. 20,000 crore or nearabout allocated for the Central Vista project were to be utilised instead to set up oxygen plants, two-thirds of the over 25,000 government hospitals across India could acquire their own oxygen source, thus helping to save the lives of lakhs of COVID-19 and non-COVID-19 patients. A larger programme which requires the immediate attention of the Health Minister is the National Health Mission (NHM); since 2017-18, Union government allocations for the NHM have declined in real terms, resulting in inadequate support to States for core activities such as immunisation, while systemic gaps affect the delivery of COVID-19 vaccination.
Although urban people across India have experienced major shortages of public health services during COVID-19, the condition of the National Urban Health Mission (NUHM) remains pathetic. This year’s Central allocation for the NUHM is Rs. 1,000 crore, which amounts to less than Rs. 2 per month per urban Indian. This situation must change, and as recommended by the Parliamentary Standing Committee, for reaching National Health Policy targets, the Government must allocate Rs. 1.6-lakh crore for public health during the current year. This would amount to a doubling of the present central health Budget, which could enable major strengthening of health services in rural and urban areas across the country.
Private sector regulation
Another clear priority that has been highlighted during the COVID-19 pandemic is the need to regulate rates and standards of care in the private sector. Massive hospital bills have caused untold distress even among the middle class; COVID-19 care often costs Rs. 1 lakh to Rs. 3 lakh per week in large private hospitals. The ‘Remdesivir panic’ was significantly linked with major overuse of this medicine by unregulated private hospitals, despite the drug lacking efficacy to reduce COVID-19 mortality. Although various determinants have contributed to the Mucormycosis outbreak, irrational use of steroids in COVID-19 patients, especially diabetics, appears to be an important factor.
Yet, despite accumulating evidence on the need for comprehensive regulation of private hospitals, the central government is yet to take necessary steps to promote the implementation of the Clinical Establishments (Registration and Regulation) Act (CEA).
Passed in 2010 and presently applicable to 11 States across India, this Act is not effectively implemented due to a major delay in notification of central minimum standards, and failure to develop the central framework for regulation of rates. Responding to public distress, around 15 State governments invoked disaster-related provisions to regulate rates for COVID-19 treatment in private hospitals. However, initiatives from the central government to promote regulation of private hospitals during the COVID-19 situation are conspicuously inadequate. Learning from stark market failures during the COVID-19 pandemic, comprehensive regulation of private health care in public interest now must be a critical agenda for the new Health Minister.
NITI Aayog prescriptions
A logical corollary of the first two lessons is that health services should not be further privatised. However, flying in the face of health-care distress faced by ordinary Indians during the last 16 months, NITI Aayog has recently published the document, ‘Investment Opportunities in India’s Healthcare Sector’ (https://bit.ly/3em8myP). This promotes further privatisation of health care in a country which already has one of the most privatised health systems in the world.
Published in the midst of widespread experiences of large-scale overcharging and irrational care by private providers during the COVID-19 epidemic, the report fails to acknowledge the negative aspects of unregulated private health care; neither is there any mention of the need for regulation of private hospitals. Instead, the document celebrates the COVID-19 epidemic as a prime business opportunity to be exploited, stating that ‘in the hospital segment, the expansion of private players to Tier 2 and Tier 3 locations, beyond metropolitan cities, offers an attractive investment opportunity’. Proposals for handing over public hospitals to private operators, who would presumably now run these key public institutions on commercial lines under the ‘Viability Gap Funding’ scheme are deeply worrisome, especially since public health services which were hitherto free of cost, would begin to be charged for.
Assuming that the Union Health Ministry has a primary mandate to shape national health policy in India, the Health Minister must assert his authority to stop such moves for further privatisation, which might benefit health-care corporates but would be damaging for ordinary people.
To conclude, this is a time when it is critical to rebuild people’s trust in public health systems. This would help in overcoming COVID-19 vaccination hesitancy while strengthening the promotion of healthy behaviours necessary to deal with the current wave of COVID-19 and prevent a third wave. This would be done best if the new Health Minister acts on three core health system lessons of the COVID-19 pandemic — a need for strengthening public health systems; regulating private health care, and preventing further privatisation of the health sector. It is not unjustified to expect our new Health Minister to present an example to the people of India, by acting decisively for public health systems.
Dr. Abhay Shukla, a public health professional and health activist, is a National Co-convenor of Jan Swasthya Abhiyan
Many of us working in the field of public health and social development have been taken aback, if not downright shocked, by the recently announced draft Uttar Pradesh Population (Control, Stabilization and Welfare) Bill, 2021 (https://bit.ly/3eoMRh3) that focuses exclusively on making a two-child norm a law, specifying various incentives and penalties for contravention. The burgeoning negative reaction to this proposal derives from a variety of inherent dangers, but also because most experts would agree that the conceptual clarity on ‘development being the best contraception’ and the irrationality of incentives-disincentives had been, ostensibly, long settled.
As early as 1994, the Programme of Action of the International Conference on Population and Development (UN 1994); to which India is a signatory, strongly avers that coercion, incentives and disincentives have little role to play in population stabilisation and need to be replaced by the principle of informed free choice.
This principle is also echoed in the National Population Policy 2000, which unequivocally supports a target-free approach and explicitly focuses on education, maternal and child health and survival, and the availability of health-care services, including contraceptive services, as key strategies for population stabilisation. The logic and rationale for this global and national articulation against incentives and disincentives, and in favour of the developmental measures mentioned above applies as much to Uttar Pradesh and other States today as they did when these policies were formulated.
Signs of stabilisation
Consider the rationale below with the facts as they stand:
The population of India, and Uttar Pradesh is on the road to stabilisation regardless of coercive policies such as the two-child norm. The fertility rate for Uttar Pradesh (National Family Health Survey, or NFHS-4) is 2.7, compared to 3.8 10 years ago (NFHS-3). This trend is correlated with improvements in health indicators for the State, such as infant mortality rate (IMR), maternal mortality ratio (MMR) and malnutrition, in the same period.
There are many States that have attained the replacement-level fertility rate of 2.1 by NFHS-4 such as Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Odisha, Telangana, Tamil Nadu, Uttarakhand, West Bengal (excluding Union Territories and some northeastern States); all of which have much better development indicators. For instance, by NFHS-4, child mortality rate in Uttar Pradesh is 78 compared to seven in Kerala and 27 in Tamil Nadu. Women with 10 or more years of schooling stand at 33% in Uttar Pradesh compared to 72% in Kerala and 50% in Tamil Nadu. Thus, there is much scope for acceleration of population stabilisation through better delivery of health and education services.
Issue of child sex ratios
Second, one of the greatest concerns with coercive policies such as the two-child norm is their potential impact upon child sex ratios in a society that has such a high preference for male children. That this concern is only too real is well demonstrated by the example of China that had to detract from its stringent one-child norm, first in favour of a two-child norm and then to remove targets altogether, after experiencing a disastrous reduction in its child sex ratio. Considering that Uttar Pradesh is amongst the worst across Indian States, with the lowest child sex ratio of 903 compared with 1,047 in Kerala and 954 in Tamil Nadu, and that; unlike other development indicators, this has deteriorated in NFHS-4 compared to NFHS-3, why it would want to take such a foolhardy misstep is hard to understand.
The correlation between poor socioeconomic status and family size also impacts the potentially discriminatory effect of the proposed measures upon communities that house the poorest of the poor, such as the religious minorities and Dalits, as already pointed out by many. Leaving these communities out of political and administrative spaces as well as curtailing their access to welfare is hardly likely to advance any kind of social justice or equity.
In our experience with poor communities that are often blamed for not exerting population control, a vast majority are keen to receive and actively seek contraceptive services. With an unmet need of 18% in Uttar Pradesh (as compared to, for example, 10% in Tamil Nadu), it is the State that is failing to provide a service at all to almost a fifth of its people that actively seek it, and services with quality to a far higher percentage. If the law has to be used to correct the situation, why do we not see a move to enact ‘the Right to Healthcare’ as being demanded by health groups for decades? And why do we not find penalties upon the State for failing to provide services on demand within a reasonable period of time within this law itself?
We still have memory of hundreds of lives needlessly lost and human rights violations in almost criminal sterilisation ‘camps’ that the Supreme Court of India had to step in to regulate (Devika Biswas vs Union of India & Others, Petition No. 95 of 2012). Most recently, a disabled man from a village in Uttar Pradesh was lured into going for a COVID-19 vaccination and was forcibly sterilised instead to fulfil targets.
A wrong path to follow
Clearly, as is evident in so many antiquated ‘control’ measures the state has been displaying in recent times, the Government has no trust in the ability of its citizens to take well-reasoned steps for their own welfare. Rather than do its job as a supporter of these decisions, and a duty bearer towards their rights, the state visualises itself as a paternal figure that must ‘control’ a recalcitrant immature populace at best, and a policeman wielding the law as an instrument of imperiousness at worst. This irrational and ill-considered proposed Act should be retracted forthwith if the Uttar Pradesh government has any appreciation for the collective understanding based on decades of scientific evidence of what does and does not work for population stabilisation. Instead, we are seeing other State governments displaying signs of following its lead. Clearly, it is easier for our governments to blame the victims of maldevelopment and apply penalties upon them than be held accountable for their own failures in delivering basic services of health and education.
Vandana Prasad is an independent public health expert associated with the Public Health Resource Network. Dipa Sinha is a faculty member at Ambedkar University Delhi
It is gratifying to note that the Supreme Court, while indicating its intention to reconsider the sedition provision in the IPC, has raised the question most relevant to the issue: “Why does Section 124A continue in the statute book even after 75 years of independence?” The Chief Justice of India, N.V. Ramana, has also pointed to its rampant misuse by the police across the country, and reminded the Government that it was a legal provision that the colonial regime had used to suppress the freedom movement. The issues flagged by the CJI may set the tone for what would be a comprehensive reconsideration of a section that has been frequently and wrongfully used, especially in the last few years, to suppress dissent, criminalise strident political criticism and taint opponents with the tag of being ‘anti-national’. Even though it is often argued that the misuse of a law alone does not render it invalid, there is a special case to strike down Section 124A because of its inherent potential for misuse. There is a pattern of behaviour among all regimes that indicate a proclivity to invoke it without examining its applicability to the facts of any case. Recent cases show that sedition is used for three political reasons: to suppress criticism and protests against particular policies and projects of the government, to criminalise dissenting opinion from rights defenders, lawyers, activists and journalists, and to settle political scores, sometimes with communal hues.
It is not to be forgotten that the section was upheld in 1962 by a Constitution Bench mainly by reading down the import of the terms “bring into hatred or contempt”, or “to create disaffection towards the government established by law” and limit its scope to only those instances of speech or writing that show a pernicious tendency to create public disorder. Without this attenuated interpretation, the restriction imposed on free speech by Section 124A would have been declared unconstitutional. The Court is now seized of several cases that seek a reconsideration of the 1962 verdict, citing more recent judgments expanding the scope of fundamental rights and doctrines that have been subsequently evolved. In particular, the “chilling effect” that a law may have on free speech and the vague and ‘overbroad’ definition of sedition that renders both provocative and innocuous speeches or writings equally liable for prosecution, are points to be examined. In 2016, the Government itself admitted in Parliament that the definition of sedition is too wide and requires reconsideration. The Law Commission’s consultation paper in 2018 had said: “In a democracy, singing from the same songbook is not a benchmark of patriotism... People should be at liberty to show their affection towards their country in their own way.” While issuing fresh guidelines and safeguards is one way of quelling the potential for its misuse, it will be more helpful if Section 124A is struck down altogether.
Fresh daily cases of the coronavirus, globally, after touching a new peak of over 0.9 million on April 28, began to drop steadily, reaching a low point on June 21, when only over 0.3 million cases were reported. But there has been a rise in cases, again globally, since then. July 15 saw 0.53 million daily cases and the second week of the month witnessed nearly three million new cases. A total of 188.9 million cases have been reported worldwide as on July 15, driven in most countries by the highly transmissive Delta variant. A total of 111 countries now have this variant. Brazil, India, Indonesia, the U.K. and Colombia have reported the most cases in the past week, with the sharpest increase being in Zimbabwe (72%), Indonesia (44%), the U.S. (38%), Bangladesh (35%), and the U.K. (30%). Many Asian countries, including Vietnam, Malaysia, South Korea and Japan, where the spread was under control, have also been reporting a high number of daily cases. Indonesia has seen a surge in new cases, with each day witnessing a sharp increase over the previous day. With 56,757 cases on July 15, Indonesia is now the new Asian epicentre; India reported over 39,000 cases on July 15. According to WHO, COVID-19 deaths are increasing again after falling for nine straight weeks, with the sharpest upticks in Africa and Southeast Asia. On July 7, the total global COVID-19 deaths crossed four million. It took just 90 days for the last million deaths to occur, the shortest time span for every one million deaths recorded.
The U.S. and much of Europe have demonstrated how high vaccination coverage can sharply reduce the number of deaths and even hospitalisation. For instance, with over 87% of the adult population vaccinated with one dose and over 67% with two doses in the U.K., there have been fewer hospitalisations and deaths despite spikes in cases. In the U.S., the case rise is largely in States with low vaccination coverage, and deaths mainly in the unvaccinated. Over 55% of the U.S. population has had one dose; 48% are fully vaccinated. This brings the focus back on increasing vaccination coverage and striving for global vaccine equity to prevent deaths and the emergence of deadlier variants. Ironically, the discussion in some countries is on a booster dose even while health-care workers in many African countries have not been fully vaccinated. Israel has begun giving booster shots to people with a compromised immune system, while the U.S. has ruled out booster shots for now. With several Indian States reporting vaccine shortages, strict adherence to COVID-appropriate behaviour even by the fully vaccinated is the only way to delay and reduce the impact of a third wave.