The Hindu Editorial Analysis- 21st May, 2021 - UPSC PDF Download

1. The fault line of poor health infrastructure

GS 2 - Health

Background

In the second COVID-19 wave there have been several shortcomings in the health system of our country which have been exposed by it.

What's the issue?

• The poor state of health can be understood by the data of World Bank on Health systems across the world.
• World Bank data reveal that India had 85.7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan),
• It had 53 beds per 1,00,000 people (in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan)
• 172.7 nurses and midwives per 1,00,000 people (in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan)

Stagnant expenditure

• Current situation is a direct result of the low public health expenditure.
• According to Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that this has been stagnant for years: 1% of GDP 2013-14 and 1.28% in 2017-18.
• Health is a State subject in India and State spending constitutes 68.6% of all the government health expenditure. Because the Center is the key player as major bodies like ICMR etc are under its control so the onus lies on centre.

Inter-State variation

• The interactive graphic shows the inter-State variation in per capita health-care expenditure in 21 major States and how this has changed from 2010-11 to 2019-20. Kerala and Delhi have been close to the top in all the years.
• Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in all years, are struggling to cope with the pandemic.
• Odisha is noteworthy as it had the same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh. This is reflected in its relatively good COVID-19 management.
• India has among the highest out-of-pocket (OOP) expenditures of all countries in the world.
• The World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
• Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha have a high ratio of OOP expenditures in total health expenditure.
• Thus, the most vulnerable sections, are the worst victims of a health emergency.

Government’s role critical

• The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
• Centre controls major decisions of health , including additional resources raised specifically for pandemic relief, PM CARES Fund.
• Data by CEDA shows that first round of vaccination was biased as it showed Inter state disparity, which was neither explained by the case load nor by the share of eligible (45+) population.
• Centre can bargain vaccines for a good price from vaccine manufacturers in its capacity as a single large buyer and benefit from the economies of scale in transportation of vaccines into the country.
• These could be distributed across States equitably in a needs-based and transparent manner.
• Distribution of constrained resources (medical supplies, financial resources) can internalise the existing disparities in health infrastructure across States.
• Author argues that decentralized management exacerbates the inter state inequalities as the richer states can compete better in procuring resources.

A policy brief

• Following suggestions would help tackle pandemic properly:
• Pandemic Preparedness Unit” (PPU) by the central government, which would streamline disease surveillance and reporting systems;
• coordinating public health management and policy responses across all levels of government;
• formulating policies to mitigate economic and social costs,
• effective communication

Conclusion

The central government needs to deploy all available resources to support the health and livelihood expenses of COVID-19-ravaged families immediately. After this wave, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States.

2. The outdated nature of bureaucracy

GS 2 - Role of Civil Services in a democracy

Context

The author tries to highlight that despite its efforts, bureaucracy has emerged as a major concern for the ineffective response to the COVID-19 crisis. This inadequacy is the reflection of the outdated nature of public bureaucracy.

Generalist over Specialist

• Democratic countries relies on traditional bureaucracies to perform public policy formulation and implementation roles.
• The author says these bureaucracies have outlived their relevance. Weberian bureaucracy still prefers a generalist over a specialist.
• Specialists in every government department have to remain subordinate to the generalist officers. The COVID-19 pandemic has exposed this weakness.
• The author argues that policy options should be left to the in the hands of the specialists rather than generalists.

Weberian bureaucracy

• Traditional bureaucracy gives preference to leadership of position over leadership of function.
• Leadership of function is when a person has expert knowledge of a particular responsibility in a particular situation. Whereas Weberian bureaucracy prefers leadership based on position.
• Rigid adherence to rules has resulted in the rejection of innovation, example being COVID-19 aid getting stuck in cumbersome clearance processes.
• Author argues that often suggested reform new public management is not viable in case of India as there are social inequalities and regional variations in development.
• If new public management is implemented it has risk of state a bystander among the multiple market players with accountability being constantly shifted.

Collaborative governance

• The most appropriate administrative reform suggested by author is the model of new public governance.
• It is based on collaborative governance in which the public sector, private players and civil society, especially public service organisations (NGOs), work together for effective public service delivery.
• In such model there won't be no domination of public bureaucracy as the sole agency in policy formulation and implementation.
• A network of social actors and private players would take responsibility in various aspects of governance with public bureaucracy steering the ship rather than rowing it. 
• It needs a change in the behaviour of bureaucracy and needs flexibility in hierarchy.
• A relook at the generalist versus specialist debate, and an openness to reforms such as lateral entry and collaboration with a network of social actors.

Conclusion

All major revolutions with huge implications on public service delivery have come through the collaboration of public bureaucracy with so-called outsiders like  These Green Revolution (M.S. Swaminathan), the White Revolution (Verghese Kurien)etc. Thus new public governance is the future of governance, especially public service delivery.