The Indian healthcare story has achieved notable successes.
Pharmacy of the world
Doctors and nurses from India – US, Europe, West Asia
Private hospitals - key driver of medical tourism
WEAKNESS: Centre and states together spends a mere 1.13% of GDP on health.
Out-of-pocket expenditure: 62%
98% of healthcare facilities in India are provided by those who employ fewer than 10 people.
Studies: countries with strongprimary healthcare systems have better health outcomes, lower inequalities and much lower costs of care.
The creation of 1,50,000health and wellness centres by 2022 by transforming existing sub-centres and primary health centres under the Ayushman Bharat Scheme is a major move in this direction.
Currently, the primary healthcare service is largely focussed on hospital based curative services, which fail to provide a continuum of care.
The healthcare system is fragmented with focus on disease-centricprogrammes rather than integration of programmes.
We need to design integrated and comprehensive ways of delivering primary healthcare.
This is the critical paradigm shift that India needs.
There’s also a need to strengthen district and subdistrict hospitals to provide high quality referral cases.
Shortage of qualified doctors across the country, especially in rural areas.
Global average - 1.72:1000
WHO - 1:1000
India - 0.7:1000
Core - augmenting the number of medical seats in the country
Rationalise – high capital costs - medical colleges
Over Rs 250 crore capital expenditure - 150 seat college
Widespread opening of medical schools across districts throughout the country
Opportunity to local students - encouraging them to continue in their district
There are 22 times more engineers than doctors in India.
Self-styleddoctors without formal training provide up to 75% of primary care visits.
Major surge in non-communicablediseases
Increasing demand for mental health and palliativecareservices
Undertake reskillingof human resources and utilise them fully
For instance, nurses in the UK, Thailand and Africancountries are increasingly taking doctors’ role at the primary level.
Chhattisgarh’sthree-year community medical course
The measures initiated by the government for reforming the Medical Council of India need to be extended to the Dental and Nursing Council of India.
Substantial funding has to be earmarked for health research
Focus on developing novel diagnostics, drug molecules, therapies, morbidities and surveillance for diseases.
We must create an enabling environment so that products are designed, developed, validated and technologies converted into products.
Lastly, we need to harness the power of digital health as a critical enabler for transforming the health system.
India must use technology to leapfrog and become a model for digital health adoption.
Data produced can provide valuable information, which can be analysed to improve the health system.
This will fuel mobile technologies, telemedicine application, use of AI and cloud-based solutions.
India’s health sector can emerge as its biggest driver of growth and employment in pharmaceuticals, bio-pharma, hospitals, doctors, nurses and medical equipment.
The great greying of China
China’s one child policy (OCP) was conceived by Senior Leader Deng Xiaoping in 1979 to seek popular support for the Chinese Communist Party (CCP) after Mao’s disastrous ‘Great Leap Forward’ and ‘Cultural Revolution’ (which led to the death of about 60-65 million people).
Prof. David Lampton, an American sinologist, has observed that Deng was worried that “if the party did not produce significant gains in per capita income, it would lose what little legitimacy” it had retained.
The results of the one child policy have been disastrous.
Average birth rate in China has fallen to 1.6 births per woman (National Bureau of Statistics of China) in 2017, though the unofficial figures put it as low as 1.05 (the United States: 1.77, India: 2.24) and much less than the population replacement rate of 2.1.
Fewer children were born and of them, fewer were females (given China’s preference for boys like in some other countries).
Research by Prof. Yi Fuxian (2019) at the University of Wisconsin-Madison, U.S., reveals that the proportion of China’s population aged above 65 years would increase from 10% in 2010 to 32.6% in 2050 (corresponding figures for India are 5.6% and 14.2% and the U.S. 14.6% and 23.2%).
Its labour force (ages 20-64) will reduce from about a billion in 2017 to 787 million by 2050.
Thus, China will be a country dominated progressively by older people in the coming years.
Despite the raising of the limit to two children in 2016, the number of newborns has not improved and slipped to the pre-2016 level.
The one child policy has changed China’s child-bearing attitudesfor the worse as many young couples do not want to have two babies for economic and lifestyle reasons.
Prof. Fuxian has affirmed that China’s population has started contracting from 2018 onwards; local authorities in China bloat the births and school enrolment figures to seek more funds from the central government.
If China can stabilise its fertility rate at 1.2, its population will fall to 1.07 billion in 2050 and 480 million by 2100.
The aging population will have a multi-dimensional impact.
China will need huge expenditures on health, social welfare and pensions; its savings rate will decline; a fall in the number of young people will lead to a decline in manufacturing, exports, and also mean lower revenues for government.
With its annual per capita income at $10,000, increasing population of older people and slowing economic growth rates, China will get old before reaching the levels of rich countries like the United States, Singapore, Japan and others. China’s armed forces are already struggling as many one child policy children are often misfit for fighting in tougher conditions.
Will the population decline create a richer society in China?
Developed countries have reduced the impact of declining population by raising the total factor productivity (TFP) growth (ratio of output versus cost of inputs per hourly basis).
Three factors are considered critical for increasing the TFP: market reforms, improvement of governance andscaling of human skills in manufacturing and services.
Many economists have argued that faster rates of TFP growth are associated with rapid and liberal economic reforms.
In China’s case, while President Xi has talked of market reforms and increasing consumption, there has been little progress on the ground on issues such as opening of services such as banking, insurance, education or the establishment of an independent legal system for the enforcement of contracts or a creative education system.
Post-2008, China’s economic growth has been driven progressively by higher government investment which has created unproductive assets in many cases, i.e., overcapacity in metals, cement and other industries, empty apartment complexes, or rarely used infrastructure such as metro networks, oil pipelines and ports.
China has never ranked very high in governance indicators of international organisations such as the World Bank; in 2016, it was in 68th percentile for ‘government effectiveness’ and 77th in the annual Corruption Perceptions Index of Transparency International (2017).
Instead of giving representation to new interest groups such as industrialists, micro, small and medium enterprises (MSMEs), professionals, media and academics, Mr. Xi has moved in the direction of curbing any dissent and establishing absolute control over Chinese society.
In improvement of China’s human resources, there are big variations in high school pass rates of urban (90%) and rural children (24%). Considering that about 40% of China’s population still lives in rural areas, this huge gap will be an inhibiting factor in raising TFP.
In the last 70 years, only 15 countries have managed to climb from middle to high income status, e.g. Singapore, South Korea, Taiwan, others and all of them had skilled their workforces with three quarters or more of their working population having completed high school.
Under Mr. Xi, China is not moving in the direction of reforms incorporated by developed countries, but evolving its own agenda mainly focused on administrative and bureaucratic improvements concomitantly enhancing party’s control over the economy.
Also, unlike the past, China will face a hostile external environment in the coming years as a reaction to Mr. Xi’s unfair and aggressive policies, which will further constrain cooperation in new technologies.
Drawdown in Iraq
The U.S.’s decision to cut troops in Iraq is both a relief and a challenge to the Iraqi government.
It is a relief because public opinion in Iraq is increasingly against the continuing presence of U.S. troops in the country, particularly after the assassination of Iranian General Qassem Soleimani in Baghdad in January.
U.S. troops had played a key role in the war against the Islamic State (IS), and with the drawdown, the Iraqi forces would have to share a greater burden in the fight against jihadists.
The Americanpolitical leadership has long wanted to pull troops out of Iraq.
At the height of the war, the U.S. had over 1,50,000 troops in Iraq.
But in recent years, it found stationing even 10,000 troops risky.
This is partly because of the hostile political environment and partly due to the growing influence of Iran and Shia militias in Iraq.
Iran retaliated by launching ballistic missile attacks on a U.S. air base in Iraq, injuring some 100 American soldiers, while the Shia militias continued attacking U.S. troops.
While the Americans leave, the Iraqi government should be careful of not letting any security vacuum being filled by jihadist groups.
Though the IS has been driven underground, atleast10,000 IS fighters are still active in Iraq, according to UN assessments.
The Iraqi government should not allow history to repeat itself.
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