Editorials/Opinions Analysis For UPSC 17 March 2025

CONTENT:

1. The Challenges of Public Health Education in India
2. From Insurance-Driven Private Health Care to Equity
3. Rare success

The Challenges of Public Health Education in India

Public health plays a crucial role in shaping healthcare delivery, as recognized by Article 47 of the Indian Constitution. However, public health education in India faces a crisis due to a mismatch between supply and demand, lack of standardization, and insufficient job opportunities. The COVID-19 pandemic underscored the need for a robust public health workforce, yet systemic issues persist.

Relevance : GS 2(Health , Governance)

Practice Question : The challenges of public health education in India stem from systemic gaps in regulation, employment opportunities, and institutional capacity.Discuss the key issues and suggest policy measures to address them. (250 words)

Historical & Contemporary Context

• Colonial Legacy: Public health education in India traces back to British rule, with early efforts confined to medical institutions.
• Post-Independence: The All India Institute of Hygiene and Public Health (1932) and community medicine specializations laid the foundation, but opportunities remained limited.
• Expansion Phase (2000–2020s): The number of MPH programs surged from one (2000) to over 100 today, largely driven by the National Rural Health Mission (2005). However, job creation has not kept pace, leading to underemployment of public health graduates.

Challenges

1. Mismatch Between Supply & Demand
   1. More graduates than available jobs; high competition for limited entry-level positions.
   1. Public health roles in government shrinking despite increasing disease burden.
   1. Private sector prioritizing hospital/business management over public health professionals.

• Lack of Standardization & Regulation
  • No mandatory regulation by NMC or UGC.
  • Varied curricula and low admission standards due to intense competition.
  • Faculty shortages and inadequate practical training opportunities.

• Regional Disparities
  • States like Bihar, Jharkhand, and Assam lack adequate public health institutions.
  • Over-concentration of institutions in select urban areas.

• Funding & Institutional Constraints
  • Development sector and research bodies reliant on foreign grants, which are declining.
  • Limited national health research funding.

Policy Implications & Actionable Insights

1. Creation of Public Health Jobs
   1. Establish a public health cadre within state governments.
   1. Integrate public health professionals into primary and preventive care.

• Regulatory Reforms
  • A dedicated Public Health Education Council within NMC/UGC to standardize curricula.
  • Mandatory accreditation for MPH programs.

• Strengthening Practical Training & Institutional Growth
  • Increase public health fieldwork and system integration.
  • Expand public health schools in underserved states.

• Diversification of Funding Sources
  • Increase domestic funding for public health research.
  • Encourage public-private partnerships for sustainable workforce development.

Future Outlook

The public health education crisis in India demands urgent structural reforms. Without a balanced approach that integrates regulatory oversight, job creation, and sustainable funding, India risks a surplus of underutilized professionals. The emerging global health landscape necessitates self-reliance, emphasizing local capacity-building over dependence on international aid.

From Insurance-Driven Private Health Care to Equity

India’s health care system is undergoing a critical transformation with increasing dependence on insurance-driven models like the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). While the scheme aims to reduce out-of-pocket expenditure (OOPE) and improve financial protection, it sidelines primary health care (PHC), which is the cornerstone of Universal Health Coverage (UHC).

Relevance : GS 2(Health , Governance)

Practice Question: Critically analyze the impact of an insurance-driven private healthcare model on universal health coverage (UHC) in India. How can policy reforms ensure equitable access to quality healthcare, particularly for marginalized communities? (250 words

Historical and Contemporary Context

Evolution of India’s Health Care Approach

• Bhore Committee (1946): Advocated for a strong PHC foundation with a pyramid-shaped health system focused on preventive care.
• National Health Policy (1983, 2002, 2017): Emphasized PHC, but funding and implementation gaps led to increased OOPE.
• Launch of AB-PMJAY (2018): Aimed at providing health insurance for low-income families, covering hospitalisation expenses but shifting focus away from PHC.

Current Scenario and Budget Allocations

• 2025 Budget for AB-PMJAY: ₹9,406 crore, up by ₹2,000 crore, signaling increasing privatisation and insurance dependence.
• National Health Mission (NHM) Fund Decline: Weakens grassroots health services, affecting rural and informal workforce health coverage.
• FDI Increase in Insurance (74% to 100%): Encourages private sector growth but raises concerns about affordability and regulatory gaps.

Arguments:

Strengthening Private Health Care and Financial Protection

• Reduction in OOPE: Insurance-driven models like AB-PMJAY reduce catastrophic health expenses for the poor.
• Increased Access to Advanced Treatments: Tertiary care coverage ensures life-saving procedures for low-income groups.
• Boost to Medical Infrastructure: Private hospitals expand to accommodate insured patients, improving overall health care capacity.
• Foreign Investment Benefits: Higher FDI in insurance expands the market, increasing competition and coverage rates.

Weakening of Public Health Care and Rising Inequality (Critics’ View)

• Neglect of PHC: Insurance-based funding diverts resources from preventive and community health care.
• Market-Driven Pricing: Insurance models incentivise private players to increase costs, leading to inflated medical expenses.
• Exclusion of Informal Sector and Migrants: Many lack awareness or access to insurance, remaining dependent on high-cost private care.
• Regulatory Deficiencies: Weak consumer protections allow claim denials, high deductibles, and profit-driven health care practices.

Policy Implications

Impact on Health Care Access and Equity

• Marginalised Groups Left Behind: The informal workforce, daily wage laborers, and rural populations struggle with access due to digital and insurance illiteracy.
• Gender Disparities in Coverage: Women, particularly homemakers, often lack individual health insurance, worsening gender health gaps.
• Outdated Population Data: Lack of an updated Census (since 2011) affects policy planning and benefit distribution accuracy.

Lessons from Global Health Models

• U.S. Experience: Private insurance dominance led to skyrocketing health costs, disparities in coverage, and profit-driven medical practices.
• Thailand’s Universal Coverage Scheme: Tax-funded model ensures free PHC, reducing OOPE and improving long-term health outcomes.
• Costa Rica’s Social Security System: Mandatory insurance with strong public investment ensures equity in health services.

Way Forward

Strengthening Public Health Care Systems

• Increase PHC Investment: Redirect funds toward preventive care and community health centers.
• Expand NHM Funding: Revitalize public hospitals and ensure affordable services.
• Regulate Private Insurance: Set cost-control mechanisms to prevent excessive pricing.

Addressing Vulnerable Populations’ Needs

• Universal Coverage for Informal Workers: Develop a simplified enrollment system for insurance access.
• Education and Awareness Programs: Improve insurance literacy to ensure informed choices.
• Climate-Resilient Health Policies: Address emerging health risks due to climate change.

Comprehensive Reform for Sustainable Health Care

• Hybrid Model of Financing: Balance public funding with private sector participation while ensuring equity.
• Cost Transparency in Insurance: Prevent hidden charges and exclusions that burden patients.
• Data-Driven Policy Making: Conduct updated Census and Labour Force Surveys to target schemes effectively.

Rare success

The recent arrest of former Philippine President Rodrigo Duterte by the International Criminal Court (ICC) is a landmark event in global justice. It underscores the ICC’s continuing efforts to hold political leaders accountable for crimes against humanity, despite its structural weaknesses and reliance on state cooperation. However, this arrest remains an exception rather than the norm, highlighting the court’s dependence on political alignments and national interests.

Relevance : GS 2(International Relations)

Practice Question : Critically analyze the role of the International Criminal Court (ICC) in ensuring global justice. Discuss the challenges it faces in executing its mandate and suggest measures to enhance its effectiveness. (250 words)

Historical and Contemporary Context

• Origins of the ICC
  • Established by the Rome Statute in 1998, the ICC was envisioned as a permanent tribunal to prosecute individuals for genocide, war crimes, and crimes against humanity.
  • It emerged in response to limitations of ad hoc tribunals, such as those for Rwanda and the former Yugoslavia.

• Challenges in Execution of Arrest Warrants
  • Since its inception, the ICC has struggled to execute arrest warrants, largely due to the lack of enforcement power.
  • Many high-profile figures, such as Sudan’s Omar al-Bashir and Russia’s Vladimir Putin, have evaded arrest due to political protection.

• Duterte’s Case and the ‘War on Drugs’
  • Duterte’s presidency (2016-2022) saw thousands of extrajudicial killings as part of his ‘war on drugs.’
  • The ICC is investigating crimes from 2011 to 2019, during which the Philippines was a member of the ICC.
  • Despite the country’s withdrawal from the ICC in 2019, the Pre-Trial Chamber upheld jurisdiction over crimes committed while it was a party.

Arguments from Multiple Perspectives

The ICC’s Role in Global Justice

• Supporters’ View:
  • The ICC plays a critical role in delivering justice when national systems fail.
  • Its jurisdiction over Duterte despite the Philippines’ withdrawal reinforces international accountability.
  • Past successes, such as the conviction of Congolese warlord Thomas Lubanga, prove its effectiveness.

• Critics’ View:
  • The ICC disproportionately targets African and weaker states, raising concerns of selective justice.
  • The court lacks enforcement powers, making its judgments largely symbolic.
  • Powerful nations like the U.S. have actively undermined the ICC, limiting its influence.

Political Influence and Selective Justice

• The ICC’s actions are often influenced by geopolitical considerations:
  • Examples: Arrest warrants for Putin (Ukraine war) and Netanyahu (Gaza conflict) remain unexecuted due to global power dynamics.
  • Countries like the U.S. and Israel have refused to recognize ICC jurisdiction, creating a double standard in international justice.
  • In Duterte’s case, his arrest may have been politically motivated, given the tensions between the Marcos Jr. administration and his daughter, Vice-President Sara Duterte.

State Cooperation and Enforcement Issues

• Cases of Non-Cooperation:
  • Sudan’s Omar al-Bashir traveled freely to ICC member states without being arrested.
  • Several European countries have hesitated to act on ICC warrants for fear of diplomatic repercussions.

• Cases of Successful Cooperation:
  • The arrest of Slobodan Milošević (former Yugoslav President) by Serbia in 2001, under international pressure, demonstrated the ICC’s potential when state cooperation exists.
  • Duterte’s case was made possible by the willingness of the Marcos Jr. government to execute the warrant.

Policy Implications and Future Outlook

Strengthening ICC’s Enforcement Mechanisms

• The ICC needs a structured enforcement mechanism, possibly via a UN mandate or regional partnerships.
• Greater integration with Interpol and international agencies could enhance its operational capacity.

Addressing Perceived Bias and Selective Targeting

• Expanding investigations beyond Africa and weaker nations will improve ICC’s legitimacy.
• Ensuring uniform application of justice, including cases involving powerful nations, is crucial for credibility.

Enhancing State Cooperation

• Diplomatic incentives for states to execute ICC warrants (e.g., conditional aid, trade agreements) could improve compliance.
• Encouraging domestic judicial reforms may reduce reliance on international courts.

Conclusion

The arrest of Rodrigo Duterte represents a rare but significant victory for the ICC. However, its dependency on political alignments and state cooperation remains a fundamental weakness. Unless the ICC addresses its enforcement challenges, strengthens global cooperation, and eliminates selective prosecution, it risks remaining a court of limited influence rather than a true pillar of international justice.