Editorials/Opinions Analysis For UPSC 27 August 2024

CONTENTS

1. Crime, Health-Worker Safety and a Self-Examination
2. The Delay in Census

Crime, Health-Worker Safety and a Self-Examination

Context:

In 2017, Maharashtra witnessed intense protests by resident doctors following a series of brutal attacks on medical staff in quick succession—typical of how sensationalized criminal offenses often unfold. Despite the severity of the issue, the solution was straightforward and conventional: enhancing security in public hospitals and strengthening legal mechanisms to swiftly bring perpetrators to justice. Similar incidents have occurred over the years, particularly during the COVID-19 pandemic, yet the responses have remained reactive and lacking in effectiveness. Instances of swift justice are hard to recall.

Relevance:

GS Paper – 2

• Government Policies and Interventions
• Human Resource
• Health
• Issues Relating to Development

Mains Question:

Emerging answers to the issue of health-worker safety continue to remain reflexive and simplistic, and could show an incomplete understanding of the malady beneath. Discuss in the context of recent violence inflicted upon healthcare workers. (15 Marks, 250 Words).

The Deeper Issue:

• A deeper issue lies beneath the surface. The recent tragic death of a promising resident doctor in Kolkata has shocked the nation and prompted the Supreme Court of India to take suo motu cognizance of the event.
• However, the emerging solutions continue to be reflexive and simplistic, possibly indicating an incomplete understanding of the underlying problem.
• On August 20, the Court ordered the creation of a national task force to develop measures to enhance hospital safety.
• Proposed improvements include better infrastructure, increased closed-circuit television surveillance, a stronger security presence at hospitals, and safe night transportation.
• Similarly, the West Bengal government has launched the ‘Rattierer Saathi’ (night companion) program, aimed at improving the safety of women working night shifts, particularly in medical colleges and hospitals.
• While such initiatives are crucial, they implicitly equate the issue with typical health worker violence, often perpetrated by frustrated patients due to perceived poor healthcare services, or with broader concerns about women’s safety.
• However, the more insidious issue lurking beneath is the corruption of criminal proportions.

Corruption as a Contributor:

• Conventional responses to health worker violence, such as improving hospital security and introducing new legislation, have consistently failed to address the problem effectively over the years.
• The reasons, such as underfunding, are similar to why our healthcare systems remain generally fragile. However, the extent to which corruption contributes to the overall loss of lives has been vastly underestimated.
• If recent reports are accurate, there is a strong likelihood that deep-rooted, organized corruption played a significant role in this gruesome crime, as well as in other incidents and the gradual deterioration of public health services that may have previously gone unnoticed.
• The fact that this issue concerns a top healthcare institution within an already underfunded state public health system is particularly alarming.
• The World Health Organization (WHO) estimates that corruption costs the world nearly $455 billion annually—more than the amount required to provide universal health coverage to everyone.
• In much of the developing world, corruption, rather than a mere lack of funds, is a significant factor contributing to healthcare crises and poor health outcomes.
• In India, while the discourse on medical corruption often focuses on private losses and malpractices, its criminal aspects have largely been overlooked.
• Human resource-intensive healthcare systems are fertile ground for expanding corruption, including severe forms like sextortion, especially in political systems plagued by underfunding and poor oversight.
• Given these conditions, it’s difficult to imagine how much improvement could realistically come from merely enhancing the security of health workers and hospital infrastructure, even if these measures are effectively implemented.
• The realization that medical corruption can lead to the deaths of healthcare workers as well as patients suggests that the public health system and its leadership may need a thorough self-assessment.
• Swift justice in the Kolkata case is unquestionably crucial, as nothing else can serve as an effective deterrent. Unfortunately, India has traditionally fallen short in this area, with visible consequences.

Way Forward:

• The national task force has a monumental task ahead, one that goes beyond simply recommending safety measures—it must develop a robust plan to prevent and combat medical corruption, particularly in the public sector.
• This cannot be achieved by a team of medical doctors alone; it requires input from experts in public health, medico-legal fields, and other relevant areas, as well as the involvement and approval of the broader governing and administrative community.
• The strategies devised must go beyond introducing yet another piece of legislation.
• Reforms should focus on enhancing administrative transparency, accountability, and oversight, implementing effective whistle-blower protections, and thoroughly digitizing public management systems.
• The importance of ombudsmanship and other tools to reduce political interference cannot be overstated. Lessons could be learned from how countries like Brazil continue to fight political corruption in healthcare.

Conclusion:

There is much to be done in modernizing the traditional “command and control” structure of Indian public hospitals, which remain entrenched in outdated practices. While there are numerous efficiency reasons for such modernization, the urgent moral and regulatory justifications are now glaringly evident and can no longer be ignored.

The Delay in Census

Context:

In what appears to be a case of complicating matters, the Union government is reportedly considering expanding data collection in the long-delayed Census to include caste enumeration. This inclusion of caste as a variable could be a response to the strong demand for a caste census from several political parties.

Relevance:

• GS1- Population and Associated Issues
• GS2- Government Policies & Interventions

Mains Question:

Highlight the origin and evolution of the decennial census in India. What have been the repercussions of the delay in conducting the census after 2011? (10 Marks, 150 Words).

About the Census:

Definition:

• A Population Census is a comprehensive process that involves collecting, compiling, analyzing, and distributing demographic, economic, and social data for all individuals in a country or a clearly defined region at a specific point in time.
• The Census serves as the foundation for evaluating the country’s progress over the previous decade, monitoring current government programs, and planning for the future.
• It offers a snapshot of a community that is accurate at a particular moment.

Frequency:

• The first synchronized Census in India was conducted in 1881 under the supervision of W.C. Plowden, the Census Commissioner of India. Since then, the Census has been consistently conducted every ten years.
• The Census of India Act of 1948 provides the legal framework for carrying out the Census but does not specify its timing or periodicity.
• Therefore, while a Census is mandated by the Constitution in India, there is no Constitutional or legal requirement for it to be conducted every ten years.
• Although many countries, such as the US and the UK, adhere to a 10-year Census cycle, others like Australia, Canada, and Japan conduct it every five years.

Nodal Ministry:

• The decennial Census is overseen by the Office of the Registrar General and Census Commissioner, under the Ministry of Home Affairs.
• Before 1951, the Census organization was established on an ad-hoc basis for each Census.

Recording Caste Data:

• However, given the incomplete and poorly designed nature of the Socio-Economic and Caste Census of 2011, which produced data that were unwieldy, inaccurate, and therefore unusable, the government should not rush into using the Registrar General’s office and other agencies to record caste data.
• A clear and definite timeline for conducting the Census with urgency should be established first.
• If the delay is intentional, possibly to allow for delimitation to occur first in 2026, this could be detrimental not only to public policy but also to relations with the States.

Impact of the Delay:

• As of June 2024, out of 233 countries, India was one of 44 that had not conducted a Census this decade.
• While the Union Home Ministry cited delays due to the COVID-19 pandemic, 143 other countries conducted their Census after March 2020, when the pandemic began.
• India now shares the unfortunate distinction of not having conducted a Census with countries affected by conflict, economic crises, or turmoil, such as Yemen, Syria, Afghanistan, Myanmar, Ukraine, Sri Lanka, and several in sub-Saharan Africa.
• There is little justification for the ongoing delay of the decennial Census, an exercise that has been consistently conducted from 1881 to 2011.
• Yet, the deadline to finalize the administrative boundaries of districts, tehsils, towns, and municipal bodies—a necessary step before conducting the Census—expired on June 30 this year. This deadline has been extended 10 times since 2019.
• Numerous public schemes, such as the National Food Security Act, the National Social Assistance Programme, and the delimitation of constituencies, depend on the Census being conducted.
• Additionally, statistical surveys that inform policy, like those on household and social consumption, the National Family Health Survey, the Periodic Labour Force Survey, and the Sample Registration System, among others, rely on the Census to establish their sampling frames.
• As the 2011 Census data becomes increasingly outdated, with phenomena such as migration within and across states, urbanization of Indian societies, and suburbanization of cities becoming more pronounced in recent years, the absence of a Census is glaring.
• Relying on various sample surveys to fill this gap only leads to debates over methodology and politically motivated conclusions.

Conclusion:

The Union government must cease neglecting its responsibilities and proceed with the Census without further delay.