Ayushman Bharat: India’s Flagship Programme

Nearly 3000 years ago, one of ancient India’s great sages Yajnavalkya composed the Shanti Sukta: “Sarve Bhavantu Sukhinah; Sarve Santu Niramayah” (May all be happy, may everyone be free of diseases). What is striking is not the prescience and universality of this invocation, but also the insight that happiness and health in a populace are inextricably interwined.

Today, as we reflect upon the journey of India as an independent nation over the last seven decades, there can be no denying the fact that a lot of potential in this sector remains unharnessed and ill-health is one of the leading causes of Indians falling into poverty. The government spends barely 1% of the GDP on health even as we are confronted with a two front war  1) rising burden of non-communicable diseases 2) control of communicable diseases and reproductive and child health issues. As a result, the citizens Out-of-Pocket (OOP) expenditure on health constitutes 62% of the total expenditure on health, placing India at 182^nd position out of 191 countries on this indicator. In fact, over 55% of this expenditure is on Outpatient care, of which drugs constitute the biggest component. 71^st round of National Sample Survey Organization (NSSO) found 85.9% of rural households and 82% of urban households have no access to healthcare insurance/assurance. Catastrophic healthcare related expenditure pushes families into debt, with more than 24% households in rural India and 18% population in Urban area have met their healthcare expenses through some sort of borrowings. This structure of health financing places a disproportionate burden on the poor families and catastrophic health expenses have contributed to an increase in poverty levels in rural and urban areas by 3.6% and 2.9% respectively.

Mindful of this reality and to plug the existing gaps in our health system, the government announced a new flagship scheme “Ayushman Bharat” in the Union Budget 2018-19.

Ayushman Bharat Programme:

On 1st February’18, the NDA Government announced two major initiatives in health sector as a part of Ayushman Bharat programme. The two initiatives: 1) Health and Wellness Centre (HWC)  2) National Health Protection Mission (NHPM).

On 23 September’18, India took a giant leap towards providing accessible and affordable healthcare to the common man with the launch of Ayushman Bharat – National Health Protection Mission (AB-NHPM) by Prime Minister Narendra Modi at Ranchi, Jharkhand.

AB-NHPM will target poor, deprived rural families and identified occupational category of urban workers families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban population. The scheme is designed to be dynamic and aspirational and it would take into account any future changes in the exclusion/inclusion/deprivation/occupational criteria in the SECC data.

AB-NHPM is a paradigm shift from sectorial, segmented and fragmented approach of service delivery through various national and State schemes to a bigger, more comprehensive and better converged and need based service delivery of secondary and tertiary care. When fully implemented, AB-NHPM will become the world’s largest fully government financed health protection scheme. It is a visionary step towards advancing the agenda of Universal Health Coverage (UHC).

Benefits under Ayshman Bharat:

1. The AB-NHPM will provide a coverage up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).
2. Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) will be eligible for these benefits. There is no cap on family size and age as well as restriction on pre-existing conditions.
3. AB-NHPM will provide cashless and paperless access to services for the beneficiary at the point of service.
4. NHPM will help reduce catastrophic expenditure for hospitalization, which impoverishes people and will help mitigate the financial risk arising out of catastrophic health episodes.
5. Entitled families will be able to use the quality health services they need without facing financial hardships.

Salient Features of Ayshman Bharat:

1. Creation of 1,50,000 Health and Wellness Centres (HWCs) to bring healthcare closer to the homes of the people. These centres will provide Comprehensive Primary Health Care (CPHC) covering both maternal and child health services and non- communicable diseases, including free essential drugs and diagnostics. HWCs will play a critical role in creating awareness about NHPM.
2. The EHCP network will provide cashless and paperless access to services for the beneficiaries at both public and private hospitals. The services will include 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc.
3. The beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly.
4. NHPM scheme is principle based rather than rule based, allowing States enough flexibility in terms of packages, procedures, entitlements as well as other guidelines while ensuring that key benefits of portability and fraud detection are ensured at a national level.
5. States can implement the scheme through an insurance company or directly through the Trust/Society/Implementation Support Agency or a mixed approach.
6. Thirty states and UTs have signed the MoU and have started working on implementation of the mission.
7. The scheme is creating a cadre of certified frontline health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs) who will be primary point of facilitation for the beneficiaries to avail treatment at the hospital and thus, act as a support system to streamline health service delivery.
8. Training  programs for State, District and PMAMs have been conducted in 27 states. A total of 3936 personnel have been trained at State, District and PMAM levels.
9. So far 15,686 applications for hospital empanelment have been received.
10. Detailed guidelines have been prepared to address the issues around potential fraudulent activities that could be committed by any individual or organization.
11. Pilot launch is taking place in specific hospitals to test the Beneficiary Identification System (BIS) and Transaction Management System (TMS). National Health Agency (NHA) has tested the software in 80 districts across 10 states.
12. Robust systems are put in place in the IT platform to ensure privacy and security of the data.

The government’s active stewardship in leveraging the potential of the mixed health system is a very welcome development. It is heartening to note the political commitment at the highest levels to transform India’s health system into an affordable, accessible, inclusive and efficient system.

  

Namami Gange : India’s Flagship Programme under PM Modi

Overview of River Ganga

The river Ganga rises in the western Himalayas in the state of Uttarakhand and flows south and east through Gangetic plain of North India. After entering West Bengal, it divides into two rivers, the Hooghly and Padma river. The Hooghly or Adi Ganga, flows through several districts of West Bengal and into the Bay of Bengal near Sagar Island. The Padma river flows into and through Bangladesh and empties into the Bay of Bengal. The Ganga basin is the largest river basin in India in terms of catchment area (8,61,404 km² ) and covers 11 states: Uttarakhand, U.P, M.P, Rajasthan, Haryana, Himachal Pradesh, Chhattisgarh, Jharkhand, Bihar, West Bengal and Delhi. 46% of India’s population reside along the main stem of Ganga: Uttarakhand, Uttar Pradesh, Bihar, Jharkhand and West Bengal. Out of the total length of 2525 km Ganga, 450 km passes through Uttarakhand, 1000 km through Uttar Pradesh, 110 km through sharing length (UP-Bihar), 405 km through Bihar, 40 km through Jharkhand and 520 km through West Bengal.

Ganga is not only a holiest river to Hindus, it has some inherent qualities of cultural amalgamation, heritage notions and diversity. It gives vibrancy to many Ghats and Temples and hope to millions for a new phase of life every day. What ails Ganga today is the Urban and Industrial pollution due to discharge of sewage, industrial effluents, religious offerings wrapped in non-degradable plastics, human activities such as bathing, washing clothes, human waste and other pollutants, catchment degradation, bio-diversity loss, Deforestation, failure of pollution control mechanism, governance and mindset of water resources establishment and the people. Today, river Ganga is considered as the sixth most polluted river in the world.

"Namami Gange" Programme

A number of initiatives have been undertaken to clean the river but failed to deliver the desired results. After getting elected, Prime Minister Modi affirmed to work in cleaning the river and controlling pollution by announcing Namami Gange Programme in July 2014 budget.

Namami Gange Programme, is an Integrated Conservation Mission, approved as a “Flagship Programme by Government of India in May’15 with an outlay of Rs. 20,000 crore for a five year period. The programme has twin objectives of effective abatement of pollution, conservation and rejuvenation of National River Ganga.

The vision for Ganga Rejuvenation constitutes restoring the wholesomeness of the river defined in terms of ensuring “Aviral Dhara” (continuous flow), “Nirmal Dhara” (unpolluted flow), Geologic and ecological integrity.

Namami Gange will focus on pollution abatement interventions namely; Interception, diversion and treatment of wastewater flowing through open drains through bio-remediation/ appropriate in-situ treatment/use of innovative technologies/sewage treatment plants (STPs)/effluent treatment plant (ETPs); rehabilitation and augmentation of existing STPs and immediate short term measures for arresting pollution at exit points on river front to prevent inflow of sewage. The program is expected to deliver socio-economic benefits in terms of job creation, improved livelihoods and health benefits to the vast population on the river.

For effective implementation, the government is focusing on involving people living on the banks of the river to attain sustainable results. The program focuses on involving the states and grassroots level institutions such as urban local bodies and Panchayati Raj institutions in implementation. The program is implemented by National Mission for Clean Ganga (NMCG) and its state counterpart organizations i.e State Program Management Groups (SPMGs). A three-tier mechanism is used for project monitoring comprising of 1) High level task force chaired by Cabinet secretary assisted by NMCG at national level   2) State level committee chaired by chief secretary assisted by SPMG at state level  3) District level committee chaired by District Magistrate.

The main pillars of Namami Gange Programme:

1. Sewage treatment Infrastructure 
2. River Surface Cleaning
3.  Afforestation
4.  Industrial Effluent Monitoring
5.  River Front Development
6.  Bio-diversity
7.  Public Awareness
8.  Ganga Gram

Its implementation has been divided into:

1. Entry Level Activities: River surface cleaning, Rural Sanitation, Modernization, Renovation of Ghats and Crematoria (for immediate visible impact).
2. Medium Term Activities: Muncipal Sewage Management, Industrial Effluent Management (to be implemented within 5 years of time frame).
3. Long Term Activities: Adequate Waterflow (to be implemented within 10 years).

Efforts are being made to complete Short Term and Medium Term projects by 2020.

The project is being carried out aggressively under the supervision of the Minister for Ministry for Water Resources, River Development and Ganga Rejuvenation, Nitin Gadkari, who said during a press conference in New Delhi on 10^th May’18 that “70 to 80 percent of Ganga would be clean by March 2019”.

The key achievements under Namami Gange Programme:

1. In order to create Sewarage Treatment Capacity, 63 sewerage management projects are under implementation in the states of Uttarakhand, U.P, Bihar, Jharkhand and West Bengal; 12 new sewerage management projects launched in these states.
2. 28 River Front Development projects and 33 Entry level projects for construction, modernization and renovation of 182 ghats and 118 crematoria has been initiated.
3. River Surface Cleaning for collection of floating solid waste from the surface of the Ghats and River and its disposal are afoot and pushed into service at 11 locations.
4. For Bio-Diversity Conservation, projects namely; Bio-Diversity conservation and Ganga Rejuvenation, Fish and Fishery Conservation, Ganges River Dolphin Conservation Education programme has been initiated. Bio-Diversity centers at Dehradun, Narora, Allahabad, Varanasi and Barrackpore has been developed for restoration of identified priority species.
5. Afforestation: Forestry interventions for Ganga through Wildlife Institute of India; Central Inland Fisheries Research Institute and Centre for Environment Education has been initiated. Forestry interventions for Ganga has been executed as per the Detailed Project Report prepared by Forest Research Institute, Dehradun for a period of 5 years (2016-2021) at a project cost of 2300 crores. Work has commenced in 7 districts of Uttarakhand for medicinal plants.
6. For public Awareness, a series of activities such as events, seminars and conferences, Information Education Communication (IEC) activities were organized to make a strong pitch for public outreach and community participation in the programme. Various activities through rallies, campaigns, exhibitions, competitions, plantation drives and development and distribution of resource materials were organized. “Gange Theme Song” was released widely and played on digital media to enhance the visibility of the programme. National Mission for Clean Ganga (NMCG) ensured presence at social media platforms like Facebook, Twitter, Youtube etc.
7. Real Time Effluent Monitoring Stations (EMS) has been installed in 572 out of 760 Grossly Polluting Industries (GPIs). Closure notice have been issued to 135 GPIs so far and others have been given deadlines for compliance to stipulated norms and for installations of online EMS.
8. Ministry of Drinking Water and Sanitation (MoDWS) identified 1674 Gram Panchayats situated on the bank of River Ganga in states ( Uttarakhand, U.P, Bihar, Jharkhand, West Bengal). Rs 78 crores has been released to MoDWS for construction of toilets in 1674 Gram Panchayats of 5 Ganga Basin states. Out of the targeted 15,27,105 units, MoDWS has completed construction of 8,53,397 toilets. Consortium of 7 IITs has been engaged in the preparation of Ganga River Basin Plan and 65 villages have been adopted by 13 IITs to develop as model villages. United Nations Development Programme (UNDP) has been engaged as the executing agency for rural sanitation programme and to develop Jharkhand as a model state at an estimated cost of  Rs. 127 crore.
9. Banks of River Ganga are set to get major facelift as several companies like Shipping Corporation of India, Indorama Corporation, IndusInd Bank, Yes Bank, Hinduja group, Arcelor Mittal, New Indian Express, Bajaj Electricals and few others have undertaken CSR projects for Ghat cleaning/crematoria construction and Development, River Surface Cleaning, Solid Waste Disposal, Afforestation, provision of amenities and similar work under Namami Gange.
10. NMCG has bought on board Survey of India, oldest scientific department, to facilitate Ganga Rejuvenation by using Geographic Information System (GIS) technology. The project uses Digital Elevation Model (DEM) technology to collect accurate data for river basin management planning and enables identification of entire topography of an area making it easy for policy makers to analyse the data and support decision making process. The data collected and subsequent actions taken by the government can be shared with the local public through geo-portals and mobile apps. The technology will also enable people to send their feedback upto national level thereby providing an interactive and transparent platform.
11. On Rural Sanitation front, all 4465 villages on the bank of river Ganga have been made Open Defecation Free (ODF) and 10,83,688 individual household toilets have been constructed.
12. Five crore plants are being planted along Ganga Basin as part of afforestation drive at a cost of Rs. 112 crores for preventing soil erosion and groundwater recharge.
13. A composite Ecological Task Force with HQ at Allahabad and three companies of 100 men each being raised with Territorial Army. They would take up plantation, public awareness, patrolling of river fronts and monitor river pollution.
14. In an expedition which lasted over a month, a 40 member team led by Everester Bachendri Pal, the country’s first women who reached summit of Mount Everest in 1984, removed 55 tons of garbage from Ganga.

India Japan Relations: Expanding Special Strategic And Global Partnership

India Japan Relations

Prime Minister Modi, after coming to power, chose Japan as his first destination for a bilateral visit outside India’s immediate neighbourhood, reflecting importance of Japan in India’s foreign policy, economic development and her place at the heart of  India’s Act East Policy. India and Japan are Asia’s two largest and oldest democracies with ancient cultural links and enduring goodwill between their people. The two countries are joined together by convergent global interest, critical maritime inter-connection and growing international responsibilities. They share an abiding commitment to peace and stability, international rule of law and open global trade regime. Their economies have vast complementarities that create boundless opportunities for mutually beneficial economic partnership.

Prime Minister Narendra Modi and Prime Minister Shinzo Abe  in a meeting in Tokyo in September’14, pledged to realize the full potential of India-Japan strategic and global partnership for continuing progress and prosperity for their people and for advancing peace, stability and prosperity in Asia and the world, marking a dawn of a new era in India-Japan relations.

Since their first meeting in September’14, the two Prime Ministers have intensified and invigorated multi-sectoral dialogues between their Foreign Ministers, Defence Ministers, National Security Advisors and Ministers dealing with finance, economy, trade, science & technology, infrastructure and connectivity and energy to build deeper mutual understanding and cooperation. Both leaders reaffirmed the importance of defence relations between them in their special strategic partnership by signing Memorandum of Cooperation and Exchanges in the field of Defence by regularization of bilateral maritime exercises, joint exercises between Coast Guards and Japan’s continued participation in India-US Malabar series of exercises. Japan’s new policy on transfer of defence equipment and technology has ushered a new era of co-operation by unlocking enormous potential for transfer and collaborative projects in defence equipment and technology between the two countries e.g US-2 amphibian aircraft. The two leaders have affirmed their shared commitment to maritime security, freedom of navigation and overflight, civil aviation safety, unimpeded lawful commerce and peaceful settlement of disputes in accordance with international law.

At a time of growing global turmoil, tensions, transitions and disruptions, the two leaders affirmed that a closer and stronger global partnership between the two countries is indispensible for a prosperous future of the two countries and peace, stability and prosperity in the world, in particular, in the inter-connected Asia, Pacific and Indian Ocean Regions. The two leaders have committed to build strong partnership to promote economic and social development, capacity building and infrastructure development in other countries and region.

The India Japan relationship is rapidly gathering momentum. A foundational pillar of this relationship is connectivity. Apart from development on the domestic front, such as the inauguration of the Ahmedabad-Mumbai bullet train project, India and Japan are now projecting this partnership at a regional level, beginning in South Asia, expanding into the Indian Ocean and onwards to Africa. Where India struggled to meet its domestic requirements on infrastructure development, it is now outlining regional strategic connectivity and infrastructure investments in partnership with Japan.

Geopolitical Competition

Post 2016 annual summit in November’16, PM Modi and PM Shinzo Abe announced their intention to build a maritime corridor connecting Asia and Africa. This intention crystalized into the “Asia Africa Growth Corridor” (AAGC) in May’17, a week after India refused to join China’s Belt and Road Initiative (BRI).

Japan’s concern about China’s assertive behavior and rising profile in South China sea and Indian Ocean Region (IOR) and India’s concern about disputed land border with China and its strategic implications of commercial engagements in its neighbourhood, created a platform for deeper collaboration between India and Japan and their partners. India and Japan realized the need to act on the changing security dynamics to secure their interests and strategic ambitions. Instead of competing with China’s ambitious BRI backed by unrivalled capital, India and Japan began creating an alternative to BRI and complicate China’s strategic calculus and maintain a multipolar world by stabilizing the region in times of uncertainty. The intention of AAGC is to address the region’s challenges, deepen regional co-operation and integration, strengthen regional economic and security forums and promote peaceful resolution of disputes. The AAGC focuses on four areas 1) Development Co-operation projects  2) Quality infrastructure and institutional connectivity  3) Enhancing Skills  4) People to People Partnership.

The development of connectivity via quality infrastructure and other projects including capacity building for shared prosperity under AAGC will be carried out bilaterally and with other partners in an open, transparent and non-exclusive manner and based on international standards, responsible debt financing practices and in alignment with local economic and development strategies and priorities of the countries, These parameters of AAGC removes flaws under Chinese built projects, especially fears of “debt traps”.

India Japan Collaboration for "Act East Policy"

Apart from AAGC, the two countries are collaborating to enhance connectivity in North East India through India Japan Act East Forum and develop “smart islands”, interpreted to be Andaman and Nicobar islands.

The Act East Forum established last year has served as a driving force to advance India-Japan co-operation in the North East. Its second meeting was held on 8 October’18 with the following outcomes:

For implementation:

1. Meghalaya North East Connectivity  Phase 1: Tura-Dalu (NH-51)  Phase 2: Shillong-Dawki (NH-40)
2. Mizoram North East Connectivity  Phase 1&2 : Aizwal-Tuipang (NH-54)
3. Sikkim: Biodiversity conservation & Forest Management
4. Nagaland: Forest conservation livelihood improvement

Reaffirmed Intentions:

1. Completion of Gelephu-Dalu corridor including Dhubri/Phulbari bridge project, which will be the longest river bridge in India, as Phase 3 of North East Road Network connectivity improvement project.
2. Main District Roads (MDRs) and Other District Roads (ODRs) for socio-economic development
3. Project for Renovation and Modernization of Umiam-Umtru stage III hydroelectric power station.
4. Sustainable Forest Management in Tripura and similar project for consideration in Meghalaya.

13^th India-Japan Annual Summit (28-29 October’18)

Prime Minister Narendra Modi visited Japan on October 28-29, 2018 for India-Japan Annual Summit with Prime Minister of Japan Shinzo Abe. The visit saw deepening ties across the board, especially on defence and security. Both leaders reviewed the significant milestones achieved over the last four years and outlined shared vision for the future of India-Japan relations.

The two leaders shared their view that in order to achieve this shared vision, India and Japan must endeavour to work together for a rules-based and inclusive world order that fosters trust and confidence by enhancing communication and connectivity to ensure rule of law, unimpeded trade and flow of people, technology and ideas for shared prosperity.

Key Highlights of Annual Summit:

1. Establishing the “Platform for Japan-India Business Cooperation in Asia-Africa Region to enhance the exchanges between Japanese and Indian businesses toward developing Industrial corridors and Industrial network in the region.
2. India Japan plan to cooperate in areas such as development of LNG-related infrastructure in Sri Lanka; housing, education and electrification projects in Myanmar; bridge and rail projects in Bangladesh and business development and health initiatives like cancer hospital in Kenya.
3. Launching of a comprehensive India-Japan Digital Partnership with the vision to develop IoT and AI solutions for societal benefits.
4. Deepen bilateral security and defence co-operation by instituting Foreign and Defence Ministerial (2+2) dialogue.
5. Commence negotiations on the Acquisition and Cross Servicing Agreement (ACSA) to enhance the strategic depth of bilateral security and Defence co-operation. This is similar to logistic support agreement which India has signed with US and France which allow navies to use each others bases, either at home or overseas, thereby fundamentally increasing a country’s ability to sustain its presence in an expanded region. 
6. Signed agreement towards enhanced exchange of information to expand Maritime Domain Awareness (MDA) between the Indian Navy and the Japan Maritime Self-Defence Force (JMSDF).
7. Commencement of co-operative research in the area of Unmanned Ground Vehicle (UGV) and Robotics.
8. To continue efforts with regard to cooperation on US-2 amphibian aircraft.
9. Japan announced joining of International Solar Alliance.
10. Agreement to conclude a bilateral Swap Agreement of USD 75 billion For External Commercial Borrowing (ECB), no mandatory hedging will be required for infrastructure ECB of more than 5 years minimum average maturity.