Chandrasekaran Balakrishnan

Need to Rope in Private Sector Hospitals in the Fight against COVID Need to Rope in Private Sector Hospitals in the Fight against COVID Chandrasekaran Balakrishnan June 1, 2020 Public Policy   Unprecedentedly, the world humanity has been at peril since the spread of the Coronavirus, which emerged first in Wuhan, China in December 2019, and it reminds us about the two World Wars and a host of plagues of the past. The initial attitudes of both China and the World Health Organization in communicating the massive spread of the virus were not impressive, despite the best use of their collective powers and advanced science and technology in identifying the deadly virus’s life cycle and nature of reproduction. The global community is in an abject condition fighting the tiny, yet deadly virus for the past six months and has become more fragile now than ever in human history. Authorities across the globe have responded varyingly depending upon the velocity of the virus spread and its sustainability and longevity.  The public health systems across the globe, even though with their limited resources, have become a machinery of warriors in the fight against COVID-19.The collaborative systems have become dynamic to save lives by preventing the spread. A health emergency like COVID-19 was a big blow to the public health system in a country like India in many ways more than the shortage of doctors, nurses, ventilators, masks, bed capacities, ICU, etc. But the actual realities are undermined to some extent. It is now close to four months since the first COVID-19 positive case was reported in India. Now, COVID-19 has gone beyond a metaphor testing the capacities of the government system in India. The public health systems in Indian States are in different stages of evolution and are far away from the capacity of handling emergencies like COVID-19. They are by and large not well equipped with the necessary medical equipment and thereby causing more mental stress to patients and medical staff. Nevertheless, the State’s health systems responded swiftly, despite their systemic limitations, to best handle the COVID-19 patients. But despite the best efforts to observe a complete lockdown, the number of COVID-19 positive cases have been significantly increasing in major populated States. Now, two months after the total lockdown forced by the Indian government to contain the pandemic, one of the pertinent questions arises is about its failure to engage private sector hospitals optimally. As on May 31, there are only 676 testing labs across the country, of which only 204 testing labsof private hospitals are approved and engaged by the Indian Council of Medical Research (ICMR) to conduct the testing. Given the growing number of COVID-19 positive cases in the country, especially in the major populated States, the number of private hospitals approved are nothing but a drop in the ocean. Private hospitals in India have 80 per cent of the available ventilators but are handling less than 10 per cent of the critical care for COVID-19.[1] All the private hospitals empanelled under the Ayushman Bharat Scheme—the State’s own health insurance scheme—have a huge capacity to complement the public health systems to effectively fight COVID-19. But the nexus between the National Health Mission and the private sector healthcare infrastructure seems to be completely underutilised at this very critical juncture. Efficiency and quality cannot improve without choices for services like healthcare in a country like India. There is neither a legal nor a logical basis for excluding private sector hospitals from the fight against COVID and allowing only government hospitals, despite their acute shortcomings, to treat the patients. The testing of patients for COVID-19 is still very low compared to many countries and one of the main reasons might be the failure of the Indian government to strategically engage the private sector hospitals. The most contested issue now India faces is the low level of testing of people who may have symptoms, which has not been taken seriously even now by the State authorities. It is evident from the global experience that early testing is imperative for containing community spread which otherwise could devastate the country more than any cyclone or an earthquake. Why is there no effort from the Union Government to bring out a comprehensive policy framework to engage private hospitals across the country to augment the efforts of public health systems in the fight against COVID-19? Without bringing out comprehensive guidelines for involving private hospitals and providing a level playing field with price parity under insurance schemes, different State governments have enforced their power and authority to use and misuse the facilities of private hospitals across the country, setting a bad precedent. Moreover, voices were raised from some quarters in the country for the nationalisation of private hospitals. But even doing it for the cause of COVID-19 would be suicidal to the vibrant private healthcare sector in the long-term perspective. Without unified guidelines of the Union Government, both the State governments and private hospitals have gone into a firefighting over the mode of operandi. Fighting COVID-19 is a peculiar challenge for all the State governments in India. Different State governments have enforced the colonial law, the Epidemic Diseases Act, 1897 or their own health emergency law in a hasty way to take over private hospitals and their medical staff. Uttarakhand was the first State to announce on March 24 that all private hospitals have to reserve 100 or more beds—at least 25 percent of beds—for COVID-19 patients, which essentially meant for government utilisation. Similarly, States like Chhattisgarh, Rajasthan and Madhya Pradesh issued orders that the entire private hospitals would be temporarily utilised by the governments for the treatment of COVID-19 patients; though, later Chhattisgarh withdrew its order. The Delhi government had issued an order to reserve at least 20 percent of beds for COVID-19 patients in private hospitals that have 50 or more bed capacity. The government also threatened private hospitals and issued a show-cause notice to a private hospital for refusing to admit patients. The Telangana State

Structural Challenges in Reaping Demographic Dividends of India Structural Challenges in Reaping Demographic Dividends of India Chandrasekaran Balakrishnan May 26, 2020 Public Policy As India is fighting the COVID pandemic and going through an unprecedented economic situation, the Prime Minister has envisioned to focus on five pillars for rebuilding the country. India’s youth is said to be the fourth pillar in rebuilding the country and achieving the dream of a “Self-reliant India”. Unfortunately, the Union Finance Minister’s series of announcements of economic packages has not included anything for the youth population to make them more productive and resourceful to achieve this dream. There has not been any encouraging trend either in the past six years. The General Budget for 2020–21, presented by the Union Finance Minister Nirmala Sitharaman on February 1, 2020, received mixed responses to skill development programmes for youth and reaping demographic dividends. The budget provision for skill development is Rs 3,000 crore. But according to KP Krishnan, former Secretary of the Ministry of Skill Development and Entrepreneurship, the total budget provisioned for skill development for the country, aggregated by two dozen Ministries and Departments of the Union Government, is about Rs 11,000 crore. This is a huge amount for creating an institutional structure for fulfilling the aspirations and skilling the youth, but unfortunately has been in a muddle. Now with the changing global scenario, it would be interesting to look at some of the policies of the government. The Centre had announced in the Budget that it will aim to tap the potentials of overseas opportunities “for teachers, nurses, para-medical staff and care-givers…” and special bridge courses in sectors like healthcare with equivalent certification matching with the receiving countries. It had also aimed to engage 150 higher educational institutions to impart apprenticeship embedded degree and diploma courses to make the youth employable. Surely, these are no less than piecemeal announcements for some quarters because they do not match with what India contributes to the labour force every year; around 5-7 million youth are entering the labour market without any formal education or vocational skills. One of the most vital factors in production is human resources which is still underutilised, despite being imperative to economic growth and development. One of the most talked-about subjects in the last two decades is the boon of demographic dividends that India has, but emphasis is not given to the process to impart vocational education and skill development to the youth, and the need to institutionalise it both in government and private institutions beyond the ITIs, ITCs, polytechnics and apprenticeships. Though, there have been several policy initiatives since 2008, the governments did not break from their stereotype and bureaucratic silos to gauge an effective institutional mechanism to deliver a competent labour force. It is even ironic that organisations like the National Skill Development Corporation and its Sector Skills Councils, National Skills Development Agency, National Skill Development Trust, etc. could not make much impact on the district-level even now. The issue is not with the funds and industry linkages but the transparency and accountability of institutions involved in the skill development programmes across the Ministries and Departments vis-à-vis the State and UT Governments. This is akin to the case of earlier experiments done in vocational education, which was a failed attempt. In 1988, the Government of India had launched a scheme for vocationalisation of school education, providing financial support to the State governments. Unfortunately, since early 2000, the Central Government has not been providing enough financial support to them with an institutional mechanism to standardise the curriculum and teacher education for the expansion of vocational education in the higher secondary level. Thus, since 1988, the scheme has only covered close to 10,000 schools with vocational streams and trained about less than a million students. The target set for 2020–21 is to cover 1500 vocational schools across the country to impart vocational education to a few lakh students.  According to a report of the Ministry of Skill Development and Entrepreneurship, “more than One Crore youth are being imparted skills training annually under various programmes of the Central Government.” Till December 2019, under Pradhan Mantri Kaushal Vikas Yojana, about 87 lakh youth were trained. However, the Ministry on March 3, 2020 announced in Parliament that it has trained only 73.47 lakh youth in the country till January 17, 2020. Out of which, 40.27 lakh youth were trained in short-term courses and 33.20 lakh youth were felicitated in recognition of prior learning with certification. This shows that we are still far away from achieving the targets of the Skill India Mission. Nevertheless, unlike the previous general budgets, this year’s Union Budget has added another flavour with “life skills” in the field of skill development, which is interesting and imperative for the youth at this juncture. In India, except for the CBSE system of education, no other education Boards seem to have a syllabus for life skills in school education. Indeed, in 1993, the World Health Organization (WHO) had developed Guidelines on “Life Skills Education for Children and Adolescents in Schools”. It includes 10 core life skills to be acquired for a healthy and balanced life for learning and living even in an extreme situation. They are self-awareness, empathy, critical thinking, creative thinking, decision making, problem solving, and effective communication, interpersonal relationship, coping with stress and coping with emotion. These life skills are not necessarily a mere classroom textbook learning but they can also be structured with suitable narratives along with activities for effective learning for all kinds of students including those who are unable to attend schools or any institutions. Several years ago, the Madurai based Aparajitha Foundation in Tamil Nadu had developed the above 10 core life skills into systematic module-based learning for school children of Class VI to Class XII with a narrative rendering videos of about 120 in total with simple examples and illustrations to educate children. Each “Tim Tim Taare” video has 45 minutes with 15 minutes for activities. These videos were distributed to thousands of schools across

What Steers Tamil Nadu’s Higher Trajectory of Economic Growth? What Steers Tamil Nadu’s Higher Trajectory of Economic Growth? Chandrasekaran Balakrishnan May 8, 2020 Public Policy The two Dravidian political parties in Tamil Nadu are at constant war with each other on alleged use and misuse of Dravidian ideology in the name of the welfare of its people, Tamil language and delivery of various welfare schemes. Hindi hate speech and appeasement of minorities for votes are the two most contested politics of Tamil Nadu for the last half of the century. Unlike other states in the south and west, the politics of Tamil Nadu has been studied by too many, while its economy is not studied by many for no good reasons. However, despite their divisive polity, a competitive spirit can be seen among the leaders across the political spectrum towards inclusive development and growth of Tamil Nadu. At times, it is astonishing to see a sustained progress of the Tamil Nadu economy compared to other states in India. What drives Tamil Nadu is its core competence and capacities of sectors like healthcare and nutrition, education and entrepreneurship which are the main ingredients of the State’s sustained high growth trajectory. The average growth rate in the two decades following liberalisation was 7 per cent per annum. Trajectory of Growth In recent years, the State has been continuously facing calamities such as Chennai Floods in 2015, Vardah cyclone in 2016, a severe drought followed by Ockhi cyclone in 2017, Gaja cyclone in 2018, drought and water crises in 2019 and now the COVID-19 pandemic has hit the State badly. The government still gets lesser allocation under the State Disaster Relief Fund from the Union Government. Nevertheless, the Tamil Nadu economy has been showing a stable trajectory of growth during the last few years, even though the current political establishments are often caught up in corruption and scandals. During the period from 2011–12 to 2015–16, the AIADMK government had managed to secure an average growth rate of 6.7 percent as against the national average growth rate of 6.9 percent. The second term of the AIADMK, i.e., the last three years (2016–17 to 2018–19) witnessed an average GSDP (Gross State Domestic Product) growth rate of 7.7 percent which is impressive and 0.23 percent higher compared to the Indian economy (7.4 per cent). The projected GSDP growth rate for 2019–2020 is 7.3 percent compared to the 5 percent growth rate for the Indian economy, which shows a significant difference of 2.3 percent. Tamil Nadu is ranked first among the states in terms of the highest number of factories and industrial workers. Also, the State is ranked second in terms of employment generation in the organised sector. Sector-wise Contribution to GSDP The State’s primary sector which includes agriculture and allied activities contributes 11.8 percent to the GSDP. Also, Tamil Nadu has a dynamic manufacturing sector, comprising textiles, leather products, automobiles, pharmaceuticals, chemicals, engineering, agro-based products and food processing, etc, significantly contributing to the national economy. The State’s secondary sector’s GSDP share is 36.0 percent. During the last two decades, Tamil Nadu has been witnessing thriving trends in the services sector by value addition as well as employment generation with IT and ITeS, electronic hardware, banking, financial services, healthcare, tourism, etc. growing dynamically. The tertiary sector’s GSDP share in the State economy is 52.2 percent. The State is capable of financing the targeted welfare schemes for improving the living standards of people as the treasury yields higher revenue from a higher trajectory of economic growth. One of the sources of higher income for the State is the sale of liquor, which also creates social disruptions in terms of loss of income and health hazards to millions of poor families. Still, the State spends beyond its income keeping a revenue deficit of Rs 25,071 crore. Strong Foundation of Infrastructure The key strengths of the State are premised on its strong foundation of both social and physical infrastructure which paves for diversification of sectors by taking advantage of human resource capital for continuous progress and revenue generation to improve social development. Tamil Nadu has a well-developed infrastructure with good road and rail network connectivity. The State has three major ports, fifteen minor ports and seven airports for moving goods and services as well as people from one point to another within a matter of a few hours. Trichy, a tier-two city, is emerging as the fastest growth centre with transformations including a massive expansion of its airport with Rs 950 crore investments, which is a first of its kind in the country. Moreover, the State has leading higher and technical education and research institutions which strive for the next generation of industrial growth. Tamil Nadu has also been building robust industrial training and technical institutions with multi-skill development centres collaborating with industries for a sustainable industrial growth and to achieve productivity having the right mix of skilled and competent human resources. State’s Policy Initiatives The State machinery is continuously working closely with subject experts in the industry across the sectors to take advantage of the emerging trends at the national and international levels for reaping the benefits of markets without a loss in employment generation. The policy initiatives in sectors such as Business Facilitation for ease of doing business, New Information and Communication Technology, Aerospace, Defence, Solar Energy, New Integrated Textiles, Promotion of Farmer Producer Organisations and Treated Waste Water Reuse intending to reduce dependence on freshwater and to prevent pollution of water bodies, Electric Vehicles, etc are aimed at sustainable approaches to achieve inclusive growth and development. Tamil Nadu is also working to introduce a new industrial policy to provide incentives to the MSME sector which is facing critical challenges after the implementation of GST. Out of the 68 working PSUs (Public Sector Undertakings) in the State, only 39 are making profit and 25 are loss-making units with an incurred loss of Rs 9,366.31 crore for the year 2016–17 alone, as per the CAG report released in

COVID-19: Time to Review Governance Structure of Global Institutions? COVID-19: Time to Review Governance Structure of Global Institutions? Chandrasekaran Balakrishnan March 28, 2020 Public Policy A laboratory worker places a test tube containing a patient’s sample into a box during coronavirus detection tests in the virology research labs at UZ Leuven university hospital in Leuven, Belgium, on Friday, Feb. 28, 2020. China has kick-started a clinical trial to speedily test a drug for the novel coronavirus infection as the nation rushes therapies for those afflicted and scours for vaccines to protect the rest. Photographer: Geert Vanden Wijngaert/Bloomberg via Getty Images[/caption]   Today, most nations (over 196) of the world have declared an unprepared war against the coronavirus disease (COVID-19) which first erupted in the Wuhan city of China in December, 2019. This pandemic, a huge threat to humanity, is by far the biggest since the First World War and the Flu of 1918–1919. The outbreak has become a global phenomenon in a record span of time, posing the biggest threat to healthcare systems. The situation has become more frightening in the developing economies which are now strategically tweaked as emerging economies for reaping the market potentials which are not entrusted often in mutual interests. Global institutions like the United Nations (UN), the World Health Organization (WHO), etc. seem to have underestimated the menace erroneously for at least a few crucial weeks of January and February, 2020. These institutions failed to sense the spread of the virus and communicate it to the developing countries and the rest of the world to get prepared for taking necessary actions to prevent the spread. Of late, on 11 March, 2020, the UN had announced a state of emergency that sent shock waves across the world. Given the fragile system of functioning of the WHO during crises, it is really not surprising. The global institutions have at times misused their power leaning towards the West vis-à-vis East benefiting neither but resulting in their failure. Despite having many international organisations of governance and collective efforts and voices stretched after the World War II, the world does not seem to be united, breaking the egos of national interests of countries, for peace and prosperity in the larger interests of humanity. In the past, unprecedented events of ideological revolutionary leaning of nations, territorial disputes, cross-border terror threats, sharing of natural resources, economic depression, economic co-operation, climate change, technology revolution, space exploration, etc. have really tested the efficacy of global institutions’ resilience and manifestation of remedies beyond mere lip services rendered for the strategic nudge. This casts doubt on the ability of global institutions like the United Nations (UN) and its allied institutions like the World Health Organization (WHO), The World Bank Group, United Nations Development Programme (UNDP), Economic and Social Council (ECOSOC), etc. Besides, given their last three decades of experience in dealing with emergency situations, the best these institutions could do was merely document what had happened in the past rather than taking any efforts towards prevention of such events in the future. In the wake of the novel COVID-19 outbreak, some of the advanced economies like the United States, Spain, France, Italy, the United Kingdom, Europe, etc. were in the belief that they were prepared to face human sufferings and horrific deaths, but were unable to do so despite having the most advanced healthcare systems in the world. For the past several decades, almost every global institution is coercively controlled by these nations with their colonial mentality and preaching to the Third World Countries. The coronavirus outburst across the world is a strong case to assess the governance structure of the UN-funded institutions like the WHO, having 194 member states, which miserably failed to gauge the real situation in Wuhan city and Italy for several weeks after the massive outburst. During a pandemic, is it wise to divide the affected people according to their nationalities and deport them to their countries? Does it not further lead to the spread of the disease among millions of people? We should try to answer these questions and think of the possibility of setting up a powerful and well-equipped global institution with a good governance system that can support the medical treatment of people affected by diseases like COVID-19 in the same country where they work and live. History has taught us many lessons and we should learn from our past mistakes. Unlike in 2020, there was no influential global institution in 1918–19 to manage the Flu epidemic which rampaged and complicated world humanity during the First World War. Nevertheless, the world has changed since 1918. The Chinese government should have acted promptly and taken seriously the outbreak of coronavirus in the month of January 2020 itself, and communicated about the disease to the world much faster than their usual suspect mode without relying solely on the WHO. Siddharth Chandra and Eva Kassens-Noor’s 2014 research paper titled “The Evolution of Pandemic Influenza: Evidence from India, 1918–19” has scientifically documented the devastating pandemic of Spanish Flu of 1918–19 and its impacts on India. The data on peoples’ death were collected for a five year period from 1916 to 1920 covering 9 provinces like Assam, Bengal, Bihar and Orissa, Bombay, Central Provinces, Madras, Northwest Frontier Province, Punjab and United Provinces. They have estimated that about 10 to 20 million people died due to the Spanish Flu in 213 districts across 9 provinces in British India. Across the world, the death toll was between 20 and 50 million people. The study concludes that the entry point of the first wave of the disease and the time taken for calibrated efforts towards emergency management are crucial. A basic analysis of the study reveals that the focal point of a pandemic spreading across the country from the entry of its first wave needs to be studied for the future course of action which seems to be terribly missed out by both China and WHO in the case of COVID-19 outbreak. Perhaps, the world is divided