tag:blogger.com,1999:blog-4875780086999968212024-03-13T05:44:25.503+05:30ElementaryHarleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.comBlogger59125tag:blogger.com,1999:blog-487578008699996821.post-54609979206511919292023-01-09T17:24:00.004+05:302023-01-09T17:24:31.018+05:30Process improvement for government drug procurement in India<p> In India, drug quality is an important problem. Government agencies are an important buyer of drugs, and also face significant problems with drug quality. In this paper, we examine the mechanisms used for drug purchase by four Indian states - Rajasthan, Punjab, Bihar and Gujarat. We establish a taxonomy of 13 design elements that define the drug procurement process. We engage in deductive reasoning about the design elements that appear to be useful and those that are less so. This work would help policy makers placed in an Indian public sector context in devising better procedures for drug purchase.</p><p><i>Citation: Process improvement for government drug procurement in India, Harleen Kaur, Ajay Shah, and Siddhartha Srivastava, XKDR Working paper 18, December 2022</i></p><p>Read more here: https://www.xkdr.org/paper/process-improvement-for-government-drug-procurement-in-india</p>Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-6771917511024917002022-09-26T10:28:00.003+05:302022-09-26T10:28:55.040+05:30Response To Trai Consultation Paper On Issues Related To New Regulatory Framework For Broadcasting And Cable Services<p style="text-align: justify;">TRAI published a Consultation Paper on Issues related to new Regulatory Framework for Broadcasting and Cable Services on May 7, 2022 (https://www.trai.gov.in/consultation-paper-issues-related-new-regulatory-framework-broadcasting-and-cable-services)</p><p style="text-align: justify;">In our response, we argue that TRAIs policy of fixing tariffs of television channels (by regulating the pricing of bouquets or discounts that can be provided thereon, etc.) is an arbitrary and disproportionate intervention. Not only has TRAI failed to demonstrate evidence of harm to implement such an intrusive regulatory tool, the intervention has also failed to have any significant social or economic benefit. Accordingly, we suggest that TRAI revise its tariff policy and engage in regulatory forbearance. Alternatively, deregulation could be considered in specific markets/geographies, to provide an appropriate evidence base to gauge the results of competition and therefore fine-tune the regulatory system.</p><p style="text-align: justify;"><a href="https://xkdr.org/paper/response-to-trai-consultation-paper-on-issues-related-to-new-regulatory-framework-for-broadcasting-and-cable-services" target="_blank">Link to the response</a></p><p style="text-align: justify;">Citation: Response to TRAI Consultation Paper on Issues related to new Regulatory Framework for Broadcasting and Cable Services, Rishab Bailey, Devendra Damle, Harleen Kaur, Ajay Shah, May 2022 </p>Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-38940433830885565022021-08-18T17:07:00.001+05:302021-08-18T17:07:09.604+05:30Incentive compatibility and state-level regulation in Indian drug quality<div style="text-align: justify;"><span style="font-family: georgia;">by Harleen Kaur, Shubho Roy, Ajay Shah and Siddhartha Srivastava. </span></div><div style="text-align: justify;"><span style="font-family: georgia;"> </span></div><div style="text-align: justify;"><span style="font-family: georgia;">Originally published <a href="https://blog.theleapjournal.org/2021/06/incentive-compatibility-and-state-level.html">here</a> </span></div><div style="text-align: justify;"><span style="font-family: georgia;"><br /></span></div><div><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">The Indian pharmaceutical market is the <a href="https://www.mckinsey.com/~/media/mckinsey/dotcom/client_service/Pharma%20and%20Medical%20Products/PMP%20NEW/PDFs/778886_India_Pharma_2020_Propelling_Access_and_Acceptance_Realising_True_Potential.ashx" style="color: #7f6000; text-decoration-line: none;">third</a> largest in the world by volume of drugs sold and is dominated by local players that produce branded generics at low prices. Existing government <a href="https://main.mohfw.gov.in/sites/default/files/Chapter10SurveyReslutandAnalysis.pdf" style="color: #7f6000; text-decoration-line: none;">estimates</a> suggest that 3.16% of drugs at retail pharmacies and 10.02% of the drugs at government pharmacies are not of standard quality. Independent surveys hint at higher estimates of inadequate quality. While India is a powerhouse of drugs export, <a href="https://www.interpol.int/en/News-and-Events/News/2020/Global-operation-sees-a-rise-in-fake-medical-products-related-to-COVID-19" style="color: #7f6000; text-decoration-line: none;">foreign drug regulators</a> routinely classify Indian origin drugs as not of standard quality. This problem has been around for a while. Reports of the Comptroller and Auditor General of India (CAG) and Parliamentary Committees have repeatedly highlighted the problems and poor regulatory capacity.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">There is a need for better policy pathways to address these problems. In this article, we argue that an <i>incentive problem</i> inhibits the existing regulatory structure. The present law is set up in such a way, that it may be in the interest of the regulator <i>to not carefully monitor</i> the manufacture of pharmaceuticals. Unlike other areas where a statutory regulator is <i>responsible</i> for the safety of an industry, the legislative system of for the pharmaceutical sector does not create a body dedicated to ensuring that medicines are safe and up to standards. Alongside this, there are long-standing problems with regulators in India, where laws create arbitrary power, and the feedback loops of accountability mechanisms do not create a striving for improved state capacity. Certain solutions flow directly from this reasoning.</span></p><h3 style="background-color: white; color: #222222; margin: 0px; position: relative; text-align: justify;"><span style="font-family: georgia; font-size: medium;">The current system</span></h3><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Unlike the working of the market economy in most goods and services, market discipline through consumers in the field of pharmaceuticals is limited; there is market failure caused by asymmetric problem. The user (usually the patient) does not have the skills or experience to know if a pill actually contains the claimed active ingredient. When (say) a pen does not work, this is evident to a consumer. However, it is very difficult for an individual patient or even a doctor to know if a drug is substandard. When medication fails to cure the patient, this could be because of three different possibilities -- a wrong diagnosis, or the patient just did not respond to the correct drug, or a problem with drug quality. This induces an identification problem, so there is no feedback loop when a substandard drug is purchased. Similarly, when a patient does get better, a lot of the time, this would have happened through the working of the human body and is helped by a placebo effect. Here also, there are no feedback loops based on quality signals.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">The consequences of inadequate quality can be grave: substandard medication can even cause the death of a patient. And even if a patient dies, it is extremely difficult to establish (after the fact) that the medication was defective.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">As with most other countries, India has a law that creates a government apparatus for approval and manufacture of medicines in the country: the Drugs and Cosmetics Act, 1940 (<a href="https://cdsco.gov.in/opencms/export/sites/CDSCO_WEB/Pdf-documents/acts_rules/2016DrugsandCosmeticsAct1940Rules1945.pdf" style="color: #7f6000; text-decoration-line: none;">DC Act</a>). This divides the functions of regulation between the union government and state governments. The union government is responsible for the approval of new drugs, regulation of drug imports, and laying down standards for drugs, cosmetics, diagnostics and devices. State governments are responsible for licensing and monitoring manufacturers for drug quality and initiating legal action against offenders.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">The parliamentary law does not separate the regulatory duties between the union and state governments. The primary legislation allows the union government to appoint licensing authorities (S. 33 of the Act). Under this authority, the union government has delegated licensing functions to state governments (Rule 59 under the Act).</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">What was the text of the law which generated this separation? Section 33 of the legislation empowers the union government to appoint the 'licensing authority' for the manufacturing and sale of drugs and the union government has used this power to anoint the state government using subordinate legislation (See rule 59 of the DC Rules). As a result of this delegation, State governments (through their State Drug Regulatory Agencies) are responsible for licensing pharmaceutical manufacturing facilities and inspecting them.</span></p><h3 style="background-color: white; color: #222222; margin: 0px; position: relative; text-align: justify;"><span style="font-family: georgia; font-size: medium;">Misplaced incentives under the law</span></h3><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">The present arrangement of delegating inspection of manufacturing facilities to the state government, however, has problematic implications. In a unified national market, where goods flow across state borders seamlessly, pharmaceutical manufacturing factories do not limit their sales to one state. Many firms are harnessing the economies of scale that come from producing for the entire country or even the global market from a few very large manufacturing plants. Small states like Himachal Pradesh and Goa contribute disproportionately to India's total pharmaceutical production.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">This unification of markets creates a problem of incentives for the state governments where these plants are located. These states benefit from the tax revenue, jobs and licensing fees that these large plants bring to the state. If the state government is vigilant and runs a tight inspection regime, it risks discouraging pharmaceutical companies from setting up plants in their state. Companies may engage in jurisdiction-shopping, taking the tax base and manufacturing jobs to states with a lax regulatory regime. On the other hand the welfare costs associated with a poor regime -- the adverse impacts on the health of users -- is not borne by the state exclusively, but by the entire country. If the state has a small population (e.g. Goa or Himachal Pradesh) and the medicine is not commonly used, the failure of the regulatory regime may be invisible to the voters of the state. Therefore, it is not in the interest of a state government to run an efficient inspection regime.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Another dimension in the incentive problems of state governments lies in the cost and complexity of regulation. State governments are being asked to spend on manpower, testing facilities and institutional capacity for regulation, while the benefits of regulation are enjoyed by customers all over India.</span></p><p style="background-color: white; color: #222222;"></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">This incentive problem leads to a <i>race to the bottom</i> with states competing on laxity of regulation. As an example, while a <a href="https://xlnindia.gov.in/Home_xln.aspx" style="color: #7f6000; text-decoration-line: none;">single database</a> for providing information about substandard drugs to the public exists, only five state regulators provide such information through this database.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Finally, even if a drug manufactured in one state is found to be substandard by a regulatory agency in another state, it is difficult to organise enforcement actions that cut across state borders.<br /></span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Additionally, the separation of roles between state and union is not clear and leads to confusion about who is actually responsible for inspecting manufacturing facilities. For instance, under the DC Act, drug inspectors are responsible for inspecting manufacturing sites and detecting substandard medicines (Sections 22, 23). However drug inspectors can be appointed by both the central and state governments (Section 21), and function under the control/directions of an officer appointed by the relevant government (Rule 50).</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Crucially, the DC Act and Rules do not clarify the instances in which the drug inspectors are to be appointed by the central government and when they are to be appointed by the state government. Neither do they outline a scheme of accountability wherein the quality enforcement actions of the drug inspectors can be scrutinised or audited by either a state or central body.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">This results in a quality enforcement framework where there is no clear statutory body responsible for the failure in drug quality at the central or state level and therefore no incentive for individual drug inspectors to investigate and prosecute quality violations adequately. Both levels of the governments may consider the other responsible for the failure to inspect a facility.</span></p><h3 style="background-color: white; color: #222222; margin: 0px; position: relative; text-align: justify;"><span style="font-family: georgia; font-size: medium;">Solutions proposed in the prevailing literature</span></h3><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">There are broadly two schools of thought on how to reform the problem of drug quality in India. The first set of arguments favour the creation of a new central regulatory authority (Pharmaceutical Enquiry Committee (1954), Drug Policy (1994), Mashelkar Committee Report (2003)). The second set of arguments suggest that the existing State Drug Regulatory Authorities (SDRAs) be strengthened for better implementation of drug quality regulation (Hathi Committee Report (1975), Department-related Parliamentary Standing Committee on Health and Family Welfare 59th Report on the Functioning of CDSCO (2012)).</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Does the solution to the problems of drug quality in India lie in building a single agency at the union government and giving it high powers to investigate and punish? In thinking about the federal architecture of the Republic, there is merit in the separation envisaged in the 1940 Act. It is difficult for the union government to build an operational capability in any field, which is effective all across the country. The Constitution of India is imbued with federalism: India is not a unitary country ruled from New Delhi, but a union of states. The Constitution envisages a limited role for the union government: the <i>establishment of standards for quality of goods to be transported from one State to another</i> (See Entry 51 of List I of Schedule 7 of the Constitution).<br /></span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Multiple legislative attempts have been made so far to create a centralised drug authority along the lines of these recommendations but without much success. In all these instances, the bills have been opposed by state manufacturers associations and state drug regulators. But going beyond these political economy constraints, there are concerns about this pathway to policy design. Simplistic centralisation, drawing on the existing text of the DC Act, will be problematic both on the grounds that decentralisation is a valuable approach and on the grounds that the present Act has flaws on incentive compatibility. The proposals for reform have not analyzed the incentive problems and ambiguity created by the 1940 legislation. The regulatory framework for pharmaceuticals in India suffers from multiple failures which need to be addressed, over and beyond the question of decentralisation. For example, you can check the inspection dates and reports of all drug manufacturing plants in the U.S (<a href="https://www.accessdata.fda.gov/scripts/inspsearch/" style="color: #7f6000; text-decoration-line: none;">here</a>), but we do not know when Indian manufacturing plants are inspected. There is no obligation on either the state or union governments to regularly inspect manufacturing plants, and the DC Act is the site where such obligations need to be imposed upon state agencies.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">One possibility lies in reversing the focus of state-level agencies from <i>factories</i> to <i>consumers</i> of their state. E.g. if a factory makes drugs in Goa which are sold in Maharashtra, their quality characteristics would be the responsibility of the Maharashtra drugs regulator. Such a drugs regulator would achieve greater alignment with the interests of consumers in Maharashtra, and have a reduced conflict of interest with jobs and prosperity. However, there are difficulties in establishing the powers of the Maharashtra drugs regulator over a factory in Goa. There are also dangers of creating barriers to inter-state commerce.</span></p><h3 style="background-color: white; color: #222222; margin: 0px; position: relative; text-align: justify;"><span style="font-family: georgia;"><span style="font-size: medium;">How to reshape incentives</span><br /></span></h3><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;"><i>Better working of regulators</i>. An extensive body of knowledge has developed in India, in the last decade, on the working of regulators and regulation. This literature has argued that the path to high state capacity in regulation lies in: Clarity of purpose, the role/composition/working of the board, formal processes for legislative/executive/judicial functions which are written into the law, reporting and accountability mechanisms, the budget process, and low powers of investigation and punishment (FSLRC 2015, Roy et. al. 2019, Kelkar and Shah 2019). This knowledge needs to be brought into a deeper transformation of the DC Act.<br /></span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;"><i>Transparency reforms that reshape incentives</i>. A low cost intervention could be based on <i>reputation costs</i> and can usefully be placed at the level of the <i>union</i> government. There are multiple channels through which drug testing is taking place in India today. Whenever a drug is found to be substandard, the union government should obtain this information and upload that information to a publicly available repository along with the name of the manufacturer and the state in which it was manufactured. This will impose a cost on states which are lax on inspecting manufacturing facilities. The public will come to associate drugs from that state to be of poor quality and avoid them. Pharmaceutical firms will then face a market based penalty if they locate manufacturing facilities in states with lax regulatory regimes. On the other hand, states which set up good regulatory regimes will benefit from the positive publicity. Pharmaceutical manufacturers would gain respectability and may even command a price premium by locating their manufacturing facilities in states <i>with a reputation for high inspection standards</i>. Consequently, such states would gain from licensing fees, revenue, and jobs by establishing a good regulatory regime. Therefore, with a modest work program at the union government, naming and shaming bad actors and their state level regulators, we can reverse the <i>incentive problem</i> and create a virtuous cycle instead of the present race to the bottom.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Greater transparency would also kick off market discipline. Households would become more aware of quality characteristics associated with the brand names of various drugs and that would kick off greater pricing power in the hands of higher quality drugs. This process would, however, be curtailed by the extant system of price controls for drugs.</span></p><h3 style="background-color: white; color: #222222; margin: 0px; position: relative; text-align: justify;"><span style="font-family: georgia; font-size: medium;">Conclusion</span></h3><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">The current regulatory framework does not adequately define the objective, functions or powers of the de-facto regulators, the CDSCO and the SDRAs in the primary law or rules thereunder. This leads to creation of unaccountable regulators that have misaligned incentives. In this article, we have shown elements of a drug regulatory regime that are consistent with the federal vision of the Republic, and can effectively reshape the incentives of state level regulators. The union should be responsible for national public goods : drug quality standards, cGMP standards, randomised testing on a national scale, and release of this testing data. The laws that create state level regulators need to draw on modern Indian thinking about how regulators should be constructed. Put together, these reforms will modify the incentives of state level regulators. <br /></span></p><h4 style="background-color: white; color: #222222; margin: 0px; position: relative; text-align: justify;"><span style="font-family: georgia; font-size: medium;">References and further reading</span></h4><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Arrow, 1963: Kenneth J. Arrow, <a href="https://www.who.int/bulletin/volumes/82/2/PHCBP.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Uncertainty and the welfare economics of medical care</i></a> The American Economic Review, December 1963.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">National Drug Survey Report, 2016: Ministry of Health and Family Welfare, <a href="https://main.mohfw.gov.in/documents/reports/drugs-survey-report" style="color: #7f6000; text-decoration-line: none;"><i>Survey of extent of problems of spurious and not of standard quality drugs in the Country, 2014-16,</i></a> Ministry of Health and Family Welfare.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Government of India, 2012: Department-related parliamentary standing committee on health and family welfare, <a href="http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/59.pdf" style="color: #7f6000; text-decoration-line: none;"><i>59th report on the functioning of the Central Drugs Standard Control Organisation (CDSCO)</i></a> Rajya Sabha Secretariat, May 2012.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">CAG, 2007 <a href="https://www.cag.gov.in/en/old-audit-reports/view/13672" style="color: #7f6000; text-decoration-line: none;"><i>Report No. 20 of 2007 for the perriod ended March 2006 - Performance audit of Procurement of medicines and medical equipment</i></a> Comptroller and Auditor General, 2007.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Khan et al. 2016: AN Khan, RK Khar and Malairaman Udayabanu, <a href="https://innovareacademics.in/journals/index.php/ijpps/article/view/9182" style="color: #7f6000; text-decoration-line: none;"><i>Quality and affordability of amoxicillin generic products: A patient concern</i></a> Indian Journal of Pharmacy and Pharmaceutical Sciences, 2016.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Stanton et al, 2014: Cynthia Stanton et al, <a href="https://link.springer.com/article/10.1186/s12884-014-0386-y" style="color: #7f6000; text-decoration-line: none;"><i>Accessibility and potency of uterotonic drugs purchased by simulated clients in four districts in India</i></a> BMC Pregnancy and Childbirth, 2014.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Thakur and Reddy, 2016: Dinesh S. Thakur and Prashant Reddy T, <a href="https://spicyip.com/wp-content/uploads/2016/06/Report_India-Drug-Regulatory-Framework_June-2016.pdf" style="color: #7f6000; text-decoration-line: none;"><i>A report on fixing India's broken drug regulatory framework</i></a> Spicy-IP, June 2016.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Singh et al, 2020: Prachi Singh, Shamika Ravi and David Dam, <a href="https://www.brookings.edu/wp-content/uploads/2020/03/Medicines-in-India_for-web-1.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Medicines in India: Accessibility, Affordability and Quality</i></a> Brookings India, March 2020.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Krishnan, 2020: KP Krishnan, <a href="https://blog.theleapjournal.org/2020/08/the-three-tiers-of-government-in-public.html" style="color: #7f6000; text-decoration-line: none;"><i>The three tiers of government in public health</i></a> The Leap Blog, August 2020.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">MoHFW, 2017: Ministry of Health and Family Welfare, <a href="https://cdsco.gov.in/opencms/opencms/system/modules/CDSCO.WEB/elements/download_file_division.jsp?num_id=OTY4" style="color: #7f6000; text-decoration-line: none;"><i>Department of Health and Family Welfare, Notification G.S.R. 1337(E),</i></a> CDSCO, Oct 2017.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Drugs Enquiry Committee, 1930-31: Government of India, <a href="https://indianculture.gov.in/report-drugs-enquiry-committee-1930-31" style="color: #7f6000; text-decoration-line: none;"><i>Report of the Drugs Enquiry Committee</i></a>, 1930-31.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Pharmaceutical Enquiry Committee, 1954: Ministry of Commerce and Industry, <a href="http://cslrepository.nvli.in/handle/123456789/2136" style="color: #7f6000; text-decoration-line: none;"><i>Report of the pharmaceutical enquiry committee,</i></a>1954.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Hathi Committee, 1975: Ministry of Petroleum and Chemicals, <a href="http://www.communityhealth.in/~commun26/wiki/images/b/b5/Hathi_Committee_report_1975.PDF.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Report of the Committee on Drugs and Pharmaceutical Industry</i></a>, 1975.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Drug Policy, 1986: Government of India, <a href="http://www.nppaindia.nic.in/wp-content/uploads/2020/07/Drug-policy-1986.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Measures for Rationalisation, Quality Control and Growth of Drugs and; Pharmaceutical Industry In India</i></a>, 1986.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Drug Policy, 1994: Government of India, <a href="http://www.nppaindia.nic.in/en/drug-policies/modification-in-drug-policy-1986/" style="color: #7f6000; text-decoration-line: none;"><i>Modification in Drug Policy, 1986</i></a>, 1994.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">FSLRC, <a href="https://dea.gov.in/sites/default/files/Revised_Draft_IFC.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Indian Financial Code, version 1.1</i></a>, Ministry of Finance, 2015.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Vijay Kelkar and Ajay Shah, <a href="https://www.mayin.org/ajayshah/books/isotr2019.html" style="color: #7f6000; text-decoration-line: none;"><i>In Service of the Republic: The art and science of economic policy</i></a>, Penguin Allen Lane, 2019.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Mashelkar Committee, 2003: Ministry of Health and Family Welfare, <a href="https://pharmaceuticals.gov.in/sites/default/files/MashelkarCommitteeReport.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Report of the expert committee on a comprehensive examination of drug regulatory issues, including the problem of spurious drugs,</i></a> 2003.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Shubho Roy, Ajay Shah, B. N. Srikrishna and Somasekhar Sundaresan, <a href="https://macrofinance.nipfp.org.in/releases/RSSS_building-state-capacity.html" style="color: #7f6000; text-decoration-line: none;"><i>Building State capacity for regulation in India</i></a> in "Regulation in India: Design, Capacity, Performance" edited by Devesh Kapur and Madhav Khosla. Oxford: Hart Publishing, April 2019.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Task force under the Chairmanship of Dr. Pronab Sen, 2005: Government of India, <a href="https://pharmaceuticals.gov.in/sites/default/files/Dr.%20Pronab%20Sen%20Committee%20Report1_0.pdf" style="color: #7f6000; text-decoration-line: none;"><i>Task Force to Explore Options other than Price Control for Achieving the Objective of Making Available Life-saving Drugs at Reasonable Prices</i></a>, 2005.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">Jeffery and Santhosh M.R., 2009: Roger Jeffery and Santhosh M.R., <a href="http://www.chsj.org/uploads/1/0/2/1/10215849/jhs-fulltpsaarticle.pdf#page=13" style="color: #7f6000; text-decoration-line: none;"><i>Architecture of Drug Regulation in India - What are the Barriers to Regulatory Reform?</i></a>, 2009.</span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;"> </span></p><p style="background-color: white; color: #222222; text-align: justify;"><span style="font-family: georgia;">The authors acknowledge the support of Thakur Foundation in this work, and valuable conversations with Dinesh Thakur and Prashant Reddy. All errors are ours.</span></p></div>Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-30909256225428214352020-07-08T18:18:00.003+05:302020-10-28T01:30:27.064+05:30Information about COVID-19 in India<p>By Natasha Agarwal and Harleen Kaur.</p>
<p>Originally posted <a href="https://blog.theleapjournal.org/2020/06/information-about-covid-19-in-india_13.html">here</a>.</p>
<p>The presence of timely and reliable data enables informed decision-making by government organisations and individuals. When a machine-readable dataset is released on a website, it is non-rival, and thus has characteristics of a public good. There is a case for state financing or production of information. As Carl Malamund <a href="https://public.resource.org/people/3waves_pamphlet.pdf">says</a>, <i>"Government information is a form of infrastructure, no less important to our modern life than our roads, electrical grid or water systems"</i>. Open Data Governance (ODG) are structured datasets produced by government institutions that are released in a machine-readable format. These datasets contain information <a href="https://www.data.gv.at/wp-content/uploads/2016/02/Sebastian_Neumaier_MSc_2015.pdf">such as</a> statistics, plans, maps, environmental data, spatial data, materials of agencies, ministries, parliamentary data, budgetary data, and laws.</p>
<p>Governments across the globe have been actively opening their data through national and regional data transparency portals recognising the need for making data available to the public. The process is informed by <a href="https://www.oecd.org/gov/digital-government/open-government-data.htm">ODG</a> principles. There are three main reasons for opening government data; increasing transparency, releasing the social and commercial value of the data, and to encourage participatory governance (Attard et al. (2015)). As an example, the COVID-19 pandemic is best controlled through behavioral changes by each individual. To support such changes, the governments need to open their data about the pandemic at an individual and community level.</p>
<p> The ODG principles defining best practices of data sharing
include; <i>i)</i> identifying and publishing high-value datasets in
a standardised format (such as a directory of medical professionals,
tests conducted and results and information about
surveillance), <i>ii)</i> adopting open data
scheme <a href="https://5stardata.info/en/">protocol</a> to share
human and machine-readable, non-proprietary format and include
universal resource identifier and linked data to provide
access, </p> <i>iii)</i> removing barriers to data access such as requirements of establishing an account, of proving identity, or payments for data access, and <i>iv)</i> making information available in perpetuity by not deleting/changing data permanently.
<p>In this article, we examine the information systems on COVID-19 in India from the viewpoint of these issues in the design of a high performance statistical system. </p>
<h3>Data.gov.in and its limitations</h3>
<p>In India, an open data policy the <a href="https://dst.gov.in/national-data-sharing-and-accessibility-policy-0">National Data Sharing and Accessibility Policy (NDSAP)</a> was announced in 2012 to open government data to the public by following ODG principles.</p>
<p> The policy requires all ministries, departments, subordinate bodies, organisations, and autonomous bodies of the Indian Government to share all publicly generated non-sensitive data in both human-readable and machine-readable formats. The data is disseminated through a common government data platform deployed and managed by the National Informatics Centre (NIC), Ministry of Communications and Information Technology. It mandated that datasets be periodically updated by government agencies along with comprehensive meta-data which enables data discovery and access through departmental portals.</p>
<p>Furthermore, NDSAP requires the Department of Information Technology (DIT) to publish guidelines to implement NDSAP. The implementation <a href="https://data.gov.in/sites/default/files/NDSAP%20Implementation%20Guidelines%202.4.pdf">guidelines</a> provide details of the data contribution process including; the role and responsibilities of the data controller, approval, publishing process for catalogs and resources, and management of published datasets.</p>
<p>In compliance with NDSAP, India's national data transparency website, <a href="https://data.gov.in/"><i>data.gov.in</i></a> was launched in 2012. Accordingly, data.gov.in provides a unified catalog of datasets allowing users to browse the dataset catalog, view the meta-data associated with each dataset, comment on and rank various datasets, download available datasets, submit suggestions and queries on the published dataset, and submit a request for those that are not available yet (Chattapadhyay (2013)).</p>
<p>Despite the comprehensiveness of the policy and the accompanying
guidelines, agencies have responded predictably, i.e. they neither
comply with NDSAP nor with the implementation guidelines. As a result, data.gov.in contains issues such as the absence of databases, duplicate datasets, lack of follow-up, or meta-data (Agarwal (2016) and Buteau et al. (2015)). The terms 'policy document' and 'guidelines' which are often used in India are ineffective in that they do not constrain the executive. Hence, these documents amount to exhortations that have little impact on the incentives of officials in favour of greater opacity, reduced work, or gaining power through the control of data.</p>
<h3>Ministry of Health and Family Welfare (MoHFW) and COVID-19 data</h3>
<p>We examine the data in the public domain emanating from MoHFW during the ongoing COVID-19 pandemic. To understand the availability of resources for healthcare, we searched for a directory of healthcare providers (both institutions and individuals). The latest hospital directory available on data.gov.in was for <a href="https://data.gov.in/catalog/hospital-directory-national-health-portal?filters%5Bfield_catalog_reference%5D=323881&format=json&offset=0&limit=6&sort%5Bcreated%5D=desc">2016</a> and the latest data for the number of registered allopathic doctors and dental surgeons was available for the year <a href="https://data.gov.in/catalog/number-registered-allopathic-doctors-and-dental-surgeons?filters%5Bfield_catalog_reference%5D=89574&format=json&offset=0&limit=6&sort%5Bcreated%5D=desc">2013</a>.</p>
<p> The MoHFW is disseminating limited data on the spread of COVID-19 through the data.gov.in portal. For example, as of 1st June 2020, the data reported under <a href="https://www.mygov.in/covid-19/">mygov.in</a> (not in data.gov.in) contains information on three variables namely <i>(i)</i> total number of persons infected with COVID-19; <i>(ii)</i> COVID-19 infected persons who have been cured/discharged/migrated; and <i>(iii)</i> COVID-19 infected persons who have died. The state-wise distribution of these three variables is available for a given date "T = Today". This data cannot be downloaded. The meta-data for this information is also not available. On the other hand, the <a href="https://community.data.gov.in/tag/india-fights-corona/">data.gov.in</a> only releases daily factsheets in a pdf format summarising this data.</p>
<p>The dissemination of COVID-19-related data by the MoHFW has problems. It gathers detailed COVID-19-related data from the National Centre for Disease Control <a href="https://ncdc.gov.in/"><i>(NCDC)</i></a> (surveillance data from the field) and Indian Council of Medical Research <a href="https://www.icmr.gov.in/"><i>(ICMR)</i></a> (data through the testing laboratory network), which is not reflected in data.gov.in.</p>
<p>The NCDC, under the <a href="https://idsp.nic.in/index.php">Integrated Disease Surveillance Project</a> (IDSP), consists of union, state, and district-level units responsible for the surveillance of infectious diseases in India. Although it releases <a href="https://idsp.nic.in/index4.php?lang=1&level=0&linkid=406&lid=3689">weekly outbreak reports</a> notifying the status of infectious diseases in India, the reports are available only on its website and not integrated on data.gov.in. On the COVID-19 pandemic, the <a href="https://idsp.nic.in/WriteReadData/l892s/55963304211589526100.pdf">weekly outbreak report dated 10th-16 February, 2020</a> was the latest available report under IDSP as of 8 June, 2020.</p>
<p>Similarly, ICMR, the <a href="https://www.mohfw.gov.in/pdf/NotificationofICMguidelinesforCOVID19testinginprivatelaboratoriesiIndia.pdf">designated body</a> under the National Disaster Management Act to coordinate the testing strategy for COVID-19 has been releasing its data through its website and not through data.gov.in. Through its website, ICMR <a href="https://www.icmr.gov.in/index.html">releases</a> information on two parameters, the total number of samples tested for COVID-19 over time, and in the last 24 hours.</p>
<p>Therefore, data.gov.in is not being utilised by the union government agencies for releasing information. Individuals and researchers interested in the government data on the pandemic have to access information available in different silos according to their skills and knowledge. Moreover, none of the information shared is available in a machine-readable or standardised format. This leads to a weak information base on Covid-19 available to the public and to researchers, which hampers the decision making of individuals on the appropriate care that they should take, and hampers policymaking by government organisations for want of data and research.</p>
<h3>Data disseminated by state governments</h3>
<p> The union agencies are not the only government source on COVID-19 information. We now study the data dissemination protocols for COVID-19 as followed by the states.</p>
<p>We could not find state data on COVID-19 on the data.gov.in website. As a result, the following information was collected through individual COVID-19 portals set up by the states. Table 1 shows that there is heterogeneity in reporting across states. The information shared by the states is classified into three categories; "state-level", "district-level" and "individual-level". </p>
<table border="1" width="100%">
<colgroup><col WIDTH="100" ><col WIDTH="100" ><col WIDTH="100" ><col WIDTH="100"><col WIDTH="100"><col WIDTH="100"><col WIDTH="100"><col WIDTH="100"></colgroup>
<tbody>
<tr>
<td></td>
<th><p>Parameters</p></th>
<th><p>Delhi</p></th>
<th><p>Kerala</p></th>
<th><p>Maharashtra</p></th>
<th><p>Gujarat</p></th>
<th><p>Karnataka</p></th>
<th><p>Madhya Pradesh</p></th>
</tr>
<tr>
<th rowspan="7" ><p>State-level data</p></th>
<td><p>Total COVID-19 confirmed cases</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
</tr>
<tr>
<td><p>Active cases</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
</tr>
<tr>
<td><p>Total COVID-19 tests conducted</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
</tr>
<tr>
<td><p>Hospitalisation status of positive cases</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>Only ICU patients</p></td>
<td><p>N</p></td>
</tr>
<tr>
<td><p>Isolated/quarantined patients</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
</tr>
<tr>
<td><p>Total recovered patients</p>
</td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
</tr>
<tr>
<td><p>Total deaths</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
<td><p>Y</p></td>
</tr>
<tr>
<th rowspan="2" ><p>District-level data</p></th>
<td><p>Number of people under observation</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
</tr>
<tr>
<td><p>Number of quarantined/isolated people</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
</tr>
<tr>
<th rowspan="3" ><p>Individual-level data</p></th>
<td><p>Age</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
</tr>
<tr>
<td><p>Gender</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
</tr>
<tr>
<td><p>Comorbidity</p></td>
<td><p>N</p></td>
<td><p>Y</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
<td><p>N</p></td>
</tr>
</tbody>
<caption>Table 1: State-level reporting parameters for COVID-19 (As of 9 June, 2020)</caption>
</table>
<p> Table 1, placed above, shows the data sharing protocol for COVID-19 in
selected states. We may point out a few facts that
influence the interpretation of this table:
</p><ol>
<li><p> Data as of 10th June, 2020. Sources: <a href="http://health.delhigovt.nic.in/wps/wcm/connect/doit_health/Health/Home/Covid19/Bulletin+May+2020">Delhi</a>, <a href="https://dhs.kerala.gov.in/2020/04/30/30-04-2020/">Kerala</a>, <a href="https://covid19-phdmah.hub.arcgis.com/">Maharashtra</a>, <a href="https://gujcovid19.gujarat.gov.in/">Gujarat</a>, <a href="https://covid19.karnataka.gov.in/new-page/Health%20Department%20Bulletin/en">Karnataka</a> and <a href="https://mapit.gov.in/covid-19/Covid-Dashboard.aspx">Madhya Pradesh</a>. </p>
</li><li><p> Maharashtra, Gujarat, and Karnataka share information about the same parameters at the State and District level. The information depicted here is about parameters in addition to the duplicate information.</p>
</li><li><p> In the studied states, Gujarat and Delhi inform about the number of patients on ventilators at the state level. However, the information on available hospital beds and ventilators in Delhi is shared under a separate website, https://coronabeds.jantasamvad.org/.</p>
</li><li><p> District-level information in Kerala is available for patients hospitalised, symptomatic patients hospitalised, the chronology of positive cases, and hotspots. No other states releases data on these parameters. </p>
</li><li><p> Karnataka is the only state which shared anonymised patient data related to their travel history, district, and location of isolation. It also has a dedicated patient case number for individual patients for whom information is shared.</p>
</li><li><p> Madhya Pradesh had a dedicated website for individual-level data which was discontinued from 11th May 2020 onwards following the raising of <a href="https://timesofindia.indiatimes.com/india/french-hacker-now-bares-flaw-in-mp-data-store/articleshow/75666236.cms">privacy concerns</a> over social media.</p>
</li></ol><p></p>
<p>We find that in most states, the baseline data includes overall state data about testing rates, persons infected, deaths, and recovery data. However, some states provide additional information such as the number of COVID-19 tests conducted, the number of isolated/quarantined persons, the counts of patients on ventilators, and stable patients. While some states like Maharashtra report data at the district level along with the overall state data, others like Karnataka share information at the individual level. There is a high variation in the type of data shared by the states. For instance, at an individual level, Karnataka reports anonymised information about the demographic details in addition to the baseline data. On the other hand, Madhya Pradesh used to share the name and addresses of the suspected COVID-19 patients to the public while reporting individual-level data. Similarly, Kerala, Maharashtra, and Gujarat report their data at the district level. Kerala reports its surveillance data which is not reported by Maharashtra, and Gujarat. Some states provide daily reports in English, while others do not. For example, Gujarat provides daily reports only in Gujarati.</p>
<p>Most states disseminate data through their COVID-19 websites. However, some resort to reporting through social media. For example, the Maharashtra government website on COVID-19 does not provide information other than that reported in table 1. However, the Maharashtra government has been releasing daily reports providing COVID-19-related information across age, gender, comorbidities amongst other variables through <a href="https://twitter.com/Maha_MEDD/status/1252842842268950530?s=20">Twitter</a>. While twitter can amplify the transmission of information in a public statistical system, it should not supplant the foundational systems. Data disseminated through a tweet cannot be traced to any government website. Besides, there is inconsistency in the reports shared by the Maharashtra government through twitter. For example, the <a href="https://drive.google.com/file/d/11kPsz_GQMKZT679CEx0OQaQMCYahVPX5/view">report</a> dated 22nd April 2020 provides for district-wise distribution of COVID-19 cases in Maharashtra which is not available in the <a href="https://drive.google.com/file/d/1vLNBegK3tnttTs1YVGaZiFWT8666IR6u/view">report</a> dated 1st April 2020. The data is a "delete-tweet" away from not being available.</p>
<p>There is also variation in the data sharing format. Most state governments provide data in human-readable formats like pdf. However, some state governments provide some data in machine-readable formats. For example, district-wise data on variables available on dashboard for Gujarat which contains the total number of cases tested for COVID-19, positive cases, patients recovered, people under quarantine, and total deaths can be exported to a csv document. Nevertheless, demographic details of COVID-19 patients or data patients on ventilator/stable, are only available in daily reports in pdf format.</p>
<p>We find that the states do not share their COVID-19 data through the data.gov.in framework. Users have to look for multiple information sources about COVID-19 data to access this data. Within the framework of stand-alone websites providing information, there are two concerns. The first concern is the lack of standardised parameters for information releasing. For instance, few states share the hospitalisation status and the availability of beds which would be useful for the general public in case of emergency. The second concern is the quality of data shared by the states. As discussed, most states share human-readable data and not machine-readable, downloadable data. Meta-data is not available for any state studied making it difficult to interpret. Moreover, the lack of data standardisation makes data non-interoperable. The state-level historical information is unavailable for most states. Therefore, not all data shared by the states is permanent.</p>
<h3>Difficulties of CoVID-19 data release seen elsewhere in the world</h3>
<p>So far, we have documented variation in what data is being released, and how the same is disseminated, in India. This is a global concern for COVID-19. We map the data reported by selected countries in table 2 below. We find that countries are using two forms of data distribution methods. These are daily updates and dashboards. While daily updates are usually pdf documents, dashboards provide progress of COVID-19 over time. The type of information shared by countries can broadly be classified according to the level of data as "country-level" and "individual-level". Country-level data consists of aggregate information such as the total number of tests conducted, the total number of COVID-19 positive patients, the number of patient hospitalised and deaths, etc. Some countries also share aggregate surveillance data which consists of information about individuals isolated, quarantined, and contact traced. At an individual level, we see a wide variation of data shared by the countries. While India does not provide individual-level data through its Ministry of Health, other countries share demographic information such as age, gender, race/ethnicity, and occupation. A comparison of data disclosed by selected countries is shared in table 2.
</p><table border="1">
<tbody>
<tr>
<th rowspan="2">
Country
</th>
<th rowspan="2" WIDTH="100">
Daily updates (DU) or Dashboard (DB)
</th>
<th rowspan="2" WIDTH="100">
Total Number of tests conducted
</th>
<th rowspan="2" WIDTH="100">
Total Number of COVID-19 +ve patients
</th>
<th rowspan="2" WIDTH="100">
Total Number of patients hospitalised
</th>
<th rowspan="2" WIDTH="100">
Total Number of deaths
</th>
<th rowspan="2" WIDTH="100">
Surveillance data
</th>
<th colspan="4" WIDTH="200">
Individual level data
</th>
</tr>
<tr>
<td WIDTH="50">
Age
</td>
<td WIDTH="50">
Gender
</td>
<td WIDTH="50">
Race/Ethnicity
</td>
<td WIDTH="50">
Occupation
</td>
</tr>
<tr>
<th>
India
</th>
<td>
<a href="https://www.mohfw.gov.in/"><u>DU</u></a> and <a href="https://www.mohfw.gov.in/index.php"><u>DB</u></a>
</td>
<td>
<a href="https://www.icmr.gov.in/"><u>Y</u></a>
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
N
</td>
<td>
N
</td>
<td>
N
</td>
<td>
N
</td>
</tr>
<tr>
<th>
USA
</th>
<td>
<a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html"><u>DU</u></a> and <a href="https://www.cdc.gov/covid-data-tracker/index.html"><u>DB</u></a>
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
Y
</td>
<td>
<a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html"><u>Y</u></a>
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
Y
</td>
<td>
N
</td>
</tr>
<tr>
<th>
UK
</th>
<td>
<a href="https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public"><u>DU</u></a> and <a href="https://coronavirus.data.gov.uk/"><u>DB</u></a>
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
<a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/countsandratiosofcoronavirusrelateddeathsbyethnicgroupenglandandwales"><u>Y</u></a>
</td>
<td>
<a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/datasets/coronaviruscovid19relateddeathsbyoccupationenglandandwales"><u>Y</u></a>
</td>
</tr>
<tr>
<th>
South Korea</th>
<td>
<a href="http://ncov.mohw.go.kr/en/bdBoardList.do"><u>DU</u></a> and <a href="http://ncov.mohw.go.kr/en/"><u>DB</u></a>
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
N
</td>
<td>
N
</td>
</tr>
<tr>
<th>
Singapore
</th>
<td>
<a href="https://www.moh.gov.sg/covid-19"><u>DU</u></a> and <a href="https://www.gov.sg/features/covid-19"><u>DB</u></a>
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
N
</td>
<td>
N
</td>
<td>
N
</td>
</tr>
<tr>
<th>
Canada
</th>
<td>
<a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html?topic=tilelink"><u>DB</u></a>
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
N
</td>
</tr>
<tr>
<th>
Australia
</th>
<td>
<a href="https://www.health.gov.au/resources/collections/coronavirus-covid-19-at-a-glance-infographic-collection"><u>DU</u></a> and <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers"><u>DB</u></a>
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
Y
</td>
<td>
N
</td>
<td>
N
</td>
</tr>
</tbody>
<caption>Table 2: Country-level data parameters for COVID-19 (As of 10
May, 2020) </caption>
</table>
<p>It can be seen from the above table that most countries report testing data (information about the number of tests conducted), and the number of positive cases and deaths. At the national level, India only reports these minimum consistent variables. Some countries report more variables to the public. For instance, the US, South Korea, Singapore, Canada, and Australia report surveillance data in varying details. A few countries like Canada share their database in a downloadable format. This includes information about quarantined and isolated individuals and details about contact tracing and source of infection. Singapore, Canada, and Australia also report data on the number of cases hospitalised. The UK has recently started reporting information about COVID-19 deaths, disaggregated into deaths inside and outside hospitals. Individual-level data such as age, gender, race/ethnicity, and occupation, is visible in some countries, as is the case in some states (though not the union government) in India. The US releases data about age and race, while the UK releases information about age, gender, race, and occupation. South Korea releases age details for only severe cases and Singapore releases individual-level data only in the event of the death of the individual. Canada releases data about age and pre-existing <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases/2019-novel-coronavirus-infection/surv-covid19-epi-update-eng.pdf">conditions</a> of the individuals and Australia releases information about age and gender.</p>
<p>Therefore, we find that data release for COVID-19 has issues of lack of standardisation and inter-operability globally. In India, the union and state governments have important deficiencies.</p>
<h3>Implications for India</h3>
<p>India's existing data infrastructure does not meet the demands of a public health emergency. The implications of this are multifaceted. For example, amid the COVID-19 pandemic, the government had to create a <a href="https://covidwarriors.gov.in/default.aspx">Covid19-warriors dashboard</a> that provides information on doctors, nurses, ASHA workers, and others who could be deployed for immediate response. If data.gov.in had worked well, then the government would have had this information already.</p>
<p>Likewise, the problem of <a href="https://www.article-14.com/post/flawed-covid-19-database-source-of-decisions-to-ease-lockdown">inaccurate databases</a> highlighting data discrepancies in reporting COVID-19 infected persons could have been avoided. An available database infrastructure in data.gov.in would have avoided the need for <a href="https://www.article-14.com/post/flawed-covid-19-database-source-of-decisions-to-ease-lockdown">ICMR</a> to evolve its own data-dissemination method in the middle of the COVID19 pandemic. Besides, the problem of collecting, processing, and releasing COVID-19 data with other databases would have been eased. For example, if the existing data infrastructure had data collection and reporting standards across space like district names with their respective codes, then it would not only be easy to collect the data but also facilitate easier collation with other datasets for enabling interoperability.</p>
<h3>Conclusion</h3>
<p>In the present article, we highlighted one element of the public
health response, the issue of data release by the Indian government authorities for COVID-19. We show that the statistical system for disease surveillance dissemination in India is in a need of reform. </p>
<p>The ODG platform in India, data.gov.in, can play an important role in strengthening India's public health data infrastructure. To realise the utility of public data, a data protocol framework with a legally enforceable mandate on the government is required, as is seen in countries like <a href="https://www.datacoalition.org/policy-issues/open-data/open-government-data-act/">the US</a>. The principles of standardising, anonymising, interoperability, meta-data release, and grievance redressal in the event of non-release should be in this legal framework.</p>
<p>For the union government, a data.gov.in which utilises the sound principles of OGD release could become a better foundation for data release, and thus improve India's response to an epidemic. State and city governments could choose to use the services of data.gov.in or build their own systems. An indicative list of the essential components of such a portal (as seen in NDSAP and ODG principles) are provided below: </p>
<ol>
<li><p><b>Standardising data release:</b> Standardisation of reported variables such as reporting unit, disease data, language, individual, and community-level data is required. Elements that go towards this include geotagging and coding of hospitals/labs and the adoption of <a href="https://icd.who.int/en">International Classification of Diseases (ICD)</a> for diagnosis and treatment of diseases. </p>
</li><li><p><b>Ensuring privacy:</b> Privacy is a fundamental right in India (Supreme Court of India (2017)). Despite this, states like Madhya Pradesh and Karnataka were seen to be disseminating personally identifiable information of suspected COVID-19 patients. The government would need to adopt various tools at its disposal to protect these rights at an individual and community level. These tools include tagging appropriate data, incorporating principles of Privacy by design (PBD), anonymising and utilising appropriate fiduciary principles (Cavoukian (2011) and Bailey and Goyal (2019)).</p>
</li><li><p><b>Interoperability:</b> Facilitating <i>systems interoperability</i> by incorporating common formats, software standards, and <i>semantic interoperability</i> by incorporating e-governance standards so that the meaning of data is not lost across data silos is required (Wright et al. (2010)).</p>
</li><li><p><b>Adopting an open data scheme:</b> Legislators need to create the frameworks through which the executive is required to release meta-data,
and release data in a machine-readable format.
</p></li><li><p><b>Setting up governance framework:</b> Union, state, and city governments have legitimate authority on how they organise their work, but greater consistency and predictability for API-based access is desirable.
</p></li><p></p></ol>
<h3>References</h3>
<p> Attard et al. (2015): Judie Attard, Fabrizio Orlandi, Simon Scerri, and Sören Auer, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0740624X1500091X"><i>A systematic review of open government data initiatives</i></a>, Government Information Quarterly, 2015.</p>
<p>Chattapadhyay (2013): Sumandro Chattapadhyay, <a href="http://www.opendataresearch.org/sites/default/files/publications/sumandro_icegov_2013_published.pdf"><i>Towards an Expanded and Integrated Open Government Data Agenda for India</i></a>, IDRC Digital Library</p>
<p>Agarwal (2016): Natasha Agarwal, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2822676"><i>Open Government Data: An Answer to India's Growth Logjam,</i></a> SSRN, 16 August, 2016.</p>
<p> Buteau et al. (2015): Sharon Buteau, Aurelie Larquemin and Jyoti Prasad Mukhopadhyay, <a href="http://www.opendataresearch.org/dl/symposium2015/odrs2015-paper12.pdf"><i>Open data and applied socio-economic research in india: An overview,</i></a> IFMR Working Paper, 27 May, 2015.</p>
<p>Supreme Court of India (2017): <a href="https://indiankanoon.org/doc/91938676/"><i>Justice K.S. Puttaswamy</i> v. <i>Union of India</i></a>, 2017 (10) SCC 1.</p>
<p>Cavoukian (2011): Ann Cavoukian, <a href="https://www.ipc.on.ca/wp-content/uploads/Resources/7foundationalprinciples.pdf"><i>Privacy by design: The seven foundational principles,</i></a> Information and Privacy Commissioner of Ontario, 2011.</p>
<p>Wright et al. (2010): Glover Wright, Pranesh Prakash Sunil Abraham, Nishant Shah, <a href="https://cis-india.org/openness/publications/open-government.pdf"><i>Open government data study: India,</i></a> The Centre for Internet and Society, 2010.</p>
<p>Bailey and Goyal (2019): Rishab Bailey and Trishee Goyal, <a href="http://datagovernance.org/files/research/NIPFP_Rishab_Trishee_fiduciaries_-_Paper_4.pdf"><i>Fiduciary relationships as a means to protect privacy: Examining the use of the fiduciary concept in the Draft Personal Data Protection Bill, 2018,</i></a> Data Governance Network, 2019.</p>
<p>Natasha Agarwal is an independent research economist. Harleen Kaur is a researcher at NIPFP. The authors are thankful to Ajay Shah and two anonymous referees for their valuable comments and inputs on the article.</p>
<p></p>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-63365448402264695392020-07-03T18:13:00.000+05:302020-07-17T00:53:26.925+05:30Legal and regulatory framework for laboratory testing in India: A case study for Covid-19<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">By Harleen Kaur, Ameya Paleja, and Siddhartha Srivastava.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Originally published <a href="https://blog.theleapjournal.org/2020/07/legal-and-regulatory-framework-for.html" target="_blank">here</a>.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Testing is central to understanding the spread of the SARS-CoV-2 virus at an individual & population level and designing suitable interventions (Shah, 2020). As of June 23, 2020, India has the <a href="https://www.worldometers.info/coronavirus/#countries">fourth-largest</a> number of SARS-CoV-2 cases worldwide. This is despite having conducted only 119 <a href="https://ourworldindata.org/coronavirus-testing">tests</a> per million people. In comparison, the United States and Russia, countries with more cases than India have conducted 1518 and 2074 <a href="https://ourworldindata.org/coronavirus-testing">tests</a> per million respectively. While India has somewhat improved its testing rate since the early stages of the SARS-CoV-2 pandemic (21 per million on April 24), we are still unable to test in adequate numbers. In this blog, we study the reasons behind insufficient testing rates in India by reviewing the legal environment for regulating medical testing.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Indian diagnostics industry is dominated by the private sector. The legal framework for regulation of private labs is set up under the <a href="http://clinicalestablishments.gov.in/WriteReadData/969.pdf">Clinical Establishments Act, 2010</a>. The <a href="https://www.cci.gov.in/sites/default/files/POLICY_NOTE.pdf">issues</a> of non-standardisation of service quality and supplier-induced demands are prevalent in the industry (Competition Commission of India, 2018). Therefore, these labs have been functioning under market-led and self-imposed norms. The government did not depend on this regulatory framework during the SARS-CoV-2 pandemic. Instead, it granted unchecked discretionary power to the Indian Council of Medical Research <a href="https://www.icmr.gov.in/">(ICMR)</a> to regulate the testing strategy. Under the regulatory framework set up by the ICMR, the private lab network is not being utilised optimally for SARS-CoV-2 testing. For instance, the private sector accounts for about <a href="http://rchiips.org/nfhs/NFHS-4Reports/India.pdf">70%</a> of the health care market in India. As of June 22, 2020, only 27% of all labs <a href="https://web.archive.org/web/20200623032021/https://www.icmr.gov.in/pdf/covid/labs/COVID_Testing_Labs_22062020.pdf">approved</a> for SARS-CoV-2 testing in India are private labs. In this article, we argue that; i) the private labs are governed by a weak regulatory framework that has allowed market failure to persist in the diagnostics sector in India, and ii) the testing strategy mandated by the ICMR for SARS-CoV-2 pandemic has led to poor outcomes with respect to the participation of private labs. Hence, there is an immediate requirement for reviewing the powers of ICMR for managing the testing strategy and a long term requirement for rethinking the present regulatory framework for labs.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Concerns about market failure in the field of medical testing</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><i><br /></i></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><i>A market failure</i> occurs when the free market is unable to obtain efficient economic outcomes. Of the four types of market failures, viz; externalities, asymmetric information, market power, and public goods, the diagnostics sector in India is seen to be affected primarily by information asymmetry. Information asymmetry or information inequality occurs when one party such as a physician possesses much greater information than the other, a patient (Arrow, 1963). During a pandemic, testing becomes a crucial part of a nation's public health strategy and hence, the public goods element of market failure also comes into play. For instance, testing data is a public good in as much as it is useful to understand the spread of the disease in an area that helps the government to design public health policies, and sharing of such data by the government affects behavioral changes in individuals.</span></div>
<br />
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">As a result of information asymmetry, the field of medical testing in India faces the recurring issue of quality control and standardisation of services. For instance, practices such as hiring <a href="https://www.expresshealthcare.in/lab-diagnostics/no-rules-to-the-game/116862/">unqualified professionals</a>, using <a href="https://health.economictimes.indiatimes.com/news/hospitals/corrupt-docs-chinese-equipment-led-to-kota-kids-deaths/73155856">sub-standard equipment</a>, and <a href="https://indianexpress.com/article/cities/mumbai/diagnostic-reports-have-no-signature-of-authorised-pathologist-police-case-against-lab-5430262/">proxy digital signatures</a> have become prevalent in the industry in the absence of effective regulation. In extreme cases, there have been <a href="https://www.thequint.com/news/india/pathless-path-labs-why-delhis-unethical-labs-love-lawlessness">instances</a> of private labs disbursing 300-400 diagnostic reports within a matter of hours, often without conducting any testing at all.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The free market does not solve the issues of market failure on its own and requires state intervention. This can be done through effective regulation of the market either by itself or through State coercion. We now study the existing regulatory framework for labs in India and its limitations.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Regulation of diagnostic labs</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Health care is a state <a href="https://www.mea.gov.in/Images/pdf1/S7.pdf">subject</a> under the Indian Constitution. This means that in the usual course of events, states have exclusive powers to make laws concerning different aspects of health care such as diagnostic laboratories. Article 249 of the Constitution provides exceptional powers to the union government to make laws on state subjects in the national interest. For such matters, the states retain the power to accept or reject the union law. The Clinical Establishment Act has been passed by the union government under this provision and <a href="https://web.archive.org/web/20200427194715/http://clinicalestablishments.gov.in/cms/national_register_of_clinical_establishments.aspx">11 states</a> have enacted it as of now. However, there are two difficulties with the law which have created a gap between aspiration and outcome. First, under our constitutional arrangement the Clinical Establishments Act is only applicable to those states that choose to adopt it, and only <a href="http://clinicalestablishments.gov.in/En/1077-state-and-uts-rules-and-notification.aspx">11 states</a> have adopted this law. Second, the law has serious difficulties in design and implementation.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In the 11 states where the Act is present and implemented, the regulatory function is limited to granting registration to labs and maintaining a <a href="http://clinicalestablishments.gov.in/cms/national_register_of_clinical_establishments.aspx">register</a> of clinical establishments. The labs interact with the regulatory authority only at the time of registration when they submit evidence of having complied with the prescribed standards for registration to the regulatory authority. Once a permanent registration is granted, there is no mechanism to review the functioning of the labs or provide grievance redressal to patients under the Act. If a person starts a lab without registration, the maximum punishment under the law is a monetary penalty of rupees five lakhs.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Other than the Clinical Establishements Act, private labs have to comply with the standard regulatory requirements under the state Shops an Establishments Act (relating to hours of work, cleanliness, holidays, etc.) and obtain registration under the provisions of the <a href="https://dhr.gov.in/hi/document/guidelines/bio-medical-waste-management-rules-2016">Biomedical Waste Management Rules, 2016</a>. Additionally, diagnostic kits and reagents used by labs are <a href="https://cdsco.gov.in/opencms/opencms/system/modules/CDSCO.WEB/elements/download_file_division.jsp?num_id=NTU0OA==">defined</a> as 'drugs' under the <a href="http://legislative.gov.in/sites/default/files/A1940-23.pdf">Drugs and Cosmetics Act, 1940</a>, and therefore have to be approved by the Central Drugs Standard Control Organisation (CDSCO).</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">We see that there is effectively no legal framework for regulating private labs in India. The labs only comply with allied regulatory requirements such as disposal requirements for biomedical waste and approval of diagnostic kits under the Drugs and Cosmetics Act. Given this regime, two mechanisms namely accreditation and public procurement have sought to fill the regulatory void in the diagnostics industry.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Alternative methods of regulation</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In the absence of an overarching law that assures the quality of clinical establishments, private labs have turned to voluntary accreditation for establishing credibility in the vast diagnostics market. Accreditation of labs is not mandatory in India. The National Accreditation Board for Testing and Calibration Laboratories <a href="https://nabl-india.org/">(NABL)</a>, an autonomous body under the Quality Council of India, prescribes accreditation criteria for various kinds of labs. Of the estimated <a href="https://www2.deloitte.com/content/dam/Deloitte/in/Documents/life-sciences-health-care/in-lshc-medical-devices-making-in-india-noexp.pdf">100,000-110,000</a> labs present in India, around <a href="http://13.127.105.244/nabl/index.php?c=searchlab&m=index&Itemid=177">4000</a> have NABL accreditation. Some labs prefer obtaining certifications from international accreditation bodies in addition to obtaining NABL accreditation. Accreditation helps in assuring the quality of labs to the public as well as the government.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The second method to ensure quality standards and avoid market failure is public procurement. The government has dealt with the absence of a regulatory framework in the past by using contractual mandates to avail the services of private labs. The standards expected from these labs are contractually specified by the government while entering into public-private partnership (PPP) agreements for diagnostics. For instance, the union government under the National Health Mission (NHM) has a <a href="https://nhm.gov.in/images/pdf/NHM/NHM-Guidelines/Free_Essential_Diagnostics.pdf">Free Diagnostics Services Initiative</a> which contains detailed requirements from diagnostic/pathology labs. NABL accreditation is one of the common requirements for private labs to participate in such government programmes.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">To compensate for weak regulation under the Clinical Establishments Act, voluntary accreditation by the NABL and public procurement through PPP agreements have acted as alternative strategies for regulation. These alternatives help in reducing information asymmetry and assuring the quality of services to the public and could have played an important part in the regulation of the labs for SARS-CoV-2. Yet, we find that the government strategy for medical labs for SARS-CoV-2 is based on a command-and-control approach under ICMR.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Regulation of medical labs for SARS-CoV-2</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Under the existing regulatory framework, private labs did not have to follow any criteria or adhere to any standards before starting a new/novel test, such as the SARS-CoV-2 test. This means that patients would have been able to get SARS-CoV-2 tests done in any private lab offering the test using reagents/test kits approved by the CDSCO and having a valid bio-waste and other local licenses.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The lack of a regulatory framework led to <a href="https://theprint.in/talk-point/should-indias-private-healthcare-join-covid-19-fight-or-risks-becoming-a-profit-venture/383089/">confusion</a> regarding the role of private labs in the response to the SARS-CoV-2 pandemic. As a result, the government set up an emergency regulatory framework for the SARS-CoV-2 crisis using provisions of the <a href="https://indiacode.nic.in/bitstream/123456789/10469/1/the_epidemic_diseases_act%2C_1897.pdf">Epidemic Diseases Act, 1987,</a> and the <a href="https://www.ndmindia.nic.in/images/The%20Disaster%20Management%20Act,%202005.pdf">Disaster Management Act, 2005</a>. Using these laws, it appointed the Indian Council of Medical Research <a href="https://www.icmr.gov.in/">(ICMR)</a> as the apex decision-making body for India's diagnostic testing strategy through the MoHFW (see notifications <a href="https://www.mohfw.gov.in/pdf/disastermanagmentact.pdf">here</a> and <a href="https://pib.gov.in/PressReleasePage.aspx?PRID=1606050">here</a>).</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Epidemics Act authorises the state governments to take exceptional measures and prescribe regulations to contain the spread of a dangerous epidemic disease. It lists a set of basic subjects for which regulations may be made such as travel restrictions, examination and quarantine of suspected cases, and inspections of any ship or vessel leaving or arriving at any port of call. The role of the union government under this law is limited to managing epidemic diseases at ports.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Disaster Management Act contains an administrative framework for disaster management. Section 6 of the Act sets up the National Disaster Management Authority (NDMA) as a nodal body for disaster management. Any directions issued by the NDMA and the union government must be followed by the Union Ministries, State Governments and State Disaster Management Authorities. The SARS-CoV-2 pandemic has been notified as a disaster under this Act. Under this, the government has passed various directives on different aspects of the SARS-CoV-2 response using the umbrella clauses of this legislation such as section 6(2)(i) (<i>The NDMA may lay down the policies, plans and guidelines for disaster management</i>) and Section 10(2)(l) (<i>The National Executive Committee may lay down guidelines or give directions to union ministries, state governments and state authorities for responding to the disaster</i>) have been invoked to respond to the SARS-CoV-2 crisis.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Using the powers granted to it by the government, the ICMR has placed severe restrictions on private labs to test for SARS-CoV-2. These restrictions include requiring approvals from ICMR for <a href="https://www.icmr.gov.in/pdf/covid/labs/Performa_Private_Laboratories.pdf">lab facilities</a>, <a href="https://www.icmr.gov.in/pdf/covid/labs/Addendum_ICMR_guideline_Private_Lab.pdf">commercial testing kits</a>, and <a href="https://www.mohfw.gov.in/pdf/NotificationofICMguidelinesforCOVID19testinginprivatelaboratoriesiIndia.pdf">cost-capping</a> for testing. We now study the ICMR decisions on testing strategy in detail to understand its role in the testing outcomes for SARS-CoV-2.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The role of the ICMR</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The ICMR has been responsible for the regulation of public labs under a 2012 scheme called the Viral Research and Diagnostic Laboratories <a href="https://dhr.gov.in/schemes/establishment-network-laboratories-managing-epidemics-and-natural-calamities">(VRDL) network</a> under the MoHFW. The scheme was initiated to increase government capacity for the timely detection of emerging/re-emerging viral diseases. The VRDL labs were exclusively responsible for testing in the initial phase of the SARS-CoV-2 pandemic in India.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The initial <a href="https://www.mohfw.gov.in/pdf/ICMRstrategyforCOVID19testinginIndia.pdf">advisories</a> issued by the ICMR contained no mention of private labs and focused only on directing public labs to undertake SARS-CoV-2 testing. At the time, some state governments explicitly banned private labs from testing as per their regulations issued under section 2 of the Epidemic Diseases Act, 1897. For instance, the <a href="http://health.delhigovt.nic.in/wps/wcm/connect/c05a8d804d883d25974cf7982ee7a5c7/NED+Act.pdf?MOD=AJPERES&lmod=-754584952&CACHEID=c05a8d804d883d25974cf7982ee7a5c7">Delhi Epidemic Diseases COVID-19 Regulations, 2020</a> and the <a href="http://health.bih.nic.in/17-03-2020/BiharEpidemicDiseasesCOVID-19Regulation2020.PDF">Bihar Epidemic Diseases COVID-19 Regulations, 2020</a> contain the following provision on testing of potential SARS-CoV-2 cases by private laboratories:</span></div>
<div style="text-align: justify;">
<i><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">"No private laboratory has been authorised to take samples for COVID-19 in the State. All such samples will be collected as per the guidelines of the Government of India..."</span></i></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Subsequently, the ICMR issued <a href="https://www.mohfw.gov.in/pdf/NotificationofICMguidelinesforCOVID19testinginprivatelaboratoriesiIndia.pdf">guidelines</a> for private labs to undertake SARS-CoV-2 testing on March 21, 2020. Since then, the ICMR has been responsible for approving private labs to test for SARS-CoV-2. The ICMR conducts checks on the <a href="https://web.archive.org/web/20200623095059/https://www.icmr.gov.in/pdf/covid/labs/Performa_Private_Laboratories.pdf">capability</a> of private labs to test for SARS-CoV-2 and updates the <a href="https://web.archive.org/web/20200623095311/https://www.icmr.gov.in/pdf/covid/labs/COVID_Testing_Labs_22062020.pdf">list</a> of approved private labs regularly. It also issues detailed guidelines for other aspects of testing such as <a href="https://web.archive.org/web/20200623095655/https://www.icmr.gov.in/pdf/covid/labs/Advisory_for_Reagents_TestingLabs_v1.pdf">procurement of reagents</a>, <a href="https://web.archive.org/web/20200623095505/https://www.icmr.gov.in/ckitevaluation.html">evaluation of commercial testing kits,</a> etc. In doing so, it has usurped the regulatory functions of existing statutory regulators such as the CDSCO, as well as voluntary bodies like the NABL. For instance, while diagnostic kits for SARS-CoV-2 are considered "drugs" and should be approved by the CDSCO, they also require <a href="https://scroll.in/pulse/958059/which-public-authority-should-be-in-charge-of-indias-policy-on-diagnostic-kits-for-covid-19">validation</a> by the ICMR. Similarly, NABL approved private labs are required to get a mandatory clearance from ICMR for SARS-CoV-2 testing. This means that while NABL has accredited 278 labs for RT PCR RNA testing for SARS-CoV-2, the ICMR has approved 258 of these labs for testing as of <a href="https://web.archive.org/save/https://nabl-india.org/wp-content/uploads/2020/06/RT-PCR-RNA.pdf">June 21, 2020</a>. The ICMR does not document the rationale or process of performing these regulatory functions. The Epidemics Act and the Disaster Management Act do not require the ICMR to adhere to minimum standards of accountability, transparency, and public engagement. The invocation of these laws to empower the ICMR means that there is no coherent or intellectually defensible framework for reviewing the ICMR's actions during the pandemic except that the basic rule of law principles are followed by it.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Building state capacity for regulation is a gradual process that requires backing by a comprehensive legal framework (Roy et al, 2018). ICMR was abruptly thrust into a role for which it did not have the required organisational or procedural capacity. Hence, it compensated for the lack of a regulatory framework by issuing strict command and control orders. We see that after being appointed as the government regulator for the testing strategy for SARS-CoV-2, the ICMR barred all private labs from testing unless approved by it. Given that the labs are already approved by NABL, the rationale for re-approval for testing of private labs by ICMR was never shared. Additionally, ICMR started regulation of reagents, test-kits and costs of tests. This has had an adverse impact on the testing outcomes as seen below.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Implications of regulation of private labs by ICMR</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">ICMR has been responsible for advising on the SARS-CoV-2 testing strategy for the country. The restrictive policies by the ICMR have led to the inaccessibility of the tests for a vast population. As a result, various courts in India are being involved to challenge such policies.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In April, the Supreme court heard the issue of cost-capping of lab testing for SARS-CoV-2 by ICMR and <a href="https://main.sci.gov.in/supremecourt/2020/10816/10816_2020_33_1_21598_Order_13-Apr-2020.pdf">ordered</a> that the tests shall be free for persons falling under government schemes such as Ayushman Bharat or any other category of economically weaker section of the society as notified by the government. The ICMR cost-cap of INR 4500 per test for private labs was not examined by the court in this petition, but it emphasised on the need for affordable tests to the population.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Delhi high court <a href="https://www.barandbench.com/news/litigation/delhi-high-court-caps-maximum-sale-price-of-covid19-test-kits-at-rs-400-per-unit">reviewed</a> the cost fixed by ICMR for the procurement of rapid testing kits in April. It held that the costs at which ICMR procured the kits had an unduly high profit-margin for the vendors and ordered the cost per kits to be reduced from INR 600 to INR 400. Furthermore, the kits procured by ICMR were later found to be <a href="https://www.livemint.com/news/india/icmr-directly-procured-faulty-covid-19-testing-kits-from-chinese-vendors-11587485268084.html">faulty</a>. The court <a href="http://delhihighcourt.nic.in/dhcqrydisp_o.asp?pn=83980&yr=2020">criticised</a> the government and ICMR for low testing of SARS-CoV-2 cases in another order dated June 18, 2020. It ordered the government to review ICMR policies on labs such as the protocol for sample collection, approval of labs, data sharing by labs, and costs per test through an existing government committee.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Gujarat high court is monitoring the state response to SARS-CoV-2 under a suo-motu writ petition. Under this petition, in an <a href="https://www.indiaspend.com/wp-content/uploads/2020/06/WPPIL422020_GJHC240193932020_15_29052020.pdf">order</a> dated May 29, 2020, the court modified the ICMR guidelines on testing for different categories of patients as it found the patient categories to be non-exhaustive. The court has also decided to review the rationale behind the ICMR SARS-CoV-2 testing strategy.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The ICMR has been criticised for its advisories on the evolving SARS-CoV-2 testing strategy by experts. For instance, its restrictions on the usage of <a href="https://www.financialexpress.com/opinion/covid-19-testing-indias-coronavirus-testing-strategy-has-to-be-widened/2002989/">RT-PCR</a> and <a href="https://www.financialexpress.com/opinion/testing-myopia-continues-even-for-fast-antigen-tests-icmr-has-restrictions-on-usage/1994714/">rapid antigen</a><a href="https://www.blogger.com/null"> testing are seen to be unreasonable as the testing capacity has been increasing over time. Additionally, the </a><a href="https://www.thehindu.com/news/cities/Hyderabad/clamour-for-transparency-of-testing-data-grows-shriller/article31674093.ece">issue</a> of lack of transparency in sharing testing data and its regulatory procedure makes ICMR decisions difficult to understand and implement.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The ICMR policies regarding the testing strategy for SARS-CoV-2 are restrictive for private labs. This is indicative of a trust-deficit between ICMR and the labs. The ICMR regulatory strategy to reduce this trust-deficit is to micromanage every aspect of testing sought to be done by the private labs. This has led to lower participation of such labs in testing for SARS-CoV-2 and issues of unavailability of tests to the public.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Conclusion</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The bulk of the health care services in India are provided by the private sector despite the presence of public health care facilities (Hooda, 2015). Recognising the growth and demand of the private sector, the policy framework in health has gradually shifted from the government providing health care services to being a financier of these services (Patnaik et. al, 2018). Recently, the Indian government conceded before the Supreme Court that the testing capacity of the public sector for SARS-CoV-2 is <a href="https://www.barandbench.com/news/litigation/breaking-make-covid-19-testing-free-in-govt-private-labs-private-labs-need-to-be-philanthropic-during-national-crisis-supreme-court">insufficient</a>.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In this article, we studied the regulatory framework with respect to medical laboratories in India. We find that in the regular course of events, the Clinical Establishment Act, 2010, and the rules thereunder are responsible for such regulation. Issues with the adoption and implementation of this Act leave the sector effectively unregulated. Despite the presence of some alternative methods of regulation, the regulatory gap in the diagnostic sector persists. Therefore, there is a need for a comprehensive law to deal with the market failure of information asymmetry and public goods. However, the enactment of such a law is a long-term deliberative process and should not be attempted in the face of a pandemic.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">For SARS-CoV-2 testing, the government has deviated from the existing course of minimal intervention in regulating private labs to regulating every aspect of testing through the ICMR. Government laboratories set up under the VRDL framework were initially the exclusive bodies allowed to test for SARS-CoV-2. While private labs have now been allowed to test for SARS-CoV-2, they are still heavily regulated by the ICMR. The rationale for this approach has not been provided. We believe such an approach is unsuitable for managing the SARS-CoV-2 pandemic. Using the broad powers given to it, the ICMR has reduced the capacity for testing in India by introducing prescriptive testing guidelines, licensing requirements, and cost-capping. This has resulted in non-utilisation of a bulk of the testing capacity for SARS-CoV-2 in India so far. Therefore, we suggest that the power given to the ICMR for SARS-CoV-2 regulation be minimised by specifically disallowing any duplication of regulatory functions already being performed by bodies such as CDSCO and NABL. Further, for the powers delegated to ICMR for regulating the testing strategy, due process requirements such as documenting the rationale, public consultation, sharing of public data should be mandated by the government to increase the accountability of ICMR.</span></div>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></h3>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">References and further reading:</span></h3>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Arrow, 1963: Kenneth J. Arrow, <a href="https://www.who.int/bulletin/volumes/82/2/PHCBP.pdf"><em>Uncertainty and the welfare economics of medical care</em></a> The American Economic Review, December 1963.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Nandraj, 2012: Sunil Nandraj, <a href="https://www.researchgate.net/publication/270887691_Unregulated_and_Unaccountable_Private_Health_Providers"><em>Unregulated and Unaccountable: Private Health Providers</em></a>, Economic and Political Weekly, January, 2012.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Srinivasan, 2013: Sandhya Srinivasan, <a href="https://www.epw.in/journal/2013/03/commentary/regulation-and-medical-profession.html"><em>Clinical Establishments Act, 2010 Regulation and the Medical Profession</em></a>, Economic and Political Weekly, 19 January, 2013.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Hooda, 2015: Shailendra Kumar Hooda, <a href="http://isid.org.in/pdf/WP185.pdf"><em>Private Sector in Health Care Delivery Market in India: Structure, Growth and Implications</em></a>, Institute for Studies in Industrial Development, Working Paper 185, December, 2015.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Patnaik et. al, 2018: Ila Patnaik, Shubho Roy, and Ajay Shah, <a href="https://www.nipfp.org.in/media/medialibrary/2018/05/WP_231.pdf"><em>The rise of government funded health insurance in India</em></a>, NIPFP Working Paper Series, No. 231, 21 May 2018.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Roy et al, 2018: Shubho Roy, Ajay Shah, B. N. Srikrishna, and Somasekhar Sundaresan, <a href="https://www.nipfp.org.in/media/medialibrary/2018/08/WP_237_2018_0ciIwuT.pdf"><em>Building State capacity for regulation in India</em></a> NIPFP Working Paper Series, No. 237, 3 August, 2018.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Competition Commission of India, 2018, <a href="https://www.cci.gov.in/sites/default/files/POLICY_NOTE.pdf"><em>Policy Note: Making markets work for affordable health care</em></a>, Competition Commission of India, October, 2018.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Kelkar and Shah, 2019: Vijay Kelkar and Ajay Shah, <a href="https://www.amazon.in/Service-Republic-Science-Economic-Policy/dp/0670093327">In service of the Republic: The Art and Science of Economic Policy</a>, Penguin Allen lane, December 2019.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Shah, 2020: Ajay Shah, <a href="https://blog.theleapjournal.org/2020/04/more-testing-from-concept-to.html"><em>More testing: From concept to implementation</em></a>, The Leap Blog, 06 April, 2020.</span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<i><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Ameya Paleja is a molecular biologist and science blogger based in Hyderabad. Harleen and Siddhartha are researchers at NIPFP. The authors are thankful to Ajay Shah, Renuka Sane, Amrita Agarwal, Smriti Parsheera, Shubho Roy, Anand Prakash, Arjun Sinha, and three anonymous referees for their valuable comments.</span></i></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-85297365762285023032020-04-01T16:30:00.001+05:302020-10-27T22:46:35.859+05:30Can Indian legal framework deal with the COVID-19 pandemic<div dir="ltr" style="text-align: left;" trbidi="on">
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;"><span style="font-size: 12pt; text-align: left;">The world is dealing with a novel coronavirus outbreak, COVID-19, since December 2019. COVID-19 is an infectious disease caused by a previously unknown coronavirus. The total number of confirmed cases of COVID-19 in India have been </span><span style="font-size: 12pt; text-align: left;"><span lang="zxx"><u><a href="https://covidout.in/">increasing</a></u></span></span><span style="font-size: 12pt; text-align: left;"> since its first case was seen in January.</span></span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Multiple methods to respond to the pandemic threat are being utilised in India. Contact tracing, isolation and quarantine are important to prevent the virus from spreading into communities at large. These methods used by the State invariably impinge on the autonomy, liberty and dignity of individuals. We allow these intrusions by the State for it to be able to act in the interest of the population at large. The government actions under pandemics are legitimised through laws. In the present article, I study the legal landscape of the response to the COVID-19 threat with a specific focus on <span><span lang="zxx"><u><a href="https://indiacode.nic.in/bitstream/123456789/10469/1/the_epidemic_diseases_act%2C_1897.pdf">Epidemic Diseases Act, 1897</a></u></span></span>. This law provides wide powers to the states to take action against a dangerous epidemic disease. Recently, there have been <span><span lang="zxx"><u><a href="https://www.tribuneindia.com/news/legal-framework-needed-to-manage-epidemics-50952">calls</a></u></span></span> to <span><span lang="zxx"><u><a href="https://www.ijme.in/wp-content/uploads/2016/11/2135-5.pdf">update</a></u></span></span> this colonial law as it does not provide guidelines to the states to act to prevent and mitigate epidemics. On the other hand, experts with <span><span lang="zxx"><u><a href="https://indianexpress.com/article/cities/pune/coronavirus-case-pune-positive-case-epidemic-diseases-act-covid-19-death-case-6315827/">experience</a></u></span></span> of working within the government seem to <span><span lang="zxx"><u><a href="https://www.livemint.com/news/india/a-123-yr-old-act-to-combat-coronavirus-in-india-experts-say-nothing-wrong-11584182501707.html">believe</a></u></span></span> that the law is appropriate and does not require any changes. To understand the role of this law, I study its application historically and today. I examine whether the recent COVID-19 regulations issued under it are compatible with the standards of <i>reasonable restrictions</i> under the <span><span lang="zxx"><u><a href="https://indiankanoon.org/doc/493243/">Indian constitution</a></u></span></span> using the test laid down by the Supreme Court on privacy as an example. Finally, I attempt to answer two questions based on the study; a) whether there is there a scope for improvement in current COVID-19 regulations, and b) whether any changes in the Epidemics Diseases Act, 1897 are required.</span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="the-elements-of-covid-19-response"></a>The elements of COVID-19 response</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">In case of public health emergencies like the COVID-19, prevention and mitigation is undertaken at a local level while coordination is performed by higher level of the government. The <span><span lang="zxx"><u><a href="https://www.india.gov.in/sites/upload_files/npi/files/coi_part_full.pdf">Indian Constitution</a></u></span></span> describes the responsibilities of the governments with respect to subjects related to public health. Public health and Sanitation are the responsibilities of the <span><span lang="zxx"><u><a href="https://www.mea.gov.in/Images/pdf1/S7.pdf">state government</a></u></span></span> and <span><span lang="zxx"><u><a href="http://legislative.gov.in/constitution-seventy-fourth-amendment-act-1992">local government</a></u></span></span>. The union government is <span><span lang="zxx"><u><a href="https://www.mea.gov.in/Images/pdf1/S7.pdf">responsible</a></u></span></span> for port quarantine, inter-state migration and quarantine.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">While public health is a state subject in the Indian constitution, about <span><span lang="zxx"><u><a href="http://nhsrcindia.org/sites/default/files/Task%20Force%20on%20Public%20Health%20Act_2012_approach%20paper.pdf">eight</a></u></span></span> states and union territories in India have a legislation regarding the subject. These laws help the states in defining the administrative, financial and legal framework of action for public health. For instance, the <span><span lang="zxx"><u><a href="http://www.lawsofindia.org/pdf/tamil_nadu/1939/1939TN3.pdf"><i>The Tamil Nadu Public Health Act, 1939</i></a></u></span></span> sets up public health boards and provide for public health staff in local areas who are responsible for supply of water, drainage, sanitary conveniences etc. In places where laws are absent the basic water and sanitation services are provided directly by a dedicated public health/public engineering department. The <span><span lang="zxx"><u><a href="https://academic.oup.com/heapol/article/18/3/249/792214">state capacity</a></u></span></span> to provide public health services varies considerably among the states in India.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The union government is using various measures to prepare and respond to the COVID-19 pandemic. In January, it had <span><span lang="zxx"><u><a href="https://www.mohfw.gov.in/disastermanagmentact.pdf">invoked its powers</a></u></span></span> under the <span><span lang="zxx"><u><a href="https://www.ndmindia.nic.in/images/The%20Disaster%20Management%20Act,%202005.pdf"><i>Disaster Management Act, 2005</i></a></u></span></span> to allow the Ministry of Health to "enhance the preparedness and containment of novel Coronavirus (COVID-19) and the other ancillary matters connected thereto". This would include medical preparedness as well as mass casualty management at hospitals. Notifying the pandemic as a disaster enables the states to use funds from <span><span lang="zxx"><u><a href="https://www.mohfw.gov.in/pdf/RevisedItem&NormsforutilisationofSDRFdt14032020.pdf">State Disaster Response Fund</a></u></span></span> on COVID-19. The Ministry of Health has also been issuing regular advisories for travel, mass gatherings and healthcare while keeping a tab at global scale of the outbreak. On 11 March, 2020 in a meeting of High Level Group of Ministers, it was <span><span lang="zxx"><u><a href="https://pib.gov.in/newsite/pmreleases.aspx?mincode=31">decided</a></u></span></span> that all states and union territories should be advised by the Ministry of Health to invoke the provisions of Section 2 of the <span><span lang="zxx"><u><a href="https://indiacode.nic.in/bitstream/123456789/10469/1/the_epidemic_diseases_act%2C_1897.pdf"><i>Epidemic Diseases Act, 1897</i></a></u></span></span>. This was done with an aim to implement advisories of the Ministry of Health at the union level by the states. Other than the national laws, India is also signatory to the <span><span lang="zxx"><u><a href="https://www.who.int/ihr/publications/9789241580496/en/"><i>International Health Regulations, 2005 (IHR)</i></a></u></span></span>. These regulations intend to prepare countries for establishing an appropriate public health response to international spread of diseases. The <span><span lang="zxx"><u><a href="https://idsp.nic.in/index1.php?lang=1&level=1&sublinkid=5788&lid=3721"><i>Integrated Disease Surveillance Program (IDSP)</i></a></u></span></span>, is responsible to implement the provisions under the IHR in India. It does so by strengthening disease surveillance for infectious diseases and setting response framework for outbreaks of a disease.</span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="the-role-of-epidemic-diseases-act-1897"></a>The role of Epidemic Diseases Act, 1897</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The Epidemic Diseases Act, 1897 (the law) was enacted in colonial India to enable the states to control spread of diseases. This law was designed to put government machinery into action once there is a considerable threat of a dangerous epidemic disease and not as a code for establishing general public health systems. The provisions of the law seem to be innocuous. It consists of four sections which provide wide powers to the government. The state governments are empowered to regulate <i>dangerous epidemic disease</i>, a term not defined in the law. The union government is empowered to regulate ships or vessels leaving or arriving in India. Disobedience to the regulations is made a punishable offence while providing for immunity to pubic officers for performing functions under the law.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">There is much to learn from the way the law was enacted and used by the government historically. SL Polu while describing the history of infectious diseases in India notes that in formulating Epidemics Diseases Act, 1897 and medical strategy to fight epidemics, the government primarily wanted to ensure compliance with the international sanitary conventions, protect trade, and assuage any fears abroad of the potential spread of plague or cholera outside India. (SL Polu (2012)) The epidemics of plague and cholera at that time were treated as a political emergency. David Arnold describes the law as <i>"one of the most draconian pieces of sanitary legislation ever adopted in colonial India."</i> (David Arnold (2000)) The measures under the act which invited Arnold's criticism included compulsory detention of plague suspects, destruction of houses and infected property, physical examination of persons and banning of fairs & pilgrimages. This invited distrust of the Indian communities and resistance towards action taken by the State. As a result, Arnold notes that the colonial government modified its strategy in favor of moderate measures such as creating awareness about sanitation, advocating voluntary measures, and setting up institutions for medical research.</span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="the-power-of-states-during-a-pandemic"></a>The power of states during a pandemic</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Currently, many states including <span><span lang="zxx"><u><a href="https://www.theweek.in/news/india/2020/03/13/delhi-declares-coronavirus-as-epidemic-as-india-reports-first-death-from-infection.html">Delhi</a></u></span></span>, <span><span lang="zxx"><u><a href="https://www.livemint.com/news/india/haryana-government-declares-coronavirus-an-epidemic-as-cases-rise-in-india-11583993738096.html">Haryana</a></u></span></span>, <span><span lang="zxx"><u><a href="https://www.indiatoday.in/india/story/karnataka-govt-invokes-sections-of-epidemic-diseases-act-in-form-of-covid-19-rules-2020-1654567-2020-03-11">Karnataka</a></u></span></span>, <span><span lang="zxx"><u><a href="https://punemirror.indiatimes.com/pune/others/covid-19-maharashtra-cm-uddhav-thackeray-declares-coronavirus-as-an-epidemic-in-5-cities/articleshow/74613850.cms">Maharashtra</a></u></span></span> and <span><span lang="zxx"><u><a href="https://www.indiatvnews.com/news/india/breaking-up-closes-all-schools-colleges-till-march-21-coronavirus-pandemic-597763">Uttar Pradesh</a></u></span></span> have invoked their powers under the 1897 Act for the COVID-19 pandemic. This enables the states to undertake Non-Pharmaceutical Interventions (NPIs) to mitigate the epidemic spread in absence of medicines to treat the disease. These NPIs, so far include closing of educational institutions, malls, schools, gyms, advisories on social distancing as well as regulations regarding home isolation and quarantine. However, some of the regulatory provisions provide extensive powers to government officers. For instance, state regulations such as the <span><span lang="zxx"><u><a href="http://health.bih.nic.in/17-03-2020/BiharEpidemicDiseasesCOVID-19Regulation2020.PDF">Bihar Epidemic Diseases COVID-19 Regulations 2020</a></u></span></span>, <span><span lang="zxx"><u><a href="http://www.sgpgi.ac.in/covid19/up1.pdf">Uttar Pradesh Epidemic Diseases COVID-19 Regulations 2020</a></u></span></span>, <span><span lang="zxx"><u><a href="https://main.sci.gov.in/pdf/cir/covid19_14032020.pdf">Delhi Epidemic Diseases COVID-19 Regulations, 2020</a></u></span></span> authorise officers of the government to admit and isolate a person in case he/she has a history of visit to an area known to be affected by COVID-19 or has been in contact with a symptomatic person. This can be done forcefully, if required. The officers are also given powers of surveillance of individuals as well as private premises. Lockdowns can be issued by the District Magistrate. Further, in order to prevent fake news from being published, prior restraint of free speech is authorised by not allowing anyone to publish information regarding COVID-19 without prior permission of the government.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The current regulations on COVID-19 allow states to practice the coercive actions comparable to those undertaken by the colonial government in the past. These actions have already put restriction on <span><span lang="zxx"><u><a href="https://economictimes.indiatimes.com/news/politics-and-nation/lockdown-in-75-coronavirus-hit-districts-to-be-announced/articleshow/74758755.cms?from=mdr">movement</a></u></span></span>, <span><span lang="zxx"><u><a href="https://www.indiatoday.in/india/story/rajasthan-health-worker-arrested-for-spreading-fake-news-about-coronavirus-1655950-2020-03-16">free speech</a></u></span></span>, <span><span lang="zxx"><u><a href="https://www.mohfw.gov.in/pdf/ChiefSecyDOLetter.pdf">religion, profession</a></u></span></span> and <span><span lang="zxx"><u><a href="https://www.buzzfeednews.com/article/pranavdixit/india-corona-virus-hand-stamps">privacy</a></u></span></span>. The restrictions are legal in as much as they are necessary and proportionate to a legitimate aim. (Supreme Court of India, (2019)) Given the nature of the pandemic which requires extensive state surveillance and usage of force, these must be balanced by corresponding checks on the use of State power. Unless such checks and balances are put in a legal framework, there will be a threat to the individual from the State itself.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">As discussed above, the regulations on COVID-19 impact many aspects of fundamental rights of individuals. Herein, I examine the law with respect to the right of privacy. The right to privacy, which includes personal autonomy, liberty and dignity, is a fundamental right in India. However, the right is subject to reasonable restrictions such as in furtherance of public interest. In the Puttaswamy judgment, the court laid down the following tests for limiting the discretion of the State while impinging on the fundamental right to privacy: (Supreme Court of India, (2018))</span></div>
<ol>
<li><div align="justify" class="compact-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.06cm; margin-top: 0.06cm;">
<span style="font-family: georgia;">The action must be sanctioned by law</span></div>
</li>
<li><div align="justify" class="compact-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.06cm; margin-top: 0.06cm;">
<span style="font-family: georgia;">The proposed action must be necessary in a democratic society for a legitimate aim</span></div>
</li>
<li><div align="justify" class="compact-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.06cm; margin-top: 0.06cm;">
<span style="font-family: georgia;">The extent of such interference must be proportionate to the need for such interference</span></div>
</li>
<li><div align="justify" class="compact-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.06cm; margin-top: 0.06cm;">
<span style="font-family: georgia;">There must be procedural guarantees against abuse of such interference</span></div>
</li>
</ol>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The test of legitimate aim is satisfied by the Epidemic Diseases Act, 1897 as its function is to prevent the spread of a dangerous epidemic disease. It is impossible to define specific proportionate regulations for a novel infectious disease in a parent law. Therefore, the law provides for delegated legislative power to the states as an when the situation arises. However, the parent law does not provide for procedural guarantees against abuse of State power of interference with privacy of individuals. For instance, the law does not define or provide guidelines on the meaning of a dangerous epidemic disease. Due to this, the citizens are at risk of both inaction and excessive coercion by the State. In the past, citizens have been forced to <span><span lang="zxx"><u><a href="https://indiankanoon.org/doc/140468711/">petition</a></u></span></span> to courts for directing the State to take action, or to <span><span lang="zxx"><u><a href="http://d1.manupatra.in/ShowPDF.asp?flname=Gandharva_Jena_vs_State_18111965__ORIHCO650105COM245851.pdf">defend</a></u></span></span> themselves against excessive action of the State.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">This law can also be used by the State for profiling, mass quarantine and targeting of individuals. Even then, there is legal immunity given to public servants who function under the law. Therefore, the law focuses on public interest while dispensing wih any procedural guarantees for transparency and accountability against abuse of its powers. It is due to these reasons that the Epidemic Diseases Act, 1897 does not pass the tests of reasonable restrictions on the fundamental right of privacy of individuals.</span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="envisaging-immediate-fixes"></a>Envisaging immediate fixes</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The pandemic of COVID-19 has already reached India and the Epidemics Diseases Act, 1897 does not balance the rights of individuals with the power of the State. The government can, however, still utilise learnings from its own past as well as current practices to make effective regulations.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The problems in the Epidemic Diseases Act, 1897 were apparent since its introduction. In the case of Ram Lall Mistry v RT Greer in 1904, the Calcutta High Court had to decide whether the any action can be instituted against the defendent, a government servant, for destroying the property of the plaintiff. (Calcutta High Court, (1904)) In this case, the <i>plague regulations</i> allowed an officer to destroy the property of individuals, but also mandated them to pay adequate compensation for destruction of the property. Given that the regulations specified the consequence of destruction of property to be adequate compensation, the defendent was held to be personally liable for paying such compensation. The defendent could recover the amount from municipal funds. This case clearly shows that regulations under the Epidemic Diseases Act, 1897 can introduce personal liabilities on the officers of the State while performing their functions. The current COVID-19 regulations need to be modified to introduce similar provisions. For instance, the regulations should increase accountability of the public officers by including elements of rule of law such as; defining notice and consent framework for use of sensitive personal data with a mandatory sunset clause, right to be heard, and absence of immunity against illegal actions done by State representatives.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Modern states use laws, rules and regulations not just for protection of law and order but also for social welfare. The <span><span lang="zxx"><u><a href="https://apps.who.int/iris/bitstream/handle/10665/70006/WHO_CDS_EPR_GIP_2007.2_eng.pdf">World Health Organisation (WHO)</a></u></span></span> advocates including provisions for protection of individual rights in drafting policies for pandemics. These include <span><span lang="zxx"><u><a href="https://www.sciencedirect.com/science/article/pii/S0033350608003545#bib46">transparency</a></u></span></span>, <span><span lang="zxx"><u><a href="https://www.tandfonline.com/doi/abs/10.1080/15265160903197663?journalCode=uajb20">public engagement</a></u></span></span> and <span><span lang="zxx"><u><a href="https://www.hilarispublisher.com/open-access/engaging-social-media-for-health-communication-in-africaapproaches-results-and-lessons-2165-7912-1000315.pdf">social mobilisation</a></u></span></span>. For instance in US, The Health and Human Services Department is responsible for tracking the distribution of federally purchased vaccine, identifying and sharing details about high priority population with stakeholders while maintaining confidentiality of individuals. This is done through developing guidelines on these processes and is legally mandated under the <span><span lang="zxx"><u><a href="https://legcounsel.house.gov/Comps/PHSA-merged.pdf"><i>Public Health Services Act</i></a></u></span></span>.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">In India, such provisions are absent. As a result, on COVID-19, the reports suggest that the State power has been exercised for <span><span lang="zxx"><u><a href="https://bangaloremirror.indiatimes.com/bangalore/crime/karnataka-3-arrested-for-spreading-fake-news-on-covid-19/articleshow/74632372.cms">arresting</a></u></span></span> persons spreading fake news on the disease, <span><span lang="zxx"><u><a href="https://www.businesstoday.in/latest/trends/in-corona-times-violating-health-emergency-norms-can-land-you-in-jail/story/398495.html">arresting</a></u></span></span> persons gathering in large numbers despite directives of the government, <span><span lang="zxx"><u><a href="https://nypost.com/2020/03/18/india-is-stamping-hands-of-people-under-coronavirus-quarantine/">arresting</a></u></span></span> persons not following home quarantine and <span><span lang="zxx"><u><a href="https://www.theweek.in/news/india/2020/03/22/privacy-of-covid-19-suspects-violated-names-addresses-made-public.html">sharing publicly</a></u></span></span> the list of suspected patients. Using excessive power without transparency has <span><span lang="zxx"><u><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093284/">historically</a></u></span></span> shown a negative impact on the community participation at the time of epidemics. Reports of being <span><span lang="zxx"><u><a href="https://www.theweek.in/news/india/2020/03/17/40-people-3-washrooms-5-bedrooms-quarantined-woman-shares-harrowing-experience-at-dwarka-facility.html">forced</a></u></span></span> into unhygeinic quarantine is deepening the distrust between people and the State. 2 persons have already reportedly <span><span lang="zxx"><u><a href="https://timesofindia.indiatimes.com/city/delhi/man-suspected-of-coronavirus-commits-suicide-by-jumping-off-safdarjung-hospital-building-police/articleshow/74698922.cms">died</a></u></span></span> due to <span><span lang="zxx"><u><a href="https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-indian-man-died-suicide-becoming-convinced-infected/">suicide</a></u></span></span> fearing the disease and <span><span lang="zxx"><u><a href="https://www.livemint.com/news/india/social-stigma-forcing-coronavirus-patients-to-avoid-screening-in-india-11584359972347.html">many suspected patients</a></u></span></span> have absconded public hospital facilities.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">As the science around the novel virus develops, the governments are forced to take immediate public health <span><span lang="zxx"><u><a href="https://www.ncbi.nlm.nih.gov/books/NBK54163/">measures</a></u></span></span>. One way to ensure such measures are accepted in the society is through transparency. The orders/advisories/guidelines under the regulations must be well-reasoned so as to not inadvertently encroach on the life and liberty of individuals. Within India, the states behave differently with respect to transparency. For instance, Kerala has a dedicated <span><span lang="zxx"><u><a href="http://dhs.kerala.gov.in/%E0%B4%A1%E0%B5%86%E0%B4%AF%E0%B4%BF%E0%B4%B2%E0%B4%BF-%E0%B4%AC%E0%B5%81%E0%B4%B3%E0%B5%8D%E0%B4%B3%E0%B4%B1%E0%B5%8D%E0%B4%B1%E0%B4%BF%E0%B4%A8%E0%B5%8D%E2%80%8D/">daily bulletin</a></u></span></span> with information about latest advisories, statistics about isolation, testing and results at a single place. Delhi <span><span lang="zxx"><u><a href="http://health.delhigovt.nic.in/wps/wcm/connect/DoIT_Health/health/home/covid19?WCM_Page.ResetAll=TRUE&CACHE=NONE&CONTENTCACHE=NONE&CONNECTORCACHE=NONE&SRV=Page">does not</a></u></span></span> have such a dedicated bulletin. Information about orders, notifications and minutes of meetings are disaggregated and irregular. On the other hand, information released by <span><span lang="zxx"><u><a href="https://www.icmr.nic.in/">Indian Council of Medical Research (ICMR)</a></u></span></span>, the nodal body for COVID-19 lab testing is sporadic and <span><span lang="zxx"><u><a href="https://www.icmr.nic.in/sites/default/files/whats_new/ICMR_website_update_19March_10AM_IST_V2.pdf">does not offer details</a></u></span></span> such as aggregate number of test requests accepted and rejected, time taken for test results or number of healthcare workers tested. The authorities responsible to act on COVID-19 situation in India should follow best practices in the interest of transparency such as; <span><span lang="zxx"><u><a href="https://time.com/5802293/coronavirus-covid19-singapore-hong-kong-taiwan/">risk communication</a></u></span></span> as seen in Singapore, anonymised details about suspected patient and action taken by states as seen in <span><span lang="zxx"><u><a href="http://dhs.kerala.gov.in/wp-content/uploads/2020/03/bule_10032020.pdf">Kerala</a></u></span></span>, and <span><span lang="zxx"><u><a href="http://stopcorona.tn.gov.in/files/Media_Bulletin.pdf">Tamil Nadu</a></u></span></span>, <span><span lang="zxx"><u><a href="https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030&act=view&list_no=366627&tag=&nPage=1">sharing epidemiological links</a></u></span></span> of cases as seen in South Korea, and providing <span><span lang="zxx"><u><a href="https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html">guidance to employers</a></u></span></span>, as is done in the US .</span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="the-need-for-a-legal-framework-for-epidemic-preparedness-response"></a>The need for a legal framework for epidemic preparedness & response</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">While some immediate fixes in regulatory practices can help the Indian response to COVID-19 threat, structural changes are required in order to balance health security with civil liberties. India has an <span><span lang="zxx"><u><a href="https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1652461">excessively fragmented landscape</a></u></span></span> for health policy. Epidemic Diseases Act, 1897 is one element of interventions among the multiple agencies that affect the state of public health in India. The limited purpose of the law is to allow states to take extraordinary measures at the time of a dangerous epidemic disease. It does not establish any coordination mechanism between states and the union government at the time of a dangerous epidemic outbreak. The role of the union government is also negligible (such as port quarantine) under this law. However, <span><span lang="zxx"><u><a href="https://indiankanoon.org/doc/741672/">Article 253</a></u></span></span> of the Constitution allows the union government to enact a law to give effect to the International Health Regulations, 2005 - which asks for setting up mechanisms to prevent, protect against, control and provide a public health response to international spread of disease. The union government has already been establishing public health surveillance and response mechanism for public health risks and emergencies under its international obligations under IDSP and the <span><span lang="zxx"><u><a href="https://nhm.gov.in/index4.php?lang=1&level=0&linkid=282&lid=349">National Health Mission</a></u></span></span> (NHM), instead of modernising its legal framework.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">A legal framework for infectious diseases in the interest of public health security is essential to increase transparency and accountability of the State towards the public. <span style="font-size: 12pt; text-align: left;">An example of a national law to give effect to the International Health Regulations, 2005 is seen in Australia. The </span><span style="font-size: 12pt; text-align: left;"><span lang="zxx"><u><a href="https://www.legislation.gov.au/Details/C2016C00847">National Health Security Act 2007</a></u></span></span><span style="font-size: 12pt; text-align: left;"> was formed to provide for a national system of public health events of national significance. The union government is empowered to coordinate and consult with states for sharing information and to identify and respond quickly to public health events. The law defines </span><i style="font-size: 12pt; text-align: left;">permissible purposes</i><span style="font-size: 12pt; text-align: left;"> for which state action is appropriate. The citizens are guaranteed confidentiality of information under the law, and detailed consent requirements are laid down for authorisation of use of such information.</span></span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Any such law when designed for India, needs to pass the tests of reasonableness as set out by the Supreme Court. This can be achieved by putting procedural guarantees against abuse of power provided to the State as seen above.</span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="conclusion"></a>Conclusion</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">The Indian response to COVID-19 has been fragmented. Multiple laws, rules, programmes, regulatory bodies along with national and state level advisories are the components of the response system. One of these laws is the Epidemic Diseases Act, 1897. This colonial law has been a subject of debate as calls for government action grows due to the outbreak. In this article, I attempt to study the role of the Epidemic Diseases Act within the pandemic response. Instead of building a public health framework, the limited purpose of this law is for the states to take special measures in case of outbreak of <i>dangerous epidemic diseases.</i> Within this limited framework, the law gives wide powers to the government to undertake coercive actions against individuals.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Indian states have notified COVID-19 regulations under the law. A study of the provisions of these regulations shows that there are unmitigated powers of surveillance and use of force given to state authorities under them. While such powers are envisaged to be used under the legitimate aim of protecting health of the population, neither the Epidemic Diseases Act nor the regulations under it attempt to describe procedural guarantees against abuse of state coercion.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Using examples of Indian states and past utilisation of the regulations, I attempt to understand what can the states do with their COVID-19 regulations to balance the rights of the individuals with their own power. This is important as emergency public health measures require community trust and participation. Introducing accountability of the government officials & departments while performing their functions under the law and increasing transparency are the two best practices the states can adopt immediately without requirements of changing the Epidemic Diseases Act, 1897.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">In order to mandate using such procedural best-practices in the future, a comprehensive legal framework for epidemic preparedness and response is required instead of the the current fragmented response framework through programmes and missions. This is required to increase the accountability of the government to its people. It is imperitive that such a law is passed by the union government while providing states power to utilise their public health framework. This can be done in India under article 253 of the Constitution. The role of such a legal framework to protect the rights of individuals while defining functions, powers and liabilities of government authorities for situations such as epidemics and pandemics.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">PS: A shorter version of this article was published in <a href="https://www.barandbench.com/columns/can-the-indian-legal-framework-deal-with-the-covid-19-pandemic-a-review-of-the-epidemics-diseases-act" target="_blank">Bar & Bench here.</a></span></div>
<h3 align="justify" class="western" style="direction: ltr; margin-bottom: 0cm; margin-top: 0.35cm;">
<span style="font-family: georgia;"><a href="https://www.blogger.com/null" name="references-and-further-reading"></a>References and further reading:</span></h3>
<div align="justify" class="first-paragraph-western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Salunkhe, Subhas et al., <span><span lang="zxx"><u><a href="http://nhsrcindia.org/sites/default/files/Task%20Force%20on%20Public%20Health%20Act_2012_approach%20paper.pdf">Approach Paper on Public Health Act</a></u></span></span>, National Health Systems Resource Centre, (2012).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Peters, D. H. et al., <span><span lang="zxx"><u><a href="https://academic.oup.com/heapol/article/18/3/249/792214">Lumping and splitting: the health policy agenda in India.</a></u></span></span> Health policy and planning, 18(3), 249-260, (2003).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">World Health Organization, <span><span lang="zxx"><u><a href="https://apps.who.int/iris/handle/10665/160756">International public health hazards: Indian legislative provisions</a></u></span></span>, World Health Organization, (2015).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Polu, S. L. <span><span lang="zxx"><u><a href="https://link.springer.com/chapter/10.1057/9781137009326_3">Plague and Cholera-The Epidemic versus the Endemic</a></u></span></span>, Infectious Disease in India, 1892-1940 (pp. 50-81). Palgrave Macmillan, London, (2012).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Arnold, D., <span><span lang="zxx"><u><a href="https://www.cambridge.org/core/books/science-technology-and-medicine-in-colonial-india/11078B2C9BF162E7417BCD70AAE73082">Science, technology and medicine in colonial India (Vol. 5).</a></u></span></span> Cambridge University Press, (2000).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Rakesh, P. S., <span><span lang="zxx"><u><a href="https://www.ijme.in/wp-content/uploads/2016/11/2135-5.pdf">The Epidemic Diseases Act of 1897: public health relevance in the current scenario.</a></u></span></span> Indian journal of medical ethics, 1(3), (2016).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Supreme Court of India, <span><span lang="zxx"><u><a href="https://main.sci.gov.in/supremecourt/2019/28817/28817_2019_2_1501_19350_Judgement_10-Jan-2020.pdf">Anuradha Bhasin v. Union of India and Ors.</a></u></span></span>, Writ Petition (Civil) No. 1031 of 2019.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">World Health Organization. <span><span lang="zxx"><u><a href="https://apps.who.int/iris/bitstream/handle/10665/70006/WHO_CDS_EPR_GIP_2007.2_eng.pdf">Ethical considerations in developing a public health response to pandemic influenza</a></u></span></span> (No. WHO/CDS/EPR/GIP/2007.2). Geneva: World Health Organization, (2007).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Supreme Court of India, <span><span lang="zxx"><u><a href="https://indiankanoon.org/doc/127517806/">Justice K. S. Puttaswamy v. Union of India</a></u></span></span>, Writ Petition (Civil) No. 494 of 2012, decided on 26 September, 2018.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Sivaramakrishnan, K. <span><span lang="zxx"><u><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093284/">The return of epidemics and the politics of global-Local health.</a></u></span></span> American journal of public health, 101(6), 1032-1041, (2011).</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Gujarat High Court, <span><span lang="zxx"><u><a href="https://indiankanoon.org/doc/140468711/">Devarshi Pragneshbhai Patel v. State of Gujarat</a></u></span></span>, Writ Petition no. 33 of 2015, order dated 26 February, 2015.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Orissa High Court, <span><span lang="zxx"><u><a href="http://d1.manupatra.in/ShowPDF.asp?flname=Gandharva_Jena_vs_State_18111965__ORIHCO650105COM245851.pdf">Gandharva Jena v. State</a></u></span></span>, Criminal Revision no. 233 of 1965, decided on 18 November, 1965.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Calcutta High Court, <span><span lang="zxx"><u><a href="https://indiankanoon.org/doc/1376972/">Ram Lall Mistry v. RT Greer</a></u></span></span>,(1904) ILR 31 Cal 829, decided on 13 June, 1904.</span></div>
<div align="justify" class="western" style="direction: ltr; font-size: 12pt; line-height: 19.2px; margin-bottom: 0.32cm; margin-top: 0.32cm;">
<span style="font-family: georgia;">Shah, A et al. <span lang="zxx"><u><a href="https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1652461">Financing common goods for health: a public administration perspective from India.</a></u></span> Health Systems & Reform, 1-6, (2019).</span></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-47047027922277892922020-02-28T00:29:00.001+05:302023-09-26T15:34:38.427+05:30Comments on the National Dental Commission Bill, 2020<div dir="ltr" style="text-align: left;" trbidi="on">
<h1 style="line-height: 1.38; margin-bottom: 6pt; margin-top: 20pt; text-align: left;">
<span style="text-align: justify; text-indent: 14.1732pt; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Summary of recommendations</span></span></h1>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">This response presents my comments on the Draft National Dental Commission Bill, 2020 (“ NDC Bill”) proposed by the Ministry of Health and Family Welfare. The Bill offers a fairly comprehensive set of provisions for regulating the profession and education relating to Dentistry. However, for the reasons explained in more detail in the response below, the position adopted by the Bill on certain key issues needs to be revisited. These are summarised in the present section:</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: left;">
</div>
<ol style="text-align: left;">
<li style="text-align: justify;"><span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The present bill drops the requirement to regulate the profession and education of Dental Hygienists (DHs) and Dental mechanists (DMs) from under the domain of the regulator. It is an established fact that the profession of dentistry requires contribution from the DHs and DMs. Therefore, it is recommended that the NDC Bill includes provisions for the regulation of DHs and DMs. This may be specified in the functions of the NDC and its Autonomous Boards. Due representation of DHs and DMs may be provided in these Boards.</span></span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The preamble of the NDC bill should iterate <span style="font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">“patient safety” </span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">as the objective of the NDC. Patient safety is seen universally as the ultimate goal of a regulator in the field of health services and a clear ultimate objective of patient safety would enable the NDC to align its regulations for this goal.</span></span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The definition of the terms dentists and dentistry need to be modified. This is required to include promotive healthcare as a function of dentists, including only qualified personnel as dentists as well as including promotive functions and ‘oral health’ as a function of dentistry. The detailed suggestions, as well as the rationale, is provided in the comments below.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The definition clause should also include definitions for terms like ‘Oral Health’, ‘Dental Hygienists’ and ‘Dental Mechanics’.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The term of the “part-time” members of the NDC board and Autonomous Boards may be increased to be at par with the term of the Chairperson to allow for an uninterrupted functioning of the Board. The Board should be prescribed to record the proceedings of the meetings held by it and the provision for cases where decision-making occurs without conducting the meetings should be well specified in the NDC Bill.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">It is recommended that clause 9(6) giving appellate power to the central government over decisions of the Board should be removed to reduce the risk of conflict of interest and preserve the autonomy of the NDC.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The following best principles of regulation be added to the NDC Bill: </span></li>
<ul>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The NDC Bill should ensure that the regulation-making process be overseen by the Board to increase accountability of the Board.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Process of public participation in regulation-making should be standardised and put in the NDC Bill.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The NDC Bill should provide for strong executive powers, balanced with greater transparency and accountability, to prevent abuse. For instance, the inspection planning guidelines, inspection reports, and action taken reports should be publicly available.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Judicial & quasi-judicial functions to be performed by the NDC should follow the proportionality principle. For instance, the NDC could develop a graded system of inspection results for dental schools and its effects on a scale from needs no improvement to recommend derecognition. Derecognition should be recommended in extreme cases and should include a transition plan for students.</span></li>
</ul>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">It is recommended that the NDC Bill specify limited or fixed-terms of appointment, extendable to a second term for the members of the Dental Advisory Council. It is also recommended that the functions of the Council mandate creating a report on all draft regulations published by the regulator stating the council’s views under clause 12.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">As elections are time-consuming and expensive, as well as the rationale for having part-time members is unclear, it is recommended that the term of all members of Autonomous Boards be made four years to enable the Boards to function without interruptions. </span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Given that a need has been felt for ensuring regular inspection of existing dental colleges in the past, it is recommended that ongoing quality assurance of established dental colleges be made a function of the DARB.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">EDRB should be mandated to maintain and make publicly available a live register of students and teachers in dental institutes across the country.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">It is recommended that the power of the central government which allows it to disregard the suggestions of the NDC under clause 34 regarding establishment of colleges and their recognition be removed from the NDC Bill to ensure autonomy and accountability of the regulator.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The provisions requiring the NDC to identify & reward better institutes and develop a graded plan for underperforming dental institutes should be made a part of the NDC Bill.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The decision as to whether a question is of policy should be taken jointly by the central government and the regulator. In case of dispute, the power may be kept with the central government with a provision for a written response to the objections by the NDC.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The power of the central government to give directions to the NDC and Autonomous board destroy the independent and autonomous nature of the NDC and should be removed completely.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">A regulator should be primarily funded through the fees it generates. The NDC Act is silent on the principles through which such fees might be charged by the NDC. The principles include, Charging fees only to cover expenses and keep adequate reserves; fees to be charged only through regulations; the regulator should clearly explain demonstrate the proportionality of the fees to the cost to the regulator; and the regulator should break up the fees into different categories.</span></li>
</ol>
<h3 style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Preamble</span></h3>
<div style="text-align: justify;"><br /></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-left: -14.1732pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> The current preamble states that the purpose of the proposed law is: </span></span></h3>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-left: 36pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">“to provide for a dental education system that improves access to quality and affordable dental education, ensures availability of adequate and high quality dental professionals in all parts of the country; that promotes equitable and universal oral healthcare that encourages community health perspective and makes services of dental professionals accessible to all the citizens; that promotes national health goals; that encourages dental professionals to adopt latest dental research in their work and to contribute to research; that has an objective periodic and transparent assessment of dental institutions and facilitates maintenance of a dental register for India and enforces high ethical standards in all aspects of dental services; that is flexible to adapt to changing needs and has an effective grievance redressal mechanism and for matters connected therewith or incidental thereto” </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The preamble in the current form includes elements of dental education as well as professional regulation, which is an improvement from the earlier preamble of the Dentists Act, 1948 which was focused at regulating the profession of dentistry.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">However, while the preamble of the proposed law lays down the objectives of the National Dental Commission (NDC) in detail, it falls short of recognising the ultimate goal of the NDC, that is, </span><span style="background-color: transparent; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Patient Safety. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The Dental Council of India is envisaged as an independent regulator of the dental profession and education in India. In 2012, the OECD published its </span><span style="background-color: transparent; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recommendation of the Council on Regulatory Policy and Governance.</span><span style="background-color: transparent; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The first principle of an independent regulator is the clarity in its role. The principle envisages that an effective regulator must have clear objectives, with clear and linked functions and the mechanisms to coordinate with other relevant bodies to achieve the desired regulatory outcomes. Clarity of purpose helps the regulator be accountable for their actions to the public.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Universally, patient safety is being seen as the ultimate concern of the regulatory bodies. WHO Safety Curriculum envisages effective regulators with the appropriate legislation, resources and tools to sanction unsafe clinician behaviour.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In India, the Report of Financial Sector Legislative Reforms Commission (FSLRC) is seen to be groundbreaking in conceptualising and defining the role of an independent financial regulator.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> The FSLRC report states that </span><span style="background-color: transparent; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">consumer protection </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">in the financial sector (much like patient protection/safety in the medical sector) is a key regulatory component that can help a regulator to initiate preventive and curative activities for the protection of the consumers (or in the present case, patients). The Commission stated that </span><span style="background-color: transparent; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">“As such, the Commission believes that it is essential to place the function of consumer protection at the heart of financial regulation”. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">It is submitted that the draft National Dental Commission Bill, 2020 (NDC Bill) considers patient safety in its objectives in its Preamble. This would make the actions of the proposed NDC accountable to the public. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<h3 style="line-height: 1.38; margin-bottom: 6pt; margin-top: 18pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter-wise comments </span></span></h3>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">This section contains comments on select sections of the Bill, arranged in chapter-wise form.</span></span></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter I Preliminary</span></span></h3>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"><div><div style="text-align: justify;"><span style="white-space-collapse: preserve;"><br /></span></div><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"><div style="text-align: justify; white-space-collapse: preserve;"><br /></div></span></div><div style="text-align: justify;"><span style="white-space-collapse: preserve;"><br /></span></div><span style="white-space-collapse: preserve;"><div style="text-align: justify;"><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">Definition of a dentist (Clause 2j) borrows from the definition of dentistry in clause 2k in the present form. It states that "dentist" means</span><span style="font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> a person who practises dentistry. </span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">However, this definition is inadequate and does not exclude persons not trained in the field from practising the profession of dentistry. Borrowing from the example of the definition adopted by the American Dental Association</span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> and adding the function of promotive oral health, the proposed definition of dentistry is recommended to be as follows:</span></div></span></span></span><div style="text-align: justify;">
<span style="font-style: italic; text-decoration-line: underline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="text-align: justify;">
<span style="font-style: italic; text-decoration-line: underline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">“The evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; and the promotion of oral health, provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.”</span></span></div>
<div style="text-align: justify;">
<span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="text-align: justify;">
<span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Definition of dentistry (Clause 2k) should include:</span></span></div>
<div style="text-align: justify;">
<span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div>
<ul style="text-align: left;">
<li style="text-align: justify;"><span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Measures for promoting dental & oral health</span></span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Measures that include promotive, preventive and curative healthcare for diseases and conditions affecting public health and population health such as oral cancer, HIV. </span></li>
</ul>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><div style="text-align: justify;">As the profession of dentistry is closely linked with ‘Oral Health’, its definition should be added to this chapter. For this, it is recommended that the World Health Organisation definition of Oral Health be adopted. The definition is reproduced below<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space-collapse: preserve;">:</span></div></span></div>
<div style="text-align: justify;">
<span style="font-style: italic; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="text-align: justify;">
<span style="font-style: italic; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">“a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing. </span></span></div>
<div style="text-align: justify;">
<span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="text-align: justify;">
<span style="white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Dentists Act, 1948 included regulation of DHs and DMs under the Dental Council of India. It is suggested that this framework continues in the NDC Bill as the DHs and DMs are an important part of the dental professional framework. The definitions of these professions as set out in the Dentists Act, 1948 be adopted:</span></span></div>
<div style="text-align: justify;">
<span style="font-style: italic; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="text-align: justify;">
<span style="font-style: italic; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">“ “dental hygienist” means a person not being a dentist or a medical practitioner, who scales, cleans or polishes teeth, or gives instruction in dental hygiene;” (Section 2(b))</span></span></div>
<div><div style="text-align: justify;"><span style="font-family: Georgia, "Times New Roman", serif; font-size: x-large; font-style: italic; white-space-collapse: preserve;">“ “dental mechanic” means a person who makes or repairs denture and dental appliances;”</span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter II The National Dental Commission</span></span></h3>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The NDC is proposed to have 30 members under clause 4 of the NDC Bill. This is a significant reduction and a welcome step from the present 95 members in the DCI.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Twenty two of these members are part-time members to be appointed for a term of two years. The majority of part-time members are nominated from the Dental Advisory Council by the states and Union Territories under the Act. The maximum term of the Chairperson of the proposed NDC will be four years. Under the proposed structure, the composition of the Board will change significantly in the four year term of the Chairperson of the NDC as 22 members will be replaced in the term. FSLRC principles on the appointment conditions on the Board Members state</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> that a fixed-term should be applicable for all members, subject to a retirement age for executive members. This is important because it will enable the Board to function without unnecessary interruptions caused by change in the composition of the Board. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Therefore, it is recommended that the duration of part-time members as proposed in the NDC Board be increased to four years, to coincide with the term of the Chairperson under clause 4 of the Bill.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The functioning of the board of regulators should primarily be left to the rules and regulations formed by the regulator. However, in the interest of accountability, certain principles must be laid down to govern the actions of the board. For instance, the NDC Bill prescribes the frequency of meetings of the Board, quorum and the process of decision making (through voting) under clause 9. The provisions under clauses 6(5)(6) and 6(5)(7) help in reducing the chances of conflict of interest as they require members to put information about their assets in a public forum as well as disallows members to obtain employment as consultants in private dental colleges for a cooling-off period of two years. This helps in reducing the chances of the members from taking advantage of their position earlier.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"> However, provisions in this chapter omit prescribing requirements for recording the proceedings of the meetings held by the Board as well as the provision for making decisions without conducting the meetings. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">These provisions may be added in the text of the Bill. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Clause 9 of the Bill deals with meetings and functions of the Board. Under clause 9(6), it is prescribed that a person aggrieved by a decision of the NDC can appeal to the Central Government. This provision is unacceptable on the grounds of causing undue influence of the central government on the functioning of the Board. The central government is one of the stakeholders running dental colleges in India. As such, the provision introduces an element of conflict of interest and therefore, should be abandoned. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">It is recommended that clause 9(6) giving appellate power to the central government over decisions of the Board should be removed in order to reduce the risk of conflict of interest and preserve the autonomy of the NDC.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> An aggrieved person should be able to approach the courts against any arbitrary and illegal actions taken by the Board. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Clause 10 of the NDC Bill lays down the powers and functions of the NDC. The NDC is tasked with legislative, executive as well as judicial functions. For instance, the NDC is required to assess the HR and infrastructure requirements in dental health care and lay down policies for the same (legislative), ensure compliance by the State Dental Councils of the guidelines and regulations framed by it (executive) and exercise appellate jurisdiction over autonomous boards (judicial). However, the provisions for accountability from these functions are absent. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">For instance, the legislative requirements do not include provisions regarding the process to be followed by the NDC to lay down policies which would include describing the scope of the exercise, conducting background research, stakeholders’ interactions, recording reasons for adoption of the policy, assessing alternate mechanisms and costing requirements for the policies, describing methods to execute them as well as the need to update such policies timely.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Including checks and balances is important for the new law as the DCI had faced challenges in performing its functions. Absence of such provisions in the Dentists Act, 1948 made the DCI complacent and its inactions went unnoticed for a long time. A CAG performance audit of the DCI observed that while the DCI was supposed to undertake periodic updates of the dental colleges, it had not designed any system to identify institutes for conducting periodic updates.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> The report also stated that DCI was also not performing its basic task of maintaining a National Register of Dentists as required by it under law. </span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">.</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">For this purpose, the following principles of FSLRC are suggested to be included in the NDC Bill:</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="text-decoration-line: underline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: left;">
</div>
<ul style="text-align: left;">
<li style="text-align: justify;"><span style="text-decoration-line: underline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The NDC Bill should ensure that the regulation-making process be overseen by the Board to increase accountability of the Board;</span></span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Process of public participation in regulation-making should be standardised and put in the NDC Bill;</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The NDC Bill should provide for strong executive powers, balanced with greater transparency and accountability, to prevent abuse. For instance, the inspection planning guidelines, inspection reports and action taken reports should be publicly available; and</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Judicial & quasi-judicial functions to be performed by the NDC should follow the proportionality principle. For instance, the NDC could develop a graded system of inspection results for dental schools and its effects on a scale from needs no improvement to recommend derecognition. Derecognition should be recommended in extreme cases and should include a transition plan for students.</span></li>
</ul>
<div style="text-align: justify;"><br /></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter III Dental Advisory Council</span></span></h3>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The establishment of the Dental Advisory Council (Council) is a welcome step in the regulatory structure of the NDC. The function of the advisory council is to ensure that there is representation from important stakeholders in the decisions taken by the Board. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">While the members of the Council have representation from various states, public and private institutes etc., the NDC Bill has not specified the term for any of its members. A defined term of the advisory council members will ensure that sufficient continuity and turnover of members is maintained to ensure that member’s expertise remains current.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The functions of the council are provided in clause 12 and include providing views on regulatory functions of the NDC. However, providing views on regulatory functions of the NDC is not mandatory for the council. As providing views on the regulatory functions of the NDC is the only function of the council, it should be mandated to do so.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Therefore, it is recommended that the NDC Bill specify limited or fixed-terms of appointment, extendable to a second term for the members of the Dental Advisory Council. It is also recommended that the functions of the Council mandate creating a report on all draft regulations published by the regulator stating the council’s views under clause 12.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter V Autonomous Boards</span></span></h3>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The NDC Bill envisages four autonomous boards under the overall supervision of the NDC. These are: </span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(a) the Under- Graduate Dental Education Board</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(b) the Post-Graduate Dental Education Board</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(c) the Dental Assessment and Rating Board; and</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(d) the Ethics and Dental Registration Board.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Each of the four boards is setup as an autonomous body and will be comprised of a President, two whole-time members, and two part-time members. The President, full-time members and one-part-time member of Autonomous Boards are to be chosen based on the recommendations of the Search Committee. The remaining part-time members for each autonomous board are elected by various State Dental Councils. Each Autonomous Board will be empowered to take decisions on all matters pertaining to its jurisdiction, and will have complete administrative and financial decision-making powers.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The part-time members of the Autonomous Boards are also eligible for two years of service as was envisaged in the NDC Board. However, their power is significantly reduced as there are no requirements for quorum and decisions of these Boards can take place by a simple majority vote. The role of the part-time members is also crucial because one of these members in all boards are elected from various states. By reducing their term to two years, the NDC Bill shall enable continuous election modes in states. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">As elections are time-consuming and expensive, as well as the rationale for having part-time members is unclear, it is recommended that the term of all members of Autonomous Boards be made four years to enable the Boards to function without interruptions. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Just like in the case of the NDC Board, the functioning of the boards should primarily be left to the rules and regulations formed by the regulator. However, in the interest of accountability, certain principles must be laid down to govern the actions of the board. For instance, the NDC Bill prescribes the frequency of meetings of the Board (monthly) and the process of decision making (through voting) under clause 22. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">However, provisions in this chapter omit prescribing requirements for recording the proceedings of the meetings held by the Board as well as the provision for making decisions without conducting the meetings.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> These provisions may be added in the text of the Bill. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Clause 28 of the NDC Bill specifies requirements for establishing new colleges. However, ongoing quality assurance of more established dental institutes is not considered in the functions of the Dental Accreditation and Ratings Board (DARB). </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Given that a need has been felt for ensuring regular inspection of existing dental colleges in the past, it is recommended that ongoing quality assurance of established dental colleges be made a function of the DARB.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Clause 31 of the NDC puts down requirements for the Ethics and Dental Register Board (EDRB). The EDRB is required to maintain a list of licensed Dentists practising in India in the National Register for Dentists. However, the NDC Bill has omitted the practice of the DCI in registration of students and teachers in the public domain.</span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> This was necessitated to increase transparency and accountability of the regulator. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">It is therefore recommended that a live register of students and teachers be be maintained and made available publicly by the EDRB in lines with the practices followed by the DCI.</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter VI Recognition of Dental Qualifications</span></span></h3>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Clause 34 deals with recognition of dental qualifications by universities and institutions in India. The Under-Graduate & Postgraduate Dental Education Boards are responsible for the recognition. This provision also deals with the quasi-judicial functions of the NDC. Currently, as per the NDC Bill, an appeal against any decision of these Autonomous Boards is to be preferred to the NDC in the first instance. Further, if aggrieved by any decision of the NDC, a final appeal lies to the central government.</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Therefore, the central government has final appellate jurisdiction under the NDC Act.</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">It has been seen in the past that the central government had established dental colleges despite the disapprovals of the Dental Council of India without giving appropriate reasoning for such actions. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Therefore, there are chances of irregularities by the central government in the present situation as well. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">It is recommended that the power of the central government to disregard the suggestions of the NDC be removed from the NDC Bill to ensure autonomy and accountability of the regulator</span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Clause 37 of the NDC Bill deals with withdrawal of recognition granted to established dental institutes in India. The clause gives powers to the NDC to withdraw the recognition of an institute if the standards prescribed by the autonomous institutes are not met by the institutes. The NDC is also mandated to undertake consultations with the stakeholders before concluding this process. Two considerations seem to be missing from this framework. The first consideration is the introduction of identification and rewarding better institutes and the second is envisaging a graded response to deteriorating quality of dental institutes. Just like sanctions for poor performing and non-complying dental institutes are necessary, there should also be a reward for colleges that perform well. The rewards can be greater autonomy to the institute for performing its functions like, in introducing new learning techniques. Similarly, instead of recommending withdrawal of recognition to underperforming dental institutes, the regulator should be mandated to introduce a method of collaborating with the institute to increase its standards. The regulator should hand-hold such institutions unless they are identified as non-recoverable. However, a graded response from the regulator is necessary given that the costs of establishing a dental college are exponential as well as derecognition could have negative impacts on the students enrolled in the institute. </span><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration-skip-ink: none; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">The provisions requiring the NDC to identify & reward better institutes and develop a graded plan for underperforming dental institutes should be made a part of the NDC Bill.</span></span></div>
<h3 style="line-height: 1.38; margin-bottom: 4pt; margin-top: 16pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Chapter VIII Miscellaneous</span></span></h3>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Clauses 44-46, 53-54 in this chapter deal with the powers of the central government under the NDC Bill. The central government has the power to give directions to the NDC as well as the Autonomous Boards with respect to questions of policy. The decision as to whether a question is one of policy or not is to be taken by the central government itself and will be binding on the commission. The central government will have a supervisory role in as much as the NDC would be responsible for submitting its minutes, reports, abstracts of accounts and other information to it. Similarly, the rules under the NDC will be made by the central government. It also has been given powers to supersede the NDC. </span></span></div>
<div style="text-align: justify;">
<b style="font-weight: normal;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></b></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">A regulator is an agent of the government. The government is expected to reasonably oversee the functions of the regulator. However, there is a corresponding risk of encroachment on the powers and functions of a regulator by the government. In order to minimise such a risk, the NDC Bill should assure the autonomy of the Commission while ensuring accountability to the central government. For this, the following is recommended:</span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="text-decoration-line: underline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></span></div>
<div style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: left;">
</div>
<ol style="text-align: left;">
<li style="text-align: justify;"><span style="text-decoration-line: underline; white-space: pre-wrap;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The decision as to whether a question is of policy should be taken jointly by the central government and the regulator. In case of dispute, the power may be kept with the central government with a provision for a written response to the objections by the NDC.</span></span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The power of the central government to give directions to the NDC and Autonomous board destroys the independent and autonomous nature of the NDC and should be removed completely.</span></li>
<li style="text-align: justify;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">A regulator should be primarily funded through the fees it generates.<span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;"> The NDC Act is silent on the principles through which such fees might be charged by the NDC. The principles include charging fees only to cover expenses and keep adequate reserves; fees to be charged only through regulations; the regulator should clearly explain demonstrate the proportionality of the fees to the cost to the regulator, and; the regulator should break up the fees into different categories.</span></span></li>
</ol>
<div style="text-align: justify;"><br /></div>
<div style="text-align: left;">
</div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<br /></div>
</span><div style="text-align: justify;">
<br /></div>
</div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0New Delhi, Delhi, India28.6139391 77.209021228.3907261 76.8862977 28.8371521 77.53174469999999tag:blogger.com,1999:blog-487578008699996821.post-4507903214766275562019-10-24T17:31:00.000+05:302020-04-01T16:31:41.072+05:30Financing Common Goods for Health: A Public Administration Perspective from India<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;"><br /><br />On average, higher per capita GDP is correlated with improved health outcomes. In parallel, improved population health also seems to foster higher GDP. Yet health and growth need not increase proportionately with one another, nor is this relationship universal. Patnaik highlights potential externalities resulting from growth that could negate efforts to improve population health: development itself can both increase and decrease certain health risks depending on how the process is planned, implemented and regulated.<br /><br />Over the last 35 years, India’s GDP grew annually at 6.3% (doubling every 11 years or so) but population-based health indicators did not improve proportionally. Instead, new health risks emerged while old ones remained unresolved. Decades of rapid urbanization led to unsafe buildings, unplanned cities, bad drainage and sewage, dysfunctional garbage disposal systems, polluted air and water, among other issues. For example, with the construction of roads catering to high-speed traffic, accompanied by inadequate design of road safety systems, road accident fatalities have surged since 1999.<br /><br />Today, India’s disease burden is evolving into two streams. The first is the persistent poverty-related health agenda (e.g. malnutrition or high infant and maternal mortality). The second relates to growth that does not consider new health risks emerging from it (e.g. air pollution resulting from rapid urbanization or infrastructure built on areas prone to natural disasters). In both areas, the key policy response involves population-based government financed interventions that generate large societal health benefits, i.e., Common Goods for Health (CGH). Moving forward, CGH is therefore at the center of Indian health policy. In this commentary, we draw on India’s experience to decompose the overall CGH agenda and identify common obstacles that countries may face in financing such goods.<br /><br /><br /><br /><br />You can read the whole article<a href="https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1652461"> here</a>.</span></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-76943988816410610172019-09-29T17:22:00.000+05:302020-04-01T16:32:28.531+05:30Significance of health policies <div dir="ltr" style="text-align: left;" trbidi="on">
<h3 style="text-align: left;">
<span style="font-size: large;">
National Health Policies in Practice: An Explorative Analysis for India</span></h3>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">The health ministry of India has released three National Health Policies (NHPs) since independence. These are guiding documents for the government for their health-related expenditure. Till 2017, India allocated central resources through five-year plans (FYPs) formed by the Planning Commission. Thereafter, the newly formed National Institution of Transforming India or the National Institute for Transforming India (NITI) Aayog released its first 3-year action agenda for different sectors. We study the translation of these policies in practice, by comparing policy recommendations with the FYPs. This article also compares the recommendation of the NHP, 2017 with the first 3-year agenda of the NITI Aayog. This explorative analysis also studies the cohesion between the three policies. Hence, it helps to identify five key issues in translating these policies to practise for and provides suggestions. Our study indicates that the NHPs in India need to be released frequently while incorporating tools of accountability, need to generate evidence on which policy decisions can be made, need to be inter-sectoral, but coordinated within different agencies of the government and need to have cohesion with budgetary allocations for allowing a better analysis.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">You can read the whole piece <a href="https://journals.sagepub.com/doi/abs/10.1177/0972063419868554" target="_blank">here.</a></span></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-80608651331768955192019-03-05T13:27:00.004+05:302019-03-05T13:29:28.907+05:30Patient's rights vs. State's duties: Publication plug<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-color: #fafafa; color: #363636; font-family: SecondaryFont; font-size: 18px; line-height: 1.445; margin-bottom: 26px;">
In 2018, the Ministry of Health and Family Welfare along with the National Human Rights Commission released a <a href="https://mohfw.gov.in/sites/default/files/PatientCharterforcomments.pdf" style="color: #b71c1c; pointer-events: auto; text-decoration-line: none;" target="_blank">draft</a> of ‘Charter of Patient Rights’ – an assembly of provisions in laws and judgments of high courts and the Supreme Court. This was done with a view to helping patients identify their rights through a single, more accessible document.</div>
<div style="background-color: #fafafa; color: #363636; font-family: SecondaryFont; font-size: 18px; line-height: 1.445; margin-bottom: 26px;">
Since healthcare is a state subject as per the constitution, the health ministry will need to roll out this charter in collaboration with state governments.</div>
<div style="background-color: #fafafa; color: #363636; font-family: SecondaryFont; font-size: 18px; line-height: 1.445; margin-bottom: 26px;">
Right to health has been accepted to be under the purview of Article 21 of the constitution through various <a href="https://indiankanoon.org/doc/1875824/" style="color: #b71c1c; pointer-events: auto; text-decoration-line: none;" target="_blank">court judgments</a>. Researchers globally are <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70043-3/fulltext" style="color: #b71c1c; pointer-events: auto; text-decoration-line: none;" target="_blank">advocating</a> that the right to health information should also be identified as a fundamental right.</div>
<div style="background-color: #fafafa; color: #363636; font-family: SecondaryFont; font-size: 18px; line-height: 1.445; margin-bottom: 26px;">
In light of this, the released draft is a welcome step. The recent calls for the adoption of the charter show the public interest in knowing and exercising their rights.</div>
<div style="background-color: #fafafa; color: #363636; font-family: SecondaryFont; font-size: 18px; line-height: 1.445; margin-bottom: 26px;">
There is a catch though. How does one give rights to patients when they are can’t even be identified in the present system? Not just patients, the healthcare system in India is notorious for not providing reliable data on any of the stakeholders. The lack of granular data on basic healthcare stakeholders makes the rights of a patient less significant than they would be in a developed country.</div>
<div style="background-color: #fafafa; color: #363636; font-family: SecondaryFont; font-size: 18px; line-height: 1.445; margin-bottom: 26px;">
Read more <a href="https://thewire.in/health/do-indian-patients-even-know-their-rights/amp/" target="_blank">here</a>: https://thewire.in/health/do-indian-patients-even-know-their-rights/amp/</div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-25056943097346537692018-11-13T11:40:00.000+05:302018-11-30T16:45:39.165+05:30The peaks of pollution discussion in India: effect of Diwali festival<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">Diwali is gone and winter is setting in. With Diwali, gone is the trend of talking about pollution or air pollution. This is despite the fact that the air quality remains off-the charts for most of the winters.<br />
</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp4hfDSVb3HQ8IlXHzbP8eHOxZPPAs1nwrWt1VRIRkEc-JxQ41kOqyWWphDs5qzUY3sEVVVsTxxTxIAM3z4eC_egcyUeSFCuqo5YXH0EF33mxFK6ETO7lmt1-S3Wo9HuKko5XwKPBkP6of/s1600/airPollutionTrend.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><img border="0" data-original-height="378" data-original-width="550" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp4hfDSVb3HQ8IlXHzbP8eHOxZPPAs1nwrWt1VRIRkEc-JxQ41kOqyWWphDs5qzUY3sEVVVsTxxTxIAM3z4eC_egcyUeSFCuqo5YXH0EF33mxFK6ETO7lmt1-S3Wo9HuKko5XwKPBkP6of/s320/airPollutionTrend.png" width="320" /></span></a></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">CPCB data shows that the air quality in Delhi was bad throughout the winter season.</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXKWExo3TQJVTo5xAiQ7nsdQU5ikF0p5PJuZM8sYOQCtFXxh6NrNs-Adbk_ITX8x5SKtWzaS8R3_E9HWAJBYoNS8lRyYFg19_JiE3Ork_IQq9fnCLgLvTuQv3cB0OnkrZNfrUazdZppzpm/s1600/airQualityDelhi.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><img border="0" data-original-height="924" data-original-width="1433" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXKWExo3TQJVTo5xAiQ7nsdQU5ikF0p5PJuZM8sYOQCtFXxh6NrNs-Adbk_ITX8x5SKtWzaS8R3_E9HWAJBYoNS8lRyYFg19_JiE3Ork_IQq9fnCLgLvTuQv3cB0OnkrZNfrUazdZppzpm/s320/airQualityDelhi.png" width="320" /></span></a></div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br />This calls for demand for better air throughout the year instead of tranches.</span><br />
<br /></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-63524149736477992572018-11-05T14:01:00.001+05:302018-11-30T16:46:02.060+05:30Apathetic Pollution Reforms Choke India – Here’s What Can Be Done<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">Air pollution harms our <a href="https://fit.thequint.com/health-news/who-report-air-pollution-and-child-health">babies</a> and rots our <a href="https://fit.thequint.com/health-news/air-pollution-is-the-new-tobacco-says-who-head">organs</a>, bones, and <a href="https://fit.thequint.com/health-news/pollution-affects-children-says-unicef">mind</a>. It can have a potentially lethal effect. The research on its ecological impact is creating knowledge, public demand and political will for implementing changes required to combat it. However, unless the attitude towards solving such problems changes, India will continue to struggle with air pollution.</span></span><br />
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">While India <a href="https://fit.thequint.com/health-news/kanpur-most-polluted-city-says-who">leads</a> in the number of cities adversely affected by the air pollution problem, it is not alone. London, Beijing, and Karachi are some other cities trying to deal with the issue of air pollution.</span></span><br />
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">Combating air pollution is not impossible. The United States has halved their deaths due to air pollution since 1990. This time period coincides with their legislative and regulatory reforms in the approach towards the problem.</span></span><br />
<div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Read the whole piece at: <a href="https://fit.thequint.com/fit-connect/how-to-reduce-pollution-india" target="_blank">fit.thequint.com</a></span></div>
<div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">#PublicationPlug</span></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-25004737021104425712018-06-28T11:17:00.000+05:302018-11-30T16:46:15.711+05:30The dilemma of Indian health policy landscape<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d"></span><br /></span>
</span><br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d" style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d" style="font-family: "georgia" , "times new roman" , serif; font-size: large;"> </span><br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large; vertical-align: baseline; white-space: pre-wrap;"><i>By Dr. Harleen Kaur and Dr. Suresh K. Rathi</i></span></span></div>
<span style="font-family: "georgia" , "times new roman" , serif;"><span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d" style="font-size: large;"> <br /><img height="2" src="https://docs.google.com/drawings/u/1/d/sd4o6ZViXJ6MImEKm8NegHQ/image?w=1&h=2&rev=1&ac=1&parent=166b71WbrUcBgcTBUuH1J11paAILABynHNI6Y_CEJ6Jo" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="1" /></span></span><br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-family: "georgia" , "times new roman" , serif;"><span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d"><span style="font-size: large; vertical-align: baseline; white-space: pre-wrap;">A health policy aims to achieve specific health goals for a society. According to the World Health Organization, an explicit health policy can achieve several things, amongst them; define a vision for the future; which in turn helps to establish targets and points of reference for the short and medium term, and outline priorities, expected roles of different groups, build consensus and informs people.</span></span></span></div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><span id="docs-internal-guid-27e5fc70-44ea-1f6d-0a38-bd74a233dc1d"> <br /><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="vertical-align: baseline; white-space: pre-wrap;">India has seen three National level Health Policy documents till date. These documents were released in 1983, 2002 and 2017 respectively by the Ministry of Health and Family Welfare. As they are too few and too far in-between, they are not the only drivers of policy action in the field. Attributing to the nature of public health and also India being a diverse country, our public health issues originate at various quarters which have direct or indirect effects on health. For instance, the dichotomy of double burden of diseases which causes harm to the rich and poor sections of society; lack of governance and proper implementation of regulations for doctors; road accidents and violence. Another factor that makes the Indian landscape complex is the interdisciplinary nature of most of health related issues. Even though the National Health Policies try to measure these risks and provide for a mechanism to prioritize them, they fall short of being comprehensive. </span></div>
<br /><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-style: italic; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Other factors influencing health policy decisions in India:</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">NITI</span><span style="vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Aayog</span><span style="vertical-align: baseline; white-space: pre-wrap;">: Since the Planning Commission was discontinued and the National Institution for Transforming India (NITI Aayog) formed in 2015, there have been a considerable number of health-related policy decisions directed by the NITI Aayog. For instance, the three-year action agenda lists priorities of the NITI Aayog which are not entirely in line with the recent National Health Policy (2017).</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Other</span><span style="vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">central</span><span style="vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">ministries</span><span style="vertical-align: baseline; white-space: pre-wrap;">: In the recent past, the Ministry of Women and Child Development (WCD) has been seen to take interest in policy decisions like the Integrated Child Development Services (ICDS). Similarly, the Ministry of Environment, Forests and Climate Change is in charge of public goods that have a direct effect on public health and is struggling with control of air and water pollution in the country. The Ministry of AYUSH is perhaps the most closely related to the health ministry. AYUSH ministry has been pushing for integration of alternative medicine in mainstream as well as has legitimate interests in preventive public health. Similarly, the decisions of the Ministry of Consumer Affairs, Food and Public Distribution and Ministry of Drinking Water and Sanitation have direct impact in health status and health policy of the residents in the country.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">State</span><span style="vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">decisions</span><span style="vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">and</span><span style="vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">politics</span><span style="vertical-align: baseline; white-space: pre-wrap;">: An interesting aspect of the federal nature of our country is that health policy domain is not entirely state or a central subject. While the state has exclusive control on public health and hospitals, the matters relating to medical education and profession are present in the concurrent list, making both the Centre and State responsible for it. Practically, Central Government has been using its fiscal power to design some health schemes affecting public health for the states, with questionable outcomes. For instance, the </span><a href="https://en.wikipedia.org/wiki/Rashtriya_Swasthya_Bima_Yojana" style="white-space: pre;"><span style="color: navy; vertical-align: baseline; white-space: pre-wrap;">Rashtriya Swasthya Bima Yojana</span></a><span style="vertical-align: baseline; white-space: pre-wrap;"> (</span><span style="vertical-align: baseline; white-space: pre-wrap;">RSBY) is a Centrally sponsored scheme where 75% of money is paid by the Centre and 25% by the states implementing it. This offer is lucrative for states as they get more health outcomes for less than half of estimated costs. However, the scheme is not proved to be successful as of yet as the scientific literature showing that it might not have impact on the necessities of the population the scheme caters to - the Below Poverty Line (BPL) population.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Public Interest Litigation and influence by media: </span><span style="vertical-align: baseline; white-space: pre-wrap;">Another driver of health policies in India is the judiciary. Through the Public Interest Litigation (PIL) mechanisms, major policy decisions have been driven by the Supreme Court and the High Courts in India. For instance, recently the Supreme Court of India has passed a judgment allowing passive euthanasia in the country and has also detailed the protocol to be followed by the stakeholders in the process. </span></div>
<br /><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="vertical-align: baseline; white-space: pre-wrap;">While participation of multiple actors in driving health policy is a good sign, we need to be careful of the implications of the same. For better regulation of such situation, the Ministry of Health and Family Welfare needs to take an overall arching- in both advisory as well as implementation of decisions affecting public health so as to be able to make better informed decisions. We suggest that the National Health Policy be released every alternate year, after careful public and stakeholders consultation, in order to have an impact in transforming Health of India. </span></div>
<br /><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="vertical-align: baseline; white-space: pre-wrap;">The authors are health policy and public health consultants and can be reached at </span><a href="mailto:selfcaretrust@gmail.com" style="text-decoration-line: none;"><span style="color: #1155cc; vertical-align: baseline; white-space: pre-wrap;">selfcaretrust@gmail.com</span></a><span style="vertical-align: baseline; white-space: pre-wrap;">. Twitter handles: @harleen_arora, @drsjrathi.</span></div>
</span>Read more at Medical Dialogues: Guest Blog : Dilemma of Indian Health Policies <a href="https://medicaldialogues.in/dilemma-of-indian-health-policies/">https://medicaldialogues.in/dilemma-of-indian-health-policies/</a></span></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-39179604574621480052018-05-05T19:34:00.000+05:302018-11-30T16:44:24.388+05:30A case for legalising Modicare: Publication at Swarajya Magazine<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="smag-img-banner" style="background-color: #fcfcfc; box-sizing: border-box; color: #555555; font-size: 16px; margin-bottom: 10px; position: relative;">
<span class="smag-seo-imgobj" itemprop="image" itemscope="itemscope" itemtype="https://schema.org/ImageObject" style="box-sizing: border-box; font-family: Georgia, Times New Roman, serif; height: 0px;"><span content="660" itemprop="width" style="box-sizing: border-box;"></span><span content="440" itemprop="height" style="box-sizing: border-box;"></span></span><span class="img-banner-caption" style="box-sizing: border-box; clear: both; color: rgba(54 , 54 , 52 , 0.6); display: block; font-size: 0.75em; overflow: hidden; padding: 7px 0px; text-align: right;"><span style="background-color: transparent; color: #ca4242; font-family: Georgia, Times New Roman, serif; font-size: 1em; font-weight: 600; text-transform: capitalize;">Snapshot</span></span></div>
<div class="story-element article__content story-element-view" itemprop="articleBody" style="background-color: #fcfcfc; box-sizing: border-box; clear: both; color: #555555; font-size: 16px; font-style: normal; font-weight: 400; letter-spacing: normal; padding: 0px; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">
<div class="story-card-view" data-card-content-id="f2a42064-373b-4118-9578-3e6dd410f3d5" data-card-version-id="d1b9edf1-a6ac-417c-aea7-117ca205ef58" style="box-sizing: border-box;">
<div class="story-elements" data-story-element-id="72995846-88b4-4248-9230-7f47a10071dc" data-story-element-type="text" style="box-sizing: border-box;">
<div class="story-element-text snapshot-card smag-snapshot-wrapper" style="background: transparent; box-sizing: border-box; display: block; margin: 0px auto 1.875em; position: relative;">
<div class="snapshot-text" style="background: transparent; border-bottom: 1px solid rgb(202, 66, 66); box-sizing: border-box; clear: both; color: #3d3d3d; font-size: 1em; margin: 10px 0px 0px; padding: 0px 0px 10px;">
<ul style="box-sizing: border-box; list-style: disc; margin: 0px 0px 0px 20px; padding: 0px;">
<li style="box-sizing: border-box; color: #ca4242; font-size: 1em; font-style: italic; font-weight: 600; list-style: none; padding-bottom: 0.625em;"><span style="box-sizing: border-box; font-family: Georgia, Times New Roman, serif;"><div style="box-sizing: border-box; color: #3d3d3d; display: list-item; font-size: 1em; line-height: 26px; list-style-image: url("swarajya/snapshot-bullet-61897096ae.svg"); margin: 0px; max-width: 100%; padding-left: 5px; text-align: left;">
When a health insurance is provided through the legal route, there are obvious advantages for patients. The government also becomes more accountable.</div>
<div style="box-sizing: border-box; color: #3d3d3d; display: list-item; font-size: 1em; line-height: 26px; list-style-image: url("swarajya/snapshot-bullet-61897096ae.svg"); margin: 0px; max-width: 100%; padding-left: 5px; text-align: left;">
A case for legalising Modicare:</div>
</span></li>
</ul>
</div>
</div>
</div>
<div class="story-elements" data-story-element-id="813203ba-c4b7-442f-9e65-0bff9a559538" data-story-element-type="text" style="box-sizing: border-box;">
<div class="smag-astory-wrapper" style="box-sizing: border-box; position: relative;">
<div class="story-element story-element-text smag-astory-container" style="box-sizing: border-box; position: relative;">
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
</div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">Originally published <a href="https://swarajyamag.com/ideas/what-are-the-arguments-for-having-a-modicare-law" target="_blank">here</a>.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">“The National Health Protection Scheme will cover over 10 crore poor families. This will be the world’s largest government funded healthcare programme.” – <a href="https://www.indiabudget.gov.in/ub2018-19/bs/bs.pdf" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">Finance Minister Arun Jaitley</a></span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">When Jaitley said this in his Union budget speech 2018-19, the statement was received with a mix of scepticism and joy. Sceptics noticed that similar announcements made in the past failed because of a lack of funding and absorption capacity. The National Health Protection Scheme<em style="box-sizing: border-box;"> </em>(NHPS), or Modicare, was announced in last year’s budget as well.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">However, currently, it is being run as Rashtriya Swasthya Bima Yojana (RSBY). The scheme is part of the Ayushman Bharat<em style="box-sizing: border-box;"> </em>programme, which includes primary and secondary care provisioning through designated wellness centres.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">Neither Ayushman Bharat nor Modicare is backed by law. Even though RSBY finds mention in Schedule 1 of the Unorganised Workers Social Security <a href="http://www.ilo.org/dyn/travail/docs/686/Unorganised%20Workers%20Social%20Security%20Act%202008.pdf" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">Act</a>, 2008, it works through a yearly contract with an insurer, who executes the scheme as per government specifications. There is a lack of accountability and due process in the existing RSBY scheme, making it impossible to understand its achievements or pitfalls. However, this scheme is one of the many health insurance schemes of the government. As an example, The Employees State Insurance Scheme, one of the oldest schemes for workers in the organised sector in the country, functions through The Employees’ State Insurance <a href="http://www.esic.nic.in/Tender/ESIAct1948Amendedupto010610.pdf" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">Act</a>, 1948 (ESI Act).</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">To grow the RSBY scheme even further as anticipated in the current budget, it would be prudent to consider having it under a legal regime for the following reasons:</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<strong style="box-sizing: border-box; font-weight: bold;"><span style="font-family: Georgia, Times New Roman, serif;">A clear definition of RSBY objectives</span></strong></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">As legislation, a statement of its objectives would define the benefits available, or those that are being aspired to, be made available to patients. Currently, the RSBY website contains the following object <a href="http://www.rsby.gov.in/about_rsby.aspx" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">statement</a>, which seems to be outdated:</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 20px; text-align: left;">
</div>
</div>
</div>
</div>
<div class="story-elements" data-story-element-id="5d144d1a-3c3c-4002-a1d2-37d74d753eb0" data-story-element-type="text" style="box-sizing: border-box;">
<div class="story-element story-element-text story-element-blockquote" style="box-sizing: border-box; margin: 0px 0px 25px; padding: 0px; position: relative;">
<div style="box-sizing: border-box; font-size: 1.125em; line-height: 1.55556em; margin: 0px 0px 30px; text-align: left;">
</div>
<div style="box-sizing: border-box;">
<blockquote style="box-sizing: border-box; font-size: 20.83px; font-weight: normal; margin: 0px 0px 0px 60px; opacity: 0.75;">
<span style="font-family: Georgia, Times New Roman, serif;">In India more than two thirds of expenditure on health is through Out of Pocket (OOP) which is the most ineficient and least accountable way of spending on health. Supply side financing on health alone has not been found to be successful in reducing OOP expenditure on health substantially and therefore, <b style="box-sizing: border-box; font-weight: bold;">to test the demand side financing approach</b>, Government of India, decided to introduce Rashtriya Swasthya Bima Yojana (RSBY) a Health Insurance Scheme for the Below Poverty Line families with the objectives to reduce OOP expenditure on health and increase access to health care. <i style="box-sizing: border-box;">(Emphasis added)</i></span></blockquote>
<span class="attribution" style="box-sizing: border-box; font-family: Georgia, Times New Roman, serif; font-weight: bold; margin: 10px 0px 0px 60px; opacity: 0.5; text-transform: capitalize;"></span></div>
<div style="box-sizing: border-box; font-size: 1.125em; line-height: 1.55556em; margin: 0px 0px 30px; text-align: left;">
</div>
</div>
</div>
<div class="story-elements" data-story-element-id="fab89beb-5847-4895-aa53-54f5c76f2fc0" data-story-element-type="text" style="box-sizing: border-box;">
<div class="smag-astory-wrapper" style="box-sizing: border-box; position: relative;">
<div class="story-element story-element-text smag-astory-container" style="box-sizing: border-box; position: relative;">
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
</div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<strong style="box-sizing: border-box; font-weight: bold;"><span style="font-family: Georgia, Times New Roman, serif;">Permanent administrative authority</span></strong></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">An administrative authority is responsible for implementing a scheme. It is a perpetual entity and the form of selection of officers, their terms as well as functions are defined. Creation of this authority by law would make RSBY transparent and accountable.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">The RSBY is currently being <a href="http://www.rsby.gov.in/contacts.aspx" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">managed</a> by a team of four bureaucrats in the Ministry of Health and Family Welfare. The members are not full-time because they are in charge of additional segments like medical tourism and national AIDS control programme, among others. They are assisted by three consultants. This leads to three problems:</span></div>
<ul style="box-sizing: border-box;">
<li style="box-sizing: border-box;"><span style="font-family: Georgia, Times New Roman, serif;">Multi-tasking members,</span></li>
<li style="box-sizing: border-box;"><span style="font-family: Georgia, Times New Roman, serif;">There is no requirements for meetings, terms, etc, making RSBY a non-priority;</span></li>
<li style="box-sizing: border-box;"><span style="font-family: Georgia, Times New Roman, serif;">No scrutiny as there is no requirement for providing annual reports, etc.</span></li>
</ul>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<strong style="box-sizing: border-box; font-weight: bold;"><span style="font-family: Georgia, Times New Roman, serif;">Management of finance and internal audit</span></strong></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">Legislation usually defines the flow of money. It also provides transparency in accounts through annual reports and calls for parliamentary or government scrutiny.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">As an example, under the ESI Act, the funds are parked with the corporation. The purpose for which the funds can be expended are clearly mentioned in Section 28. The corporation can hold property and invest funds. It is compulsory for it to make an estimated budget annually, approved by the central government. The budget, an annual report of expenditure and accounts, is laid down before Parliament. Every three years, the corporation submits a valuation report of its assets to the central government.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">The ESI Act has a clear advantage because of its legal structure. It generated Rs 16,852.38 crore and spent Rs 9,727.71 crore in 2016-17. At the same time, the <a href="http://www.indiabudget.gov.in/ub2018-19/eb/sbe42.pdf" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">budget</a> for RSBY was Rs 1,000 crore, but it spent Rs 470 crore. The population <a href="http://www.rsby.gov.in/index.aspx" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">covered</a> by RSBY in this period was 3.63 crore, while ESI <a href="http://www.esic.nic.in/attachments/publicationfile/eb8a5bdd4ad83e6f6ae325462021ff51.pdf" style="background-color: transparent; box-sizing: border-box; color: #e6614c; text-decoration: none;">covered</a> 3.19 crore individuals.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<strong style="box-sizing: border-box; font-weight: bold;"><span style="font-family: Georgia, Times New Roman, serif;">Benefits to patients</span></strong></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">Benefits in health insurance are provided in the form of fixed packages for the patients. In RSBY, they are medical benefits limited to procedures requiring hospitalisation and not the routine outpatient care. This includes diagnosis, hospitalisation, medicine, and pre-decided procedures at package rates decided between the hospitals and insurance agency.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">Because the scheme is implemented only through a yearly tender with an insurer, the government can unilaterally change its benefits available to the patients. This makes the scheme inconsistent and unreliable for the beneficiaries as they do not have any legal standing.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<strong style="box-sizing: border-box; font-weight: bold;"><span style="font-family: Georgia, Times New Roman, serif;">Adjudication of disputes and claims</span></strong></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">One of the repercussions of a large scheme is disputes arising out of transactions. Dispute resolution must be an independent, transparent, and quick process. The authority responsible as well as the jurisdiction and powers are defined in typical legislation.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">RSBY consists of a three-tier adjudication mechanism. There are three sets of grievance redressal committees – district, state, and national. The membership for these committees and timelines for adjudication are provided in tender. However, there is no explanation on the process to be adopted and powers of these committees. In contrast, under the ESI Act, the state government has to form “Employees’ Insurance Court” for a local area, which has the power of a civil court to issue summons, discovery, and demand evidence. The Act lays down the jurisdiction, power as well as the procedural aspects of this court.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<strong style="box-sizing: border-box; font-weight: bold;"><span style="font-family: Georgia, Times New Roman, serif;">Penalties</span></strong></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">In a healthcare scheme, both civil and criminal issues can arise at multiple levels. There is no mention of penalties in the RSBY website. But the tender document states that RSBY can penalise the insurance company selected by it for under-performance. The hospitals under the scheme can be disbarred if reported to the grievance redressal commission. This leaves out many issues, which can be faced by patients to be dealt between either the hospital and patient or the insurer and patient. Such a situation makes the scheme cumbersome for the beneficiaries.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 30px; text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">Even after a decade of implementation of RSBY, no efforts have been made as yet to provide healthcare to patients through law rather than yearly contracts with insurers. When a health insurance is provided through the legal route, there are obvious advantages for patients. The government becomes more accountable and the tax money is not utilised in an ad hoc manner. This route might help plug gaps which lead to under-utilisation or mis-utilisation of government funds as well. Overall, a legal status would help all stakeholders become more confident of the scheme.</span></div>
<div style="box-sizing: border-box; color: #3d3d3d; font-family: "open sans", arial, helvetica, sans-serif; font-size: 1em; font-weight: 500; line-height: 28px; margin: 0px 0px 20px; text-align: left;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-67084448417772234862018-02-20T17:57:00.000+05:302018-11-30T16:46:57.380+05:30Why is the criminal justice system failing India?<div dir="ltr" style="text-align: left;" trbidi="on">
<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">Here is the content of a recent talk I delivered on the usage (or lack of) forensic evidence in our courts.</span></span><br />
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;">I argue that almost all stakeholders in the Criminal Justice System are responsible for the current indifference towards the capability of scientific and forensic evidence to provide unbiased evidence. I also argue that though systemic changes are required, courts can help their own case by making administration level changes on how such cases are handled. You can hear me discuss this at Policy Pill. <iframe allow="autoplay" frameborder="no" height="300" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/405318681&color=%23ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&show_teaser=true&visual=true" width="80%"></iframe></span></span><br />
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;"><br /></span></span></div>
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span> <span style="font-family: "georgia" , "times new roman" , serif;"><iframe height="480" src="https://drive.google.com/file/d/16M8StAYX2Tr8s-UxdZSaIu2FF1J_5IQe/preview" width="640"></iframe></span></span></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-28128047969762359592018-01-03T12:35:00.000+05:302018-11-30T16:47:14.270+05:30Crisis in doctor-patient relationship<div dir="ltr" style="text-align: left;" trbidi="on">
<h2 style="background-color: white; font-weight: normal; line-height: 1.3em; margin: 0px 0px 10px; padding: 7px 0px 0px; position: relative; text-align: center; word-wrap: break-word;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Making sense of the trust deficit between doctors and patients</span></h2>
<div>
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">In December, 2017, I wrote an editorial for Medical Dialogues imploring on reasons for trust deficit and what can be done to bring the trust between doctors and patients back. The four broad themes include:</span></div>
<div style="text-align: justify;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">1. Time Value: Utilising the small amount of time available for consultation</span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">2. Encouraging transparency</span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">3. Emphasis on prevention</span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">4. Encouraging follow up</span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">You can read the whole piece <a href="https://medicaldialogues.in/making-sense-of-the-trust-deficit-between-doctors-and-patients/" target="_blank">here.</a></span></div>
<div style="text-align: left;">
<br /></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-18602680947370556212017-11-15T12:10:00.000+05:302018-11-30T16:47:33.918+05:30India releases it's first comprehensive disease burden report<div dir="ltr" style="text-align: left;" trbidi="on">
<h2 style="text-align: center;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> India: Health of the Nation’s States<br />The India State-Level Disease Burden Initiative</span></h2>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span> <span style="font-family: Georgia, Times New Roman, serif;">This report was initiated in 2015 and released on 14 November 2017 and is a joint effort of the Indian Council of Medical Research, the Public Health Foundation of India and the Institute for Health Metrics and Evaluation. The report can be accessed <a href="http://icmr.nic.in/publications/India_Health_of_the_Nation's_States_Report_2017.pdf" rel="nofollow" target="_blank">here.</a></span></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span> </span><br />
<h3 style="text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> Burden of disease report:</span></h3>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span> <span style="font-family: Georgia, Times New Roman, serif;">This report is a massive step in organising a wide level of information across the country. It would be helpful to the policy makers in understanding where concerted efforts are needed. Here are some interesting statistics from the report.</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span> </span><br />
<h4 style="text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> Key takeaways: </span></h4>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Even though absolute numbers of the following have decreased, the variation among states is staggering.</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">1. <i>Life expectancy:</i> Since 1990, there is an increased in life expectancy. In 1990, life expectancy at birth in India was 58.3 years for males and 59.7 years for females. By 2016, life expectancy at birth increased to 66.9 years for males and 70.3 years for females. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">2. <i>Epidemiological transition: </i>From being 60.9% in 1990, communicable diseases have reduced to 32.7% of the total DALYs (Disability Adjusted Life Years).</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">3. <i>Contributors to death: </i>Compared to 1990, the burden of communicable disease has lessened to half (53.6 to 27.5%), however burden of non-communicable diseases (37.9 to 61.8%) and injuries (8.5 to 10.7%) has increased. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">4. <i>Years of life lost (YLL): </i>is a measure that quantifies the number of years of life a person loses at the age of their death, based on the highest life expectancy for their age group anywhere in the world. Some major contributors to YLL according to the report:</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<ul style="text-align: left;">
<li><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Ischaemic Heart Disease (Group other than EAG)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Stroke (North Eastern States)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Infections and Neonatal causes? (EAG and North Eastern States)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Suicides (All States)</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Road Injuries (All States)</span></li>
</ul>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">According to gender, YLL had more effect on males in cases of Ischaemic heart diseases and road accidents while women were affected due to diarrhoea and infectious diseases like lower respiratory diseases.</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">5. <i>Years lived with disability (YLDs): </i>is a measure that takes into account both the number of individuals suffering from disability (or non-fatal poor health as a result of a particular disease or injury), and also the severity of the disability. The contribution of YLDs to the total disease burden (DALYs) increased in India from 17% in 1990 to 33% in 2016. Anaemia was the most common cause of YLD (11% of all disability) and caused more YLD in females than males. </span></div>
</div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">6.<i> Risk factors causing disease burden: </i>Risk factors are the drivers of diseases and injuries that cause premature death and disability. After maternal and child malnutrition, air pollution (both ambient and indoor) is the biggest cause of disease burden in India! Other causes in decreasing order are: dietary risks, systolic blood pressure, high fasting plasma glucose, tobacco, sanitation, cholesterol, BMI, alcohol/drugs, occupational risks, impaired kidney function, unsafe sex, environmental risks, low physical activity, low bone mineral density, sexual abuse and violence.</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The report also analyses the disease burden of each state. This is a great tool for lawmakers and policy advisers to tailor make their suggestions according to the need of the region. </span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div>
<br /></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-46855392582740886432017-11-07T11:36:00.000+05:302018-01-03T12:27:28.581+05:30Publication Plug: Need for regulated Medical Boards for MTP cases- An Analysis<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<h2 style="text-align: left;">
<span style="font-family: Georgia, Times New Roman, serif;">
Medical Termination of Pregnancy - Analysis of present situtation</span></h2>
<span style="font-family: Georgia, Times New Roman, serif;">Medical dialogues published my article on the rise of abortion applications reaching courts in India, the present scenario on the legal front and the way forward. You can read the piece <a href="http://medicaldialogues.in/the-rise-of-abortion-applications-at-the-courts-an-analysis/" target="_blank">here</a>. </span></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0New Delhi, Delhi, India28.6139391 77.20902120000005228.3907261 76.886297700000057 28.8371521 77.531744700000047tag:blogger.com,1999:blog-487578008699996821.post-80698068413577946352017-07-12T18:01:00.000+05:302018-09-24T10:12:33.699+05:30Are you mentally ill, under the Indian law?<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">A member of the Standing Committee 74th <a href="http://www.prsindia.org/uploads/media/Mental%20Health/SCR%20Mental%20Health%20Care%20Bill,%202013.pdf" target="_blank">report </a>on Mental Health Care Bill, 2013, </span><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Dr. Sudhir K. Khandelwal, Professor of Psychiatry, AIIMS, New Delhi explained why we need a precise definition of Mental Illness. He stated:</span></span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<blockquote class="tr_bq" style="text-align: left;">
<i><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">definition of mental illness is ill-conceived and is over inclusive;
features like ‘causing distress or impairment’ would make practically whole of
Indian population mentally ill at some point of time; </span></i></blockquote>
<div style="text-align: left;">
<i><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></i></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">This bill was later changed and is now a law in India in the form of <a href="http://www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdf" target="_blank">Mental Healthcare Act, 2017</a>.</span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<h4 style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">What was the earlier definition of mental illness?</span></h4>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">“Mental illness” means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence;</span></div>
<div style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></div>
<h4 style="text-align: left;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">What is the definition of mental illness under the Mental Healthcare Act, 2017?</span></h4>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">“Mental illness” means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence;</span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></span></div>
<h4 style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">What is the difference between these two definitions?</span></span></h4>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Absolutely nothing. </span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">So, I guess Dr. Khandelwal was right. Almost all of us would have been mentally ill according to this law at one point or another. </span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><br /></span></span></div>
<div style="text-align: left;">
<span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Do you think this definition negatively affects the rights of people who actually need state help? </span></span></div>
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-88874689956315520592017-07-04T16:35:00.000+05:302018-01-03T12:28:04.829+05:30Can India ensure dignity to persons suffering with HIV<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; font-variant-numeric: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Source Serif Pro, serif;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><i>In April this year, India passed a law designed to protect the rights of persons living with HIV. In this post, we see what the law offers, what it leaves out and what are the promises government made to its citizen through this law. </i></span></span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">What is this new law?</span></em></strong></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The government of India passed <a href="http://naco.gov.in/hivaids-act-2017" rel="nofollow noopener" style="border: 0px; color: #8c68cb; cursor: pointer; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline; word-wrap: break-word;" target="_blank"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">“The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome(Prevention and Control) Act”</em></a><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </em>in April 2017. This is applicable throughout the country. This law has been made to protect the human rights of persons having the disease and persons living with affected individuals. </span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The government had started working on the bill since 2002. In 2006, a draft bill was prepared by Lawyers Collective, an NGO and the bill was put before the Rajya Sabha in 2014.</span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Why was it needed in India?</span></em></strong></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">We just discussed that the government started thinking about the bill in 2002. It turns out, India had highest prevalence of Persons Living with HIV(PLHIV) of 0.38% among population between the age of 15-49 years in 2001-03. According to <a href="http://naco.gov.in/hiv-facts-figures" rel="nofollow noopener" style="border: 0px; color: #8c68cb; cursor: pointer; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline; word-wrap: break-word;" target="_blank">NACO</a>, since 2001-03, AIDS has been constantly declining with PLHIV being 0.26% in 2015.</span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">So, along the 15 years when the bill was pending, India managed to control the AIDS epidemic from spreading further.</span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">With time and advances in the Anti-Retroviral Therapy, the prognosis for PLHIV has increased and mortality has <a href="https://www.ncbi.nlm.nih.gov/pubmed/22998068" rel="nofollow noopener" style="border: 0px; color: #8c68cb; cursor: pointer; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; vertical-align: baseline; word-wrap: break-word;" target="_blank">decreased.</a> So, this law comes at a perfect time to ensure that PLHIVs can live a life of dignity. </span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">What does the law do?</span></em></strong></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> This law aims to have a multi-pronged approach. Here’s a list of objectives dealt with in the act:</span></div>
<ol style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin: 3.2rem 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> Prohibits discrimination by individuals, employers, persons living in households with PLHIV, health service providers, education or any other service providers. However, it allows insurers to not provide services to such individuals in case they can back up their claims by actuarial studies.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Lays down rules regarding informed consent and disclosure of HIV status.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Makes government responsible for providing ART and opportunistic infection management.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Makes compliance guidelines for workplaces having more than 100 persons and high risk workplaces to limit the chance of spread of the disease.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Calls for formation of an ombudsman at the state level to hear complaints regarding non-compliance with the act.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Lays down criteria for special procedures in court for PLHIV.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Incorporates special provisions like right to residence.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Promotes actions which limit the chance of spread of HIV: Including provision of condoms, drug substitution and maintenance, supply of injections etc.</span></li>
</ol>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> <strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What if people still do not comply with the law?</em></strong></span></div>
<ul style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin: 3.2rem 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> Propagating hatred, violence or discrimination against PLHIV carries an imprisonment from 3 months to up to 2 years with or without fine which could be upto one lakh rupees.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> Fine for non-compliance with the order of ombudsman is INR 10,000 for first day and INR 5000 for every subsequent day.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> Disclosing HIV status of a person based on court records unless ordered by court can introduce fine up to 1,00,000.</span></li>
</ul>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> The offences under the act are cognizable and bailable. Cognizable means that a police officer can arrest a person under this act without a warrant.</span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"> <strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What is the role of government under this act?</em></strong></span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Both central and state governments have some responsibilities under this act as can be seen here:</span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Central Government</span></strong></div>
<ol style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin: 3.2rem 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Form a model HIV and AIDS policy for establishments keeping record of HIV related information.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Issue protocols for diagnosis, ART and opportunistic infection management for HIV and AIDS infected persons.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Guidelines for care, support and treatment to children Protect the property of children affected by HIV and AIDS.</span></li>
</ol>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Central and State Government</span></strong></div>
<ol style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin: 3.2rem 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Frame schemes to address needs of infected and affected persons.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Information, education and communication programs.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Protect the property of children affected by HIV and AIDS.</span></li>
</ol>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">It is noteworthy to mention that <u style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">none of these schemes, programs etc under the act have been formed as of now.</u> </span></div>
<div style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin-bottom: 3.2rem; margin-top: 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;">
<strong style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">So, what could have been better under the Act?</span></em></strong></div>
<ol style="border: 0px; color: rgba(0, 0, 0, 0.7); font-stretch: inherit; line-height: 32px; margin: 3.2rem 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The governments could form their schemes and programs before passing the act so that there could have been some accountability.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Some believe that the role of the ombudsman under the act is limited.</span></li>
<li style="border: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 2.4rem 0px 2.4rem 3.2rem; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Terminology in the act: obligation on the State governments to provide treatment “as far as possible”, makes it weak and open to interpretation.</span></li>
</ol>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-23177794251890646152017-01-09T13:49:00.000+05:302018-01-03T12:28:28.387+05:30Publishers vs. A Photocopy shop - Where is the line of infringement?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal" style="text-align: justify;">
<span lang="EN-IN" style="font-family: Georgia, Times New Roman, serif; font-size: large;">In 2012, a few leading academic publishers of
the world which include The Oxford University Press, The Cambridge University
Press and Taylor & Francis Group (The Plaintiffs), instituted a case
against a Photocopying shop at Delhi University premises before the Delhi high
court. The photocopying shop, Rameshwari Photocopy services had been authorised
by the University to photocopy certain books of the plaintiffs and provide
course packs to the students at a cost. The plaintiffs alleged that this act
constituted infringement, an act the Delhi University sanctioned by providing
reading list as well as allowing the photocopier to use the books from their
library. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span lang="EN-IN" style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span lang="EN-IN" style="font-family: Georgia, Times New Roman, serif; font-size: large;">The copyright law has provisions which allow
fair dealing of copyrightable material. These include provisions allowing a
teacher or a pupil to use in the course of instruction, for review or reporting,
or limited publication, among various others. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span lang="EN-IN" style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span lang="EN-IN">The plaintiffs relied on established cases in
the west as well as the TRIPS and Berne Convention to plead that the rights of
authors of copyrightable material should not be prejudiced by municipal laws
and contended that the University should have applied for a license from the </span>Indian
Reprographic Rights Organization (IRRO) as the act of photocopying is competing
with their business and infringing their copyrights. The University as well as
Rameshwari photocopy admitted to copying
portions of the books but also contended that the reproduction of these books
were meant for specific students only and was covered in fair dealing as the
students would not be able to afford the books individually. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The Division Bench of the Delhi
high court decided this matter in appeal in favor of the defendants and held
that copyrights are not natural rights, but are in fact given to the authors by
legislation. The rights under the copyright law in India are given equally to
the authors as well as the public. The court held that the term ‘in the course
of instruction’ should be seen in its widest connotation and course packs
designed by the teachers and provided by the photocopier should be included in
the fair dealing scope.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">While the publishers insisted
that they are losing business because of the course packs, the university and
the students pleaded that they should be allowed to photocopy the material to
an unlimited extent, because the publishers didn’t lose their business and in
fact the course packs encouraged the students to buy the books. None of the
parties seem to have shared any data supporting their stand. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The court could not have fixed a
percentage of material from the books which should be allowed to be copied
without inviting any copyright infringement concerns as that would amount to
legislating. So, it interpreted the provisions of the Indian Copyright Act,
1957 in the broadest way keeping in view the principle of the act which is <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify;">
<i><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></i></div>
<div class="MsoNormal" style="margin-left: .5in; text-align: justify;">
<i><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Copyright, specially in literary works , is
not an inevitable, divine, or natural right that confers on authors the
absolute ownership of their creations. It is designed rather to stimulate
activity and progress in the arts for the intellectual enrichment of the
public. Copyright is intended to increase and not to impede the harvest of knowledge.
It is intended to motivate the creative activity of authors and inventors in
order to benefit the public.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><a href="http://www.thehindu.com/opinion/lead/A-blow-for-the-right-to-knowledge/article14987252.ece">Commentators</a>
have hailed the decision of the court as allowing ‘poor students’ access to
information, one thing that skips consideration is that the copyright act of
India does not define fair dealing properly. If interpreted strictly, fair
dealing should be an exception and number of copies and extent of copies of the
material in the book should be pre-defined to ensure that the commercial
interests of the authors and publishers are not unduly infringed. One possible
misuse of the interpretation of law in the present case could be visualized like
this:<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">If course packs are actually
legal, this practice would encourage Universities to buy lesser number of
copies of the books than actually required. It will also be very difficult to
determine whether the course packs are being used only by students. If the
market for these books is academia of the country and they have been given a
free hand to infringe any amount of the text from a book as long as it is not a
cover to cover copy, such wide interpretation has the potential to kill the
copyrights of all authors and publishers. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Absence of quantifiable data
makes it impossible to predict which of the two outcomes would be correct –
that whether the publishers actually suffer losses or not. Another important
feature is absence of clarity in the written law. If the judges are made to
guess the intent of the law keeping into the view the international conventions
and norms, it leads to subjective reading of the same law. For example, the
interpretation of the same high court of the term ‘fair use’ in the case of
India <i>TV Independent News Service
Pvt.Ltd. & Ors. vs. Yashraj Films Pvt.Ltd (India TV case) </i>was rejected
by the present division bench in this judgment. In the India TV case, the established principles
of determination of ‘fair use’ in American jurisprudence were accepted and
applied to determine whether copyright infringement of a song occurred. These
principles are:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.5in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.5in;">
<!--[if !supportLists]--><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(i)<span style="font-stretch: normal; line-height: normal;">
</span><!--[endif]-->the purpose and the character of the use,
including whether such use is of a commercial nature or is for non-profit
educational purposes; <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.5in;">
<!--[if !supportLists]--><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(ii)<span style="font-stretch: normal; line-height: normal;">
</span><!--[endif]-->the nature of the copyrighted work; <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.5in;">
<!--[if !supportLists]--><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(iii)<span style="font-stretch: normal; line-height: normal;">
</span><!--[endif]-->the amount and substantiality of the portion
used in relation to the copyrighted work as a whole; and <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.5in;">
<!--[if !supportLists]--><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">(iv)<span style="font-stretch: normal; line-height: normal;">
</span><!--[endif]-->the effect of the use upon the potential market
for or value of the copyrighted work.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.5in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In the present case however, the
judge’s noted that ‘general principle’ of fair use would be read into the
clause and considered only the purpose of the act alleged to be infringement in
making a decision. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Leaving interpretation of vague
laws to the judges increases confusion in the public and could take years for
an issue to be finally decided by the Supreme Court. The parliament needs to
update the outdated laws on which the courts are facing dilemmas through a
detailed analysis of the situation as well as deliberation. A clear law could
avoid cases similar to the present one entering the judiciary and make
administration of justice more accessible to citizens of the country. <o:p></o:p></span></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<div class="MsoNormal">
<br /></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-82902086470247551872016-09-29T13:26:00.001+05:302018-01-03T12:28:50.014+05:30Misuse of Courts: Bizzare instances of Public Interest Litigation petitions in India<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Public Interest Litigation developed in India in the late 1970s as a method of seeking justice for a group of individuals through a single case. In the case of <i><a href="https://indiankanoon.org/doc/1007347/" target="_blank">Husainara Khatoon v. State of Bihar</a>, </i>the Supreme Court through the Bench of Justice PN Bhagwati, Justice RS Pathak and Justice AD Kaushal took notice of a report by the Indian Express newspaper regarding the under-trials languishing in jail. The court in this judgment held that<span style="background-color: white; text-indent: 4px;"> the state cannot be permitted to deny the constitutional right of speedy trial to the accused because of lack of financial resources needed by the state to incur the necessary expenditure needed to improve the administrative and judicial infrastructure with a view to improving speedy trial.</span></span></div>
<div style="text-align: justify;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;"><br /></span></div>
<div style="text-align: justify;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;">Since then, the Indian judiciary has stepped up multiple times to ensure fundamental rights to us. However, in certain cases, some people tried their luck too far and ended up filing bizarre law suits in the name of public interest:</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: white; text-indent: 4px;"><br /></span>
<span style="background-color: white; text-indent: 4px;">1. Serial Public Interest Litigation filer, <a href="https://en.wikipedia.org/wiki/Manohar_Lal_Sharma" target="_blank">ML Sharma</a> is a caricature of the flip side of a law developed to help people secure their legal rights. To gain publicity and media attention, this lawyer has filed and gotten dismissed many frivolous, unsubstantiated petitions which have bought him ire of the court more than once and has even led to contempt charges against him multiple times. From questioning the antecedents of a woman who alleged molestation by a Judge because, according to our scriptures, women are liars or insisting that Rajiv Gandhi had Swiss accounts or that government should stop funding Kashmiri separatists, this man loves to test the patience of the court. </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: white; text-indent: 4px;"><br /></span>
</span><br />
<div style="text-indent: 4px;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;"><a href="https://s4.scoopwhoop.com/anj/ladies-gentlemen-m-l-sharmaz/546451967.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://s4.scoopwhoop.com/anj/ladies-gentlemen-m-l-sharmaz/546451967.jpg" width="320" /></a></span></div>
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://s4.scoopwhoop.com/anj/ladies-gentlemen-m-l-sharmaz/546451967.jpg" target="_blank">Source</a></div>
</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: white; text-indent: 4px;"><br /></span>
<span style="background-color: white; text-indent: 4px;">2. Pokemon Go hurts the religious sentiments of our people: The Gujarat High court is hearing the case of people getting hurt by Pokemon Go, a game based on augmented reality for showing eggs in religious places!</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: white; text-indent: 4px;"><br /></span>
</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.nonprofitmarketingguide.com/blog/wp-content/uploads/2016/07/pokemon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" src="http://www.nonprofitmarketingguide.com/blog/wp-content/uploads/2016/07/pokemon.jpg" height="181" width="320" /></span></a></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: white; text-indent: 4px;"><br /></span>
<span style="font-family: "Droid Serif", serif; font-size: 16px; text-align: start;"><br /></span>
<span style="font-family: "Droid Serif", serif; font-size: 16px; text-align: start;">The petitioner's lawyer was quoted as saying, </span><i style="font-family: "Droid Serif", serif; font-size: 16px; text-align: start;">“this game hurts religious sentiments of Hindus and various other religions since eggs are depicted at temples and other houses of prayers belonging to several religions. I moved the PIL to know what is the intention of this gaming company.”</i></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><i style="font-family: "Droid Serif", serif; font-size: 16px; text-align: start;"><br /></i>
<span style="font-family: "Droid Serif", serif; font-size: 16px; text-align: start;">3. </span><span style="background-color: white; text-indent: 4px;">In 2015, a lawyer practicing at the Supreme Court of India, Nagendra Kumar Sahoo was fined INR 1 lakh for filing a frivolous petition in the pending case of coal block allocation in Odisha. The court dismissed the petition with costs because it found no standing for the petitioner to file the PIL.</span><span style="font-family: "Droid Serif", serif; font-size: 16px; text-align: start;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><span style="background-color: white; text-indent: 4px;"><br /></span>
</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://upload.wikimedia.org/wikipedia/en/5/5d/Supreme_Court_of_India_-_Central_Wing.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" height="320" src="https://upload.wikimedia.org/wikipedia/en/5/5d/Supreme_Court_of_India_-_Central_Wing.jpg" width="260" /></span></a></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">4. Petition against Hindu Gods!</span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.hdwallpaperseek.com/coder/upload_folder/Lord-rama-sita-lakshman-t4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" src="http://www.hdwallpaperseek.com/coder/upload_folder/Lord-rama-sita-lakshman-t4.jpg" height="200" width="320" /></span></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.hdwallpaperseek.com/coder/upload_folder/Lord-rama-sita-lakshman-t4.jpg" target="_blank"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Source</span></a></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">A District court in Bihar, dismissed a petition against Lord Rama and his brother Laxman, for banishing Sita in exile without justification. The Judge dismissed the petition as it was <i>"beyond logic and facts".</i></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">According to mythology, Sita was born in Sitamarhi, the place where petition was filed. </span></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">5. <span style="background-color: white; text-indent: 4px;">Finally, In may this year Delhi High Court bench of Chief Justice G Rohini and Justice Jayant Nath refused to hear a PIL seeking guidelines to protect judges from frivolous PILs, as frivolous because the matter did not come under public interest. </span></span></div>
<div style="text-align: justify;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.livemint.com/rf/Image-621x414/LiveMint/Period1/2015/11/25/Photos/delhihc-kwwE--621x414@LiveMint.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" src="http://www.livemint.com/rf/Image-621x414/LiveMint/Period1/2015/11/25/Photos/delhihc-kwwE--621x414@LiveMint.JPG" height="213" width="320" /></span></a></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Why are these petitions filed you ask?</span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Most of the times, it is because the petitioners seek some publicity from their bizarre acts. Sometimes even with best of intentions, the petitioners might not be able to prove their standing to file the PIL or prove the allegations leveled by them justifiably. </span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">However, with commentators talking about judicial over-reach and questioning the need of public interest litigation altogether, the petitions end up being a huge burden on a system evolved for us by the courts. </span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Know about more petitions like these? Tell me about them.</span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-align: justify; text-indent: 4px;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;"><br /></span></div>
<div style="text-align: justify;">
<span style="background-color: white; font-family: Georgia, Times New Roman, serif; font-size: large; text-indent: 4px;"><br /></span></div>
<div style="text-align: justify;">
<span style="background-color: white; text-indent: 4px;"><br /></span></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-85634753830391505782016-08-31T10:22:00.000+05:302018-01-03T12:29:35.515+05:30Workshop on Workplace Sexual Harassment Prevention and training Internal Complaints Committee members<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">In August, I was invited to speak about the law on women safety and it's compliance by the Internal Complaints Committee of National Institute of Technology, Jalandhar.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">My colleague, Karan Sachdeva and I had interactive sessions with the members of the committee as well as students of the university.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">We were happy to educate the external member of the committee about her basic duties as the member and the skills she needs to develop.</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Here are some photographs:</span><br />
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7DdZS6wYwGYL2BhJau4sRbmf8IBk0_u4KBLPxDvPyFqoeEXqXmtzSiQLbj9B58sI85_tbThcgiPMRibNIRPKAUrtuU8STLeFZJyXFgTzM-Er1n2kdfFSvzgLsKwTujjiq8sFzxypcrru3/s1600/DSC_3790+%25281%2529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7DdZS6wYwGYL2BhJau4sRbmf8IBk0_u4KBLPxDvPyFqoeEXqXmtzSiQLbj9B58sI85_tbThcgiPMRibNIRPKAUrtuU8STLeFZJyXFgTzM-Er1n2kdfFSvzgLsKwTujjiq8sFzxypcrru3/s320/DSC_3790+%25281%2529.JPG" width="320" /></span></a></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgqUJpNTSTSiyx1bzhQTQ6NGnbyoPuCkRE7qYvGY1qeUNs7qHfX-4rwBCZLrm0Q-Mni2Xm2cNN6GUcWFnS1mBpJcJ3avpzPwZh88OvzGrfZbvbepD74I8Bioh3rMg4v_rVpCGHBCJdxTP2/s1600/DSC_3783.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgqUJpNTSTSiyx1bzhQTQ6NGnbyoPuCkRE7qYvGY1qeUNs7qHfX-4rwBCZLrm0Q-Mni2Xm2cNN6GUcWFnS1mBpJcJ3avpzPwZh88OvzGrfZbvbepD74I8Bioh3rMg4v_rVpCGHBCJdxTP2/s320/DSC_3783.JPG" width="320" /></span></a></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijBk12xFJ2B4wH3pTKT21NIlpxY_gF8rGQsdPwy85FnbXOXu58jjGd6lHNUWfIVhMmUVflUVefN6X1CWACnZR5gcrXD_3FRD0lAUaMd-jEczYd3ZrlfveBdqypeSr3WpYF22Zp8ewb4m0g/s1600/DSC_3782+%25281%2529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijBk12xFJ2B4wH3pTKT21NIlpxY_gF8rGQsdPwy85FnbXOXu58jjGd6lHNUWfIVhMmUVflUVefN6X1CWACnZR5gcrXD_3FRD0lAUaMd-jEczYd3ZrlfveBdqypeSr3WpYF22Zp8ewb4m0g/s320/DSC_3782+%25281%2529.JPG" width="320" /></span></a></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-cJWNxdH4J8JOSvx-htldvJlXUSsjwuyVqOlApGFbEynYJ3Rf0K8-qEWfgoVwEieH_c8DVeYDAk1cT0TqK94_GdAMEkCkNK-z72k9u6KL-ysOLxh6wbwB9Q8Cw7p9UC0nVuJ80iMuE8NE/s1600/DSC_3786+%25281%2529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-cJWNxdH4J8JOSvx-htldvJlXUSsjwuyVqOlApGFbEynYJ3Rf0K8-qEWfgoVwEieH_c8DVeYDAk1cT0TqK94_GdAMEkCkNK-z72k9u6KL-ysOLxh6wbwB9Q8Cw7p9UC0nVuJ80iMuE8NE/s320/DSC_3786+%25281%2529.JPG" width="320" /></span></a></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">For more information on Sexual harassment at workplace prevention and redressal laws, you can write to us. </span></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-32650563022220164822016-08-29T16:43:00.001+05:302016-08-29T16:43:17.888+05:306 things about Indian surrogacy law that you need to know<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: left;">
<h4 style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">1. What is the buzz regarding surrogacy law in India about?</span></h4>
</div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">The new "Surrogacy Bill" has been cleared by the Cabinet and is awaiting its passage by the Parliament. Earlier, the <a href="http://www.prsindia.org/uploads/media/draft/Draft%20Assisted%20Reproductive%20Technology%20(Regulation)%20Bill,%202014.pdf" target="_blank">Draft Assisted Reproductive Technology Bill, 2014</a> (ART Bill) which had surrogacy as one of it's concerns was awaiting to be passed but has not yet seen light of the day. Public comments on the ART bill had however been invited last year and saw responses from stakeholders.</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<h4 style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">2. How does it affect India?</span></h4>
</div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">India has been a commercial hub for surrogacy before the regulations were put by government in 2013, restricting it for Indian married couples, PIOs and NRIs and then in 2015 when it was limited to Indian married couples only. The estimated economic activity due to surrogacy was pegged to be in <a href="http://www.thehindu.com/opinion/op-ed/a-setback-for-surrogacy-in-india/article7927730.ece" target="_blank">multi-billion</a> by some publishers. Surrogacy invited "medical-tourism" from the countries where it was illegal or regularized or simply due to low costs. There are multiple research publications claiming that the industry exploited poor women in India. <a href="http://indianexpress.com/article/india/india-news-india/supreme-court-asks-centre-to-bring-commercial-surrogacy-within-ambit-of-law/" target="_blank">Supreme Court</a> has also been considering the legality of the concept of commercial surrogacy and the government's action seems to be a reaction to the questions put forward to it by the court.</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<h4 style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">3. How was surrogacy regularized earlier and what are the key changes?</span></h4>
</div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">In India surrogacy was regularized only through contracts between the surrogates and the commissioning parents. The contracts usually facilitated by the surrogacy clinics, would lay terms which many thought were harsh on the surrogate mother. The mother was basically asked to let her womb on rent and not ask questions about the child. Arguably, these clauses help to prepare women psychologically for their gestation. If there was any fallout from the contract, the parties had to approach the courts in India. What made the matters complicated is the multi-country nature of jurisdiction of the contracts. Cases of commissioning parents abandoning the baby were landmark cases due to which certain guidelines were formed to regulate surrogacy.</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">If the surrogacy bill is passed in the present form, it will lead to following major changes.</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">a. Homosexuals, foreign nationals, live-in couples, persons of Indian origin or NRIs, single people and parents who already have a kid cannot go for surrogacy in India.</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">b. The only method of surrogacy that would be allowed is altruistic, so the parents cannot pay the woman keeping the child in her womb</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">c. There will be restrictions on the surrogates age, marital status as well as a pre condition of her having a child of her own</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">d. The Indian married couple looking for surrogacy would have to be childless for at least five years before getting permission for surrogacy</span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<h4 style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">4. What is the status of the surrogacy laws in the world?</span></h4>
</div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: "times" , "times new roman" , serif;">Spain, UK, China, Canada, Thailand and Australia only allow altruistic surrogacy and some have their regulations regarding allowing only heterosexual married couples to opt for it. Surrogacy in Norway, Sweden, France forbid surrogacy<span style="color: #4d4d4d;"><span style="background-color: white; line-height: 19.6px;">. </span></span>After India shut its gates to commercial surrogacy earlier this year, Mexico, Nepal, Poland and Ukraine are increasingly getting popular as surrogacy hubs. However, the quality of medical services in India is believed to be one of the best among these countries and sometimes couples and the surrogate opt to travel to India to get the IVF cycle process done. </span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<h4 style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">5. What are the lawmakers' point of view about the surrogacy bill?</span></h4>
</div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">Foreign Minister of India, Sushma Swaraj who was a part of the panel set up by the government to draft this litigation gave following comments to the <a href="http://www.cbsnews.com/news/india-ban-surrogacy-potential-foreign-parents/" target="_blank">press:</a></span></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><span style="background-color: white;">a. Concerns about abandoned children: <i> "</i></span><span style="background-color: white; color: #202022; line-height: 22.1px;"><i>Many so-called childless couples were misusing the wombs of poor women. It was a matter of great worry because there were instances where a girl child or disabled child have been abandoned soon after birth.”</i></span></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><span style="background-color: white; color: #202022; line-height: 22.1px;"><i><br /></i></span></span></div>
<div style="background-color: white; color: #202022; line-height: 22.1px; margin-bottom: 15px; text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;">b. Chances of divorce among foreigners <i>“We have had cases where the couple take the child from the surrogate mother and then they get divorced after some time,” Swaraj said. “The child belongs to nobody. This is why we disallowed foreigners.”</i></span></div>
<div style="background-color: white; color: #202022; line-height: 22.1px; margin-bottom: 15px; text-align: left;">
<span style="font-family: "times" , "times new roman" , serif; line-height: 22.1px;">c. </span><span style="background-color: transparent; color: #3e3e3e; font-family: "droid serif" , serif; font-size: 16px; line-height: 28px;"> Concerns about surrogacy having become a fashion</span><span style="background-color: transparent; color: #3e3e3e; font-family: "droid serif" , serif; font-size: 16px; line-height: 28px;"> <i>“unfortunate” </i>that couples who already have a son and a daughter of their own, opt for surrogacy <i>“just because it is fashionable”.</i></span></div>
<div style="background-color: white; margin-bottom: 15px; text-align: left;">
<span style="color: #3e3e3e; font-family: "droid" serif , serif;"><span style="line-height: 28px;">d. Concerns about our ethics "</span></span><span style="background-color: transparent; color: #3e3e3e; font-family: "droid serif" , serif; font-size: 16px; line-height: 28px;"><i>“We do not recognise homosexual or live-in relationships, that is why they are not allowed to commission babies through surrogacy. It is against our ethos.”</i></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
<div style="text-align: left;">
<br /></div>
<br /></div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0tag:blogger.com,1999:blog-487578008699996821.post-61297500520730306862016-08-16T10:26:00.000+05:302016-08-16T10:26:35.347+05:30Is UGC recognition mandatory for your online degree- via Financial Express<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: left;">
<span style="font-family: inherit;">On August 15, my write up on the status of online legal courses in India was published by The Financial Express. </span></div>
<div style="text-align: left;">
<span style="font-family: inherit;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: inherit;">Here are the excerpts:</span></div>
<div style="text-align: left;">
<span style="font-family: inherit;"><br /></span></div>
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; line-height: 30px; outline: none; padding: 0px 0px 20px; text-align: left;">
<span style="font-family: inherit;"><i>"Although online education system in India has been catching up, the same cannot be said about the regulatory body of these courses. There exists a problem of absence of a permanent body looking after distance online courses by universities, a task which used to be handled by Distance Education Council (DEC) at IGNOU till 2012 and is now being handled by Distance Education Bureau (DEB) of the UGC.</i></span></div>
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; line-height: 30px; outline: none; padding: 0px 0px 20px; text-align: left;">
<span style="font-family: inherit;"><i>The HRD ministry had notified for the above change in its circular dated 29.12.2012. DEB was formed to conduct the process in the interim, while the draft Distance Education Council of India Act of 2014, which is supposed to be an independent organisation taking care of distance education in India, has not seen the light of day. DEB is still the authorising body for these courses.</i></span></div>
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; line-height: 30px; outline: none; padding: 0px 0px 20px; text-align: left;">
<span style="font-family: inherit;"><i>After its formation, DEB decided to change its methods of approval as compared to erstwhile DEC, and institutions were asked to get approvals not only for running distance education programmes, but also to get specific programmes approved by it.</i></span></div>
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; line-height: 30px; outline: none; padding: 0px 0px 20px; text-align: left;">
<span style="font-family: inherit;"><i>In fact, in an undated document uploaded by DEB, it claims to have decided on 83 out of 205 pending applications with them.</i></span></div>
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; line-height: 30px; outline: none; padding: 0px 0px 20px; text-align: left;">
</div>
<span style="font-family: inherit;"><i>After its establishment in 2013, DEB has been surprisingly slow in granting recognitions to new courses or institutes which were not granted automatic approval in 2013. Applications are invited only from those institutes which already ran recognised courses in the past year, in essence monopolising a promising industry against well-deserved players.</i></span><br />
<br />
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; line-height: 30px; outline: none; padding: 0px 0px 20px; text-align: left;">
<span style="font-family: inherit;"><i>With UGC trying to weed out institutions that run the danger of becoming “degree mills”, there is also a question-mark regarding the process being followed to grant acceptance for new courses because of large pendency."</i></span></div>
<div style="border: 0px; font-stretch: inherit; font-variant-numeric: inherit; outline: none; padding: 0px 0px 20px; text-align: left;">
<span style="font-family: inherit; line-height: 30px;">You can read the whole article here: </span><span style="line-height: 30px;">http://www.financialexpress.com/industry/jobs/is-ugc-recognition-mandatory-for-online-legal-courses/347586/</span></div>
</div>
Harleen Kaurhttp://www.blogger.com/profile/04171397413202786492noreply@blogger.com0