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TABLE OF CONTENTS

1. Huge Lags in Medical Education
2. POCSO and Judicial Discomfort
3. The post-COVID-19 Economic Recovery and Fiscal Stance

1. Huge Lags in Medical Education

Context:

The article discusses the issues and challenges of the healthcare sector and medical education in India.

Healthcare in India:

• Healthcare is one of the important aspects of the development of a country. 
• The availability of adequate healthcare and healthcare personnel not only ensures greater economic stability and security but also provides a boost to overall inclusive growth and employment generation. 
• Despite being a crucial element, healthcare has always been neglected by governments.

Issues and Challenges:

• There are certain issues in the healthcare sector of the Indian economy which are enumerated below:
  • Inadequate government spending on healthcare services.
  • The relatively small size of the healthcare sector.
  • Shortage of healthcare personnel.
  • Supply-side issues such as lack of skilled workforce particularly doctors.
• These issues have not been addressed by the government effectively. Even the Covid-19 pandemic has also not created any kind of major interventions by the government in the healthcare sector.

Medical Education:

• No necessary interventions have been taken by the governments to expand medical education in India. This is the major reason behind medical students moving to other countries for education.
• The outbreak of the Covid-19 pandemic and the ongoing Russia-Ukraine War have hampered the education of the students, studying abroad, to a great extent. They have had to flee back to their respective countries comprising their studies and future.
• The surprising fact behind this is that the demand for medical education is growing in India still, the supply remains unmatched by the growing demand.
• Issues in Medical Education:
• • Lack of basic infrastructure in private medical colleges.
  • Lack of qualified teachers.
  • High fees that are not affordable for many students.
• These issues result in the growing gap between the demand and supply of medical education.

Availability of Healthcare Personnel:

• In India, the requirement of healthcare personnel is 3.42 million but the availability is only 1.77 million. It implies that there is a shortage of approximately 1.65 million healthcare personnel.
• According to the norms of the World Health Organization (WHO), the density of health personnel per 10,000 persons should be 44.5 but India only has 22 per 10,000 people.
• As per the estimate of the WHO, there is a requirement of around 1.8 million doctors, nurses, and midwives to meet the norms.

Intake of Medical Students and Nurses:

• It is evident from the above data that there is a huge shortage of healthcare professionals in India. Even then, the annual intake of MBBS students in 558 medical colleges is only 83,275. 
• In the past 7 years, the number of medical colleges has increased by 44% and the seats for MBBS have also increased by 60%.
• This does not fill the gap because the number of medical colleges per crore population has a meagre increase from 3.1 to 4.1 during the period, while the number of medical seats per crore population has increased from 418 to 618.

Healthcare Personnel across States:

• There is an unequal distribution of healthcare personnel across states as well. Following are the states with the highest number of allopathic doctors per 10,000 population.
  • Highest: Kerala (25.4), Jammu and Kashmir (14.2), West Bengal (9.5), Madhya Pradesh (8.4), Telangana (8.5), and Tamil Nadu (7.2). 
  • Less than 3 percent: Himachal Pradesh, Punjab, Chhattisgarh, Rajasthan, and Odisha.
• The states with the highest number of nurses per 10,000 population are:
  • Highest: Delhi (31), Uttarakhand (24.4), Kerala (23.4), Tamil Nadu (20.4), and Andhra Pradesh (17.4). 
  • Less than 5 percent: Madhya Pradesh, Uttar Pradesh, Bihar, Odisha, and Jharkhand.
• The above data shows that there is a huge shortage and disparity across states in terms of healthcare personnel. Despite the shortage, states are not taking appropriate actions to fill this gap.
• More than 50 percent of the medical education facilities and MBBS seats are concentrated in the top six states of India which are Karnataka, Maharashtra, Tamil Nadu, Uttar Pradesh, Gujarat, and Telangana.
• The share of the top 11 states contributes to more than 75 percent of the total MBBS seats whereas the leading three states account for around one-third of the graduate medical admissions.
• States with less than 2 percent share: Punjab, Delhi, Chhattisgarh, Assam, Jammu and Kashmir, Uttarakhand, Himachal Pradesh, and Jharkhand.

Shortage of Teaching Faculty:

• The Medical Council of India has recommended a 1:10 teacher-student ratio in medical colleges. However, according to a recent study, the shortage of teaching faculty in medical colleges is approximately 40%.
• In many teaching departments, the share of non-medical teachers has gone up to even 50%.
• Other issues: 
• • Outdated curriculum and teaching methods.
  • Faulty assessment patterns.
  • Inadequate facilities.
• Outcome: These issues have resulted in the derecognition of 21 private medical colleges in the last decade.

Way Forward:

• Shortage of healthcare personnel along with the lack of efficient medical education infrastructure are the major bottlenecks in the healthcare sector in India.
• These are the basic reasons behind students going abroad for medical education. This also results in the poor quality of medical education and the different skill sets than what is required in the country.
• The government should come forward and take effective measures to improve the medical education infrastructure in India, increase the MBBS seats, and reduce the shortages of healthcare personnel and teaching faculties to meet the global norms.

2. POCSO and Judicial Discomfort

Context

This article analyses different orders of high courts across the country where judicial discomfort has been expressed over the application of the POCSO Act.

Protection of Children from Sexual Offences (POCSO) Act, 2012

• It was enacted to effectively address the evil of sexual exploitation and sexual abuse of children.
• The Act defines “children” as individuals below the age of 18 years.
• Before the introduction of the POCSO Act, the “age of consent” for unmarried girls was 16.
  • The Act increased the age of consent to 18 years and later, according to the recommendations of the J S Verma Committee, Section 375 of the IPC was also amended accordingly.
• The Act prescribes various measures to make the investigation process child-friendly.
• The Act also prescribes that the case is to be disposed of within one year from the date of reporting of the offence.
• The Act provides for the establishment of Special Courts for the trial of such offences and matters related to them.
• According to the Supreme Court’s judgement, POCSO being special legislation on the matter of child sexual abuse will prevail over the IPC, in case of any inconsistency.
• In the specific situation of the Act, it is a mandatory and legal duty to report a crime and is punishable under the law for failing to do so.

Know more about – Protection of Children from Sexual Offences (POCSO) Act, 2012

The POCSO (Amendment) Act, 2019

• Amendments were made to the POCSO Act in 2019 which made offences against children gender-neutral.
• The amendments also enhanced the punishment against sexual offences against children, with a provision for the death penalty.
• Read more about – POCSO (Amendment) Act, 2019.

Cases where the High Courts expressed discomfort over POCSO Act

G Vijayalakshmi v/s State Government of Tamil Nadu

• The case was adjudicated by the Madras High Court which describes the case as “a very peculiar petition”.
• The initial allegations were that the accused had “kidnapped” the victim and had indulged in actions that account for sexual offences under the IPC, POCSO, and the Prohibition of Child Marriage Act, 2006.
• However, during the stages of criminal proceedings, the victim and her family reversed their allegations and claimed that the relationship was consensual.
• The judges upon examination concluded that the relationship was consensual. But the strict provisions of the POCSO Act mandated the court to ignore their conclusion and allow the trial to proceed.
• Finally after quashing the case the High Court held that “It is high time that the legislature takes into consideration the cases of this nature involving adolescents involved in relationships and swiftly bring in necessary amendments under the Act.”

Ranjit Rajbanshi v the State of West Bengal

• In this case, the Calcutta High Court was adjudicating an appeal against the conviction filed by an accused held guilty of “sexual assault.”
• The victim attested that she had been subjected to sexual assault but the court found material discrepancies in her statements.
• The court notes that there was physical intimacy between them but there seems to have been a meeting between the families of the victim and accused to propose a marriage between the two, which did not work out.
• The court acknowledges the strict provisions of the Act but questions whether they can be applied to “a voluntary consensual act of sexual union.”
• The court further highlights the practical complexities of the issue and questions why consent, which is discarded at the age of 17 years and 364 days, becomes valid at 18 years.
• Like the Madras High Court in the previous case, the Calcutta High Court expressed discomfort with the consequences of applying the Act and wondered if the objective of the act was to stop child abuse or to criminalise consenting adolescents.

Atul Mishra v State of UP 

• The Allahabad High Court encountered a similar issue while adjudicating the bail application of an individual who was accused of offences under the Act.
• The court found out that the victim and the accused knew each other from school, had eloped, and even had a baby together, thus concluding that the relationship was consensual.
• The Court reiterated the judgments of the other two courts, though it did not cite either of them.
• The Court held that “a bio-social approach needs to be adopted which takes into account the biological and social requirements of two teenagers, who on account of mutual infatuation are attracted and decide for their future. Their decision could be impulsive, immature but certainly not sinful or tainted as branded in the FIR or the complaint”.

Other reports

• Studies by the Centre for Child and the Law and HAQ: Centre for Child Rights highlight that a significant number of cases under the POCSO are related to consensual adolescent relationships.
• They also report that this is seen in cases other than POCSO such as sexual assault cases used to criminalise inter-caste and inter-religious relationships between consenting adults.

Conclusion

While all the courts and judicial experts acknowledge the fact that sex offenders must be met with severe punishments under the law and the POCSO Act plays a significant and very crucial role in tackling child sexual abuse, they highlight that certain provisions of the act have gone too far in their zealousness and suggest that there is a need to have a more refined legal framework that accepts the maturity of adolescents to make choices about their own bodies to a certain level.

3. The post-COVID-19 Economic Recovery and Fiscal Stance

Context

The Union Budget 2022–23 suggests a possibility of a large-scale fiscal consolidation in the financial year.

Background

• The global economy is still struggling to get back to normal post the economic shock due to the coronavirus pandemic.
• The invasion of Ukraine by Russia and its impacts have further aggravated the global macroeconomic uncertainties manifold.

The International Monetary Fund’s (IMF) views on the current economic situation

• The IMF reports suggest that inflation “has been higher than expected in several countries and the financial markets remain volatile as the geopolitical tensions have increased.”
• The increased prices of commodities such as food and energy will further impact inflation and in turn, erode the value of incomes.
• The economies of the neighbouring countries of Ukraine and Russia will be adversely affected due to the disruptions in trade, supply chains, and inflow of remittances along with the surge in refugee influx.
• Business confidence will be severely hit and higher investor uncertainty will weigh on asset prices which will tighten financial conditions and eventually increase the capital outflows from emerging markets.
• The IMF report suggests that there is a need for stronger international cooperation to end the pandemic and navigate monetary tightening and the focus should be on furthering fiscal sustainability.

Analysis of various measures undertaken in the Union Budget 2022–23

• Union Budget 2022–23 has prioritised fiscal consolidation and higher capital spending to address the current challenges in the economy and boost growth.
  • But this increased focus on capital expenditure (CapEx) has reduced the availability of fiscal space for the development expenditure in the social sector which can have adverse consequences.
• The budget 2022-23 has seen an increase in CapEx by Rs. 3.14 lakh crore compared to allocations in the previous fiscal year.
  • It is to be acknowledged that 66% of the government’s capital expenditure is to be undertaken by the states as the Centre has announced Rs. 1 lakh crore interest-free loans to the states to increase their public investments.
  • This amount cannot be used by the States to finance revenue deficit and hence it has the potential to expand capital spending at the state level and in turn, increase the overall capital spending in the country.
  • In 2021–22, 13 states reported revenue deficits in their accounts, and this loan facility prevents the further risk of reduction in capital expenditure at the state level.
• The Medium-term Fiscal Policy and Fiscal Policy Strategy Statement presented as part of the Union Budget 2022–23 stated that “in line with the commitments made in the budget of FY 22, the government would pursue a path of fiscal consolidation to attain a level of fiscal deficit lower than 4.5% of GDP by FY 2025–26”.
• The budget 2022-23 has also increased the efforts to attain sustained, broad-based economic growth, and has taken up measures that are necessary to protect the lives/livelihoods of the people while adhering to the path of fiscal rectitude.

Fiscal Consolidation and Debt

• As the coronavirus pandemic increased the debt-to-GDP ratio of the countries worldwide, the experts are reassessing their measures on public debt.
• Compared to the year 2020–21, the fiscal challenges in 2022–23 have eased a little but still remain and pose significant risks.
• Also, it is difficult to predict the impacts of the war in Ukraine on the fiscal situation.
• The revenue deficit continues to be more than 55% of the fiscal deficit and the measures to manage such deficit must consider various aspects such as interest payments and allocation under various centrally sponsored and central sector schemes.
  • In 2021–22, interest payment was 25.7% of the revenue expenditure and 39.14% of revenue receipts. With respect to GDP, it increased from 3.1% to 3.6% of the GDP between 2012–13 to 2022–23
    • This denotes a reduction in the fiscal space for development expenditure.
  • The average allocation for centrally sponsored and central sector schemes in the budget 2022–23 is Rs. 3.83 lakh crore and the interest payment cost of the Union Government is Rs. 9.56 lakh crore.
  • This high allocation gives rise to the issues of macro-fiscal management at the union and state levels as it contributes highly to the revenue deficits of the union and state governments

Differences between Fiscal Deficit and Revenue Deficit

Way forward

• Measures aimed towards achieving sustainable levels of debt and deficit would help stabilise the current economic scenario in the country and push India to become a global growth leader.
• It is crucial for the union government to adopt a cautious fiscal stance and influence the states to accept such prudent stances.
• The strategy of increased allocation to infrastructure projects must be revisited as these expenditures make it tougher to meet the fiscal deficit targets.
• There is a need to focus more on the allocation of the social sector as the citizens are still reeling from the impact of COVID-19 and as many have lost their livelihoods.
• As the monetary policy has its limitations to trigger growth in the economy, fiscal dominance is significant for the recovery of economic growth.
• The introduction of “Digital Rupee” can be a path-breaking move as it plays a significant role in improving financial inclusion, making the payments systems more efficient
  • It will also help the government deliver end-to-end services more efficiently, thereby improving tax administration and will also help immensely in the fight against money laundering and other illicit activities that hinder economic growth.

Conclusion

The government has focused on increasing allocation to capital expenditure with an assumption that it will create a virtuous circle of higher growth, larger development spending, and revenue-led fiscal consolidation but if these goals are not achieved then there will be an increased pressure to raise the revenue expenditure which will further increase the debt and the deficit.

Hence, it is extremely important for the government to undertake cautious approaches aimed at fiscal expansion that help in rebalancing fiscal expenditure between redistribution and growth.

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