Governance & Social Justice GS Paper II by Abhishiekh Saxena

Model Answer

Question #1. Health has always been a major constraint in the economic development of the country. Is India ready to make "Right to Health" a fundamental right? Give reasons. Also discuss Constitutional difficulties and implications of making the right to health as a Fundamental Right.

Approach:

•   Introduce with briefly describing the status of healthcare system in India (40 words)
•   Give reasons for and against making health a fundamental right (170 words)
•   Conclusion (40 words)

Hint:

Health is a vital indicator of human development and human development is the basic ingredient of economic and social development. The pandemic has exposed the deep vulnerabilities of India’s healthcare system. With a meager public spending on healthcare as a percentage of its GDP and healthcare facilities across the country straddling at different levels of efficiency and sufficiency, the debate of classifying the right to health as a fundamental right has been in media and academic circles lately.

The case for declaring the "Right to Health" a fundamental right:

• Health is the basic determinant of the capacity of a person and a healthy individual is more productive and contributes more to the nation. The right to health is fundamental, since it enables an individual to enjoy all the other rights – for example, education, employment and so on.
• The right to health is a natural corollary of the right to life and, therefore, denying someone healthcare is like denying a living human being the right to live out her natural life span.
• A critical reason for the weak public health in India is the absence of a statutory framework that guarantees a fundamental right to health. Implementing the right to health within India’s framework of cooperative federalism will build capacities where they are most needed – at the grassroots.
• According to Article 25(1) of Universal Declaration of Human Rights states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family” and India is a signatory to the declaration.
• Although the Indian Constitution does not expressly recognize the fundamental right to health, Article 21 of the Constitution of India guarantees a fundamental right to life & personal liberty. The expression 'life' in this article means a life with human dignity & not mere survival or animal existence.
• Given no explicit recognition of the right to health or healthcare under the Constitution, the Supreme Court of India in Bandhua Mukti Morcha v Union of India & Ors interpreted the right to health under Article 21 which guarantees the right to life. 
• The Directive Principles of State Policy in Part IV of the India Constitution provide a basis for the right to health. Article 39 (E) directs the State to secure health of workers, Article 42 directs the State to just and humane conditions of work and maternity relief, Article 47 casts a duty on the State to raise the nutrition levels and standard of living of people and to improve public health.
• In September 2019, a High-Level Group on the health sector constituted under the 15th Finance Commission had recommended that the right to health be declared a fundamental right.
• Making health a fundamental right would thus give citizens the power to hold the state accountable for fulfilling its responsibility toward them.
• Recently, Rajasthan has introduced the ‘Rajasthan Model of Public Health’ (RMPH), wherein a Right to Health Bill will be brought, and the state will take measures towards Preventive Care, Primary Care and Curative Care as envisioned by the World Health Organisation (WHO).
• If health is a fundamental right, it will give a spine to the entire health ecosystem, empower doctors and healthcare workers, and ensure transparency, inclusivity, and accountability in healthcare.
• Moreover, it will pave the way for special legislation, capable institutions, increased budgets, medical training and research, wellness and prevention, and outreach of services; thereby instilling immense confidence and positivity amongst the citizens. 
• The example of creating a fundamental right to education through a constitutional amendment and its ensuing success has set a guiding precedent for healthcare to be made as a fundamental right as well.

But at the same time, granting the status of a fundamental right to health comes with its own share of impediments and constitutional challenges as discussed below:

• Making health as a fundamental right will need massive investments without which the infrastructure necessary to ensure public health can’t be created. Successive central and state governments have been neglecting health so much so that India spends one of the lowest shares of the GDP on health.
• It is necessary to provide sufficient resources to build and develop a vast network of infrastructure in the field of health care. Given the situation in the country’s densely populated States like Uttar Pradesh, Bihar, West Bengal and Odisha, a lot of work is required to be done.
• Making it a fundamental right will require shifting health to the Concurrent List which will lead to a constitutional conundrum on whether the centralization of public health will be helpful in the context of Indian cooperative federalism.
• A 2019 NITI Aayog report highlighted that states in India had unequal public health systems. While fiscal dependence of states on the centre continues to be a major challenge, if the subject of health was moved to the Concurrent List, it would lead to excessive bureaucracy, red tape and institutional constraints. 
• India has been struggling with deficient infrastructure in the form of lack of well-equipped medical institutes for quite a while now. To add to it, the rate of building such medical teaching or training facilities remains less as compared to the need of the hour.
• One of the most pressing problems in India remains a severe shortage of trained manpower in the medical stream, this includes doctors, nurses, paramedics and primary healthcare workers. The situation remains worrisome in rural areas, where almost 66 per cent of India’s population resides.
• The doctor-to-patient ratio remains abysmally low, which is merely 0.7 doctors per 1,000 people. This is compared to the World Health Organisation (WHO) average of 2.5 doctors per 1,000 people. Even prior to the outbreak of the Covid-19 pandemic, healthcare facilities had been feeling the strain due to unmanageable patient-load.
• High out-of-pocket expenditure remains a stress factor while public hospitals offer free health services, these facilities are understaffed, poorly equipped, and located mainly in urban areas. It is a known fact that accessible and affordable healthcare in the public sector can considerably reduce the rise in dependence on private institutions.

Conclusion:

It is time for reconsidering the idea of declaring the right to health a fundamental right. Strong health laws will help build societal resilience to future pandemics and public health emergencies. Emergency responses can’t come at the cost of neglect of human rights obligations. The COVID19 experience has also demonstrated the importance of a decentralized/polycentric response – India’s co-operative federalism, therefore, must be strengthened.

Question #2. The advantages of demographic dividends can be reaped only if the Indian education system focuses on skill formation and vocationalisation of education to engage the young workforce in productive employment. Comment.

Approach:

• Define demographic dividend 
• Presenting the status of education system in India, discuss its importance in reaping
• benefits of demographic dividend
• Suggest measures to improve skill formation and vocationalisation of education along with
• steps taken by government in this direction
• Conclusion

Hint:

Demographic dividend, as defined by the United Nations Population Fund, is "the economic growth potential that can result from shifts in a population’s age structure, mainly when the share of the working-age population is larger than the non-working-age share of the population & quot;. Statistically 49.9% of India's population would be below 29 years in 2021, leading to the possibility of 650 million people (a large number of them English speaking) being in the employable age of 15-59 years in a decade from now meeting the requirements of both the domestic and world economies.

However, as the ‘pandemic generation’ joins the workforce in an economy that is failing to provide adequate employment opportunities to its current strength, India’s chances of levering upon its demographic dividends are soon becoming obscure. Issues that prevent India from reaping the benefits of demographic dividend are: Instead of contributing to economic growth, a big chunk of the new entrants to the labour force is adding to our unemployment statistics. UNICEF 2019 reports that at least 47% of

Indian youth are not on track to have the education and skills necessary for employment in 2030.

Despite the huge labour pool, employability continues to be a major concern in India mainly due to the absence of a proper linkage between the formal education system and vocational Training. High school dropout rates (up to 56.8%) and low turnout at the vocational training institutes add on to the challenge. According to a NSSO report, vocational training is received by only 10% of persons aged between 15-29 years. Out of this only 2% receive formal training, while non-formal training constitutes the remaining 8%. Out of the formal training received by that particular age group, only 3% are employed.

Today, a mere 2% of the Indian workers are formally skilled. In-service training is received by only 15% of workers in the manufacturing sector. A significantly large bulk of the labour force in India - about 93% - works in the unorganized sector, without any formal training.

An overhaul of education system is the need of the hour that would help in realising the fruits of demographic dividend not only on paper but also on ground. Following measures can help in this direction:

The Economic Survey 2019 calls for additional jobs to keep pace with the projected annual increases in the working age population. A workforce is needed that is well educated, and appropriately skilled.

Investment in education is crucial for ensuring that working-age people are prepared for the demands of the economy. As industry and services have come to have considerably larger roles, the need for an educated workforce has grown. The current public expenditure on education in India has been around 4.4 per cent of GDP and the NEP promises to take it up to 6%.

Irrespective of rural or urban setting, the public school system must ensure that every child completes high school education, and is pushed into appropriate skilling, training and vocational education in line with market demand.

Deploy new technology to accelerate the pace of building human capital by putting in place virtual classrooms together with massive open online courses (MOOCS) to help prepare this huge workforce for next-generation jobs.

Flexible entry and exit policies for women into virtual classrooms, and into modules for open digital training, and vocational education would help them access contemporary vocations. Economist Yogendra Alagh has written that the significance of this “deferred

bonus” (women entering the workforce), could be higher than the immediate benefits of the dividend from shifts in population age structure.

Mainstreaming of vocational education and skill development within the school system is the way forward. A new set of vocational teachers for specific trades and skills would need to be trained and appointed. State-of-the-art facilities, including equipment, for such

vocational education would need to be put in place.

Skill development is indispensable to economic development. No economic development is possible without good skill. A balanced skill system promotes not only economic development, but productivity, and generates individual income per capita. Thus there is a

need for concerted action in several key areas in order to ensure that skill formation takes place in a demand driven manner. To get the desired demographic dividend, Indian policymakers need to identify which skills are in demand, and also the strongest growing sectors of the economy, both in manufacturing and modern services. Skill enhancement and training for the acquisition of these skills should be the focus of educational and employment programmes. Curriculum for skill development has to be reoriented on a continuing basis to meet the demands of the employers/industry and align it with the available self-employment opportunities. Accreditation and certification system has to be improved.

There is a need to establish an institutional mechanism for providing access to information on skill inventory and skill maps on a real time basis. 

Steps taken by government for improving India’s parameters on vocational education and skills training scale are as follows:

The National Educational Policy 2020 speaks at length about the measures to be taken by the ministry in the field of vocational education. It says that the scope of school education will be broadened to facilitate multiple pathways to learning, involving both formal and non-formal education modes. Also it advocates the removal of separation between vocational and academic streams, and students will be given increased flexibility and choice of subjects to study, particularly in secondary school—including subjects in the arts and crafts, physical education and vocational skills

To implement this, the Ministry of Education will constitute a National Committee for the Integration of Vocational Education (NCIVE), consisting of experts in vocational education and representatives from across ministries in collaboration with industries.

To stimulate and support reforms in skills development and to facilitate nationally standardized and acceptable, international comparability of qualifications, a “National Vocational Qualifications Framework” (NVQF) is being established by the government.

The Centrally Sponsored Scheme of Vocationalisation of Secondary Education envisaged the selection of vocational courses on the basis of assessment of manpower needs.  MHRD had launched a scheme on Skill Assessment Matrix for Vocational Advancement of

Youth (SAMVAY) for Credit Framework to support students mobility under National Skills Quality Framework (NSQF). Scheme for Higher Education Youth in Apprenticeship and Skills (SHREYAS) is a central government scheme for providing industry apprenticeship opportunities to the general graduates through the National Apprenticeship Promotional Scheme (NAPS).  Ministry of Skill Development and Entrepreneurship (MSDE) intends to establish visible and aspirational Model Training Centres (MTCs) in every district of the country called as Pradhan Mantri Kaushal Kendra ( PMKK ) Pradhan Mantri Kaushal Vikas Yojana (PMKVY) is a skill development initiative scheme of the Government of India for recognition and standardisation of skills.

Conclusion:

India needs to facilitate the absorption of labour into productive employment, promote relevant programmes and policies, and have well-trained people in place to reap benefits of demographic dividend. If the government wants to reap the benefits of the dynamic workforce, it will need to completely refocus its education policies and work closely with states to fix the education system focusing on vocational and skills training. Only through a robust education system, leveraging the full potential of its demographic dividend, India can take a giant leap towards establishing itself as a knowledge superpower.