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Government of India

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August 2018

In the Wellness of All Things

By Amitabh Kant & Dr. Indu Bhushan

The sight of a family teetering on the brink of hope and despondency, surviving and falling into economic ruin on account of ill health is distressingly common. GoI’s health expenditure at 1.13% of its GDP is the lowest among the emerging developing countries. China’s expenditure is 2.45%, and Thailand’s 2.90% of its GDP.

Out-of-pocket expenses push nearly 66 lakh Indian households into poverty every year. About 24.9% of households in rural areas and 18.2% in urban areas meet medical expenditures through borrowings, and 17.3% of India’s population spend more than 10% of their household budget for accessing health services. The poorest of the poor are the worst impacted.

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Ayushman Bharat demonstrates GoI’s strong resolve to address this issue by ensuring primary healthcare through the establishment of 1,50,000 health and wellness centres, the first of which was launched in Bijapur, Chhattisgarh, in May. Digitally linked to district hospitals, these will provide comprehensive healthcare and will be responsible for providing essential drugs and diagnostic services. They will also have convergence with yoga and Ayurveda.

The second key component of Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana (PMJAY) that will provide. Rs 5 lakh cover to around 50 crore economically weaker citizens and will be launched on September 25. This will be the world’s largest government-sponsored healthcare scheme covering a populationthe size of the US, Canada and Mexico.

 

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The mission will provide inpatient care in an empanelled network of healthcare providers (secondary and tertiary care) for more than 1,300 packages in specialties, ranging from general medical and surgical procedures to cardiovascular and oncological ones. The benefits shall be available to all those entitled and be cashless, paperless, portable, and backed by an IT infrastructure that will provide seamless service delivery at all points of care.

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PMJAY will leverage capacities available in both public and private sector hospitals, while providing standardised high-quality care, with strong fraud protection mechanisms and an efficient, service-driven architecture that will transform India’s healthcare systems in the years to come.

The National Health Agency (NHA) and the State Health Agencies (SHAs) are the keystone for the strategic purchasing of medical services at such a massive scale. NHA will be the instrumentality to expand coverage, benefits and financial protection.

As a substantive purchaser implementing PMJAY, NHA and SHAs will use the tools of pricing and incentives to drive down costs of services in the healthcare sector. The rates that have been fixed for the procedures have undergone a rigorous vetting mechanism in more than 50 cities in the country.

PMJAY will rely heavily on fraud detection and monitoring and building complex, intelligent systems that trigger and raise red flags on suspicious transactions, built upon extensive diagnostic guidelines and self-learning pattern-recognition algorithms.

The aim is to build a world-class intelligent system for fraud mitigation, grievance redressal, monitoring and evaluation, and research that allows the programme to scientifically evolve. Pre-authorisation protocols have been defined for 621fraud-prone and high-cost procedures for ensuring discipline in the provider network.

The states are the key partners in this alliance. The scheme architecture allows the states freedom for innovations and context-specific customisations. Till date, 29 of the 36 states and Union territories are on board. The states have been given flexibility to push for providing greater inpatient department (IPD) care through public institutions, as well as a framework for upgrading their infrastructure. The portability of services across a pan-India network provides beneficiaries in the migrant community to access services without hindrances.

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PMJAY will be a truly disruptive influence over India’s healthcare system. It presents India an opportunity to move towards a mature, data-driven, intelligent and predictive health systems built on top of individualised, secure and access-controlled health records, a verified provider registry and tech-enabled drugs and diagnostics supply chains.

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India, through health and wellness centres, is finally shifting the focus of healthcare provision towards providing primary healthcare to its citizens. The care on prevention and early management of healthcare will reduce the need for complicated specialist care and outof-pocket expenses.

While catering to 50 crore beneficiaries, PMJAY will leverage facilities in both private and public hospitals. This comprehensive healthcare system linking primary, secondary and tertiary care has the potential to transform the health delivery system in India.

Union Minister J P Nadda launches the official logo of Pradhan Mantri Jan Arogya Yojana, in New Delhi on August 27, 2018.

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*Amitabh Kant is CEO, NITI Aayog, and Dr. Indu Bhushan is CEO, Ayushman Bharat-National Health Protection Mission (AB-NHPM) and the National Health Agency (NHA).

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Demonetisation and its impact on Tax collection and Formalisation of the Economy – Arun Jaitley

 

The Reserve Bank has twice released its reports stating that the demonetised Notes of `500 and `1000 have been substantially deposited in the Banks.  A widely stated comment has been that just because most of the currency came back into the Banks, the object of Demonetisation has not succeeded.  Was the invalidation of the Non-deposited currency the only object of demonetisation?  Certainly Not.  The larger purpose of demonetisation was to move INDIA from a Tax Non-compliant society to a compliant society.  This necessarily involved the formalisation of the Economy and a blow to the black money.  How has this been achieved?

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  • WHEN cash is deposited in the Banks, the anonymity about the owner of the cash disappears.  The deposited cash is now identified with its owner giving rise to an inquiry, whether the amount deposited is in consonance with the depositor’s income.  Accordingly, post demonetisation about 1.8 million depositors have been identified for this enquiry.  Many of them are being fastened with Tax and Penalties.  Mere deposit of cash in a bank does not lead to a presumption that it is Tax paid Money.

  • In March 2014, the number of Income Tax returns filed was 3.8 crores.  In 2017-18, this figure has grown to 6.86 crores.  In the last two years, when the impact of demonetisation and other steps is analysed, the Income Tax returns have increased by 19% and 25%.  This is a phenomenal increase.

  • The number of New Returns filed post demonetisation increased in the past two years by 85.51 Lakhs and 1.07 crores.

  • For 2018-19, advance Tax in the first quarter has increased for personal Income Tax Assesses by 44.1% and in the Corporate Tax category by 17.4%.

  • The Income Tax collections have increased from the 2013-14 figure of `6.38 Lakh crores to the 2017-18 figure of `10.02 Lakh crores.

  • The growth of Income Tax collections in the Pre-demonetisation two years was 6.6% and 9%.  Post-demonetisation, the collections increased by 15% and 18% in the next two years.  The same trend is visible in the third year.

  • The GST was implemented from 1st July, 2017 i.e. Post demonetisation.  In the very first year, the number of registered assesses has increased by 72.5%.  The original 66.17 Lakh assesses has increased to 114.17 Lakhs.

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This is the positive impact of the Demonetisation.  More formalisation  of the Economy, More Money in the System, Higher Tax Revenue, Higher Expenditure, Higher Growth after the first two quarters.

 

Ayushman Bharat off to a good start

As many as 28 state governments have signed MoUs with the NHA to implement NHPM. Over 8,000 hospitals have offered to join the network of empanelled facilities that would provide inpatient care to the identified beneficiaries, and 1,350 medical packages—covering surgery, medical and daycare treatments—have already been identified.

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Nearly 3,000 years ago, one of ancient India’s great sages Yajnavalkya composed the Shanti Sukta: “Sarve bhavantu sukhinah; Sarve santu niramayah” (May all be happy, may everyone be free of diseases). What is striking is not only the prescience and universality of this invocation, but also the insight that happiness and health in a populace are inextricably intertwined.

Today, as we reflect upon the journey of India as an independent nation over the last seven decades, the achievements on the health front have not been insubstantial. The life expectancy has more than doubled, and infant and maternal mortality rates are a fraction of what prevailed in 1947. However, there can be no denying the fact that a lot of potential in this sector remains unharnessed—and ill-health is one of the leading causes of Indians falling into poverty. The government spends barely 1% of the GDP on health even as we are confronted with a two-front war—containing the rising burden of non-communicable diseases (NCD), even as we continue grappling with the control of communicable diseases and reproductive and child health issues. As a result, the citizens’ out-of-pocket (OOP) expenditure on health constitutes 62% of the total expenditure on health, placing India at 182nd position out of 191 countries on this indicator.

In fact, over 55% of this expenditure is on outpatient care, of which drugs constitute the biggest component. Expectedly, this structure of health financing places a disproportionate burden on the poor families and catastrophic health expenses have contributed to an increase in poverty levels in rural and urban areas by 3.6% and 2.9%, respectively.

Mindful of this reality and to plug the existing gaps in our health system, the government announced a new flagship scheme called the Ayushman Bharat in the Union Budget of 2018-19. One component of the scheme—the National Health Protection Mission (NHPM)—was to provide a financial cover of up to `5 lakh per family per annum to enable them increased access to secondary and tertiary healthcare, for the poor and lower middle class families, in a facility of their choice, irrespective of whether the ownership is public or private. As an initial measure, the plan is to cover 10.74 crore families, or about 50 crore individuals (roughly 40% of the total population), at the bottom of the pyramid as identified through a comprehensive Socio-Economic Caste Census (SECC) database.

The other component is to build a next-generation primary healthcare system, which would be publicly provided at locations close to the community. It sought to expand the reach and broaden the scope of our primary, preventive and promotive care through a network of 1.5 lakh Health & Wellness Centres (HWCs). It envisages population-level screening to detect diseases early and initiate timely treatment—which is especially critical in the context of India’s rising NCD burden. As an added measure, provision of free drug and diagnostics at these HWCs was expected to take care of that part of the OOP expenses borne by our poorest citizens for accessing outpatient care. The first of such HWCs has already been launched in the Bijapur district of Chhattisgarh, by the Prime Minister on April 14, and as we write this, work is going on in hundreds of others in the 117 ‘aspirational districts’ to provide meaningful and comprehensive primary care to our citizens.Image result for ayushman bharat pib

When the Ayushman Bharat was announced, critics argued that the scheme has been insufficiently imagined, that there was a lack of preparation, that it was not backed by adequate budgetary resources, and that the government lacked the techno-managerial wherewithal for its implementation. The Prime Minister, during his Independence Day address, gave a befitting response to the scepticism and to the naysayers by announcing the soft launch of NHPM, christened the Pradhan Mantri Jan Arogya Abhiyan. This clarion call from the ramparts of the Red Fort is a clear indication that the teams at the National Health Agency (NHA) and the ministry of health & family welfare (MoHFW) have been able to successfully surmount the significant challenges in terms of creating an IT backbone, cleaning up the beneficiary database, setting in place the guidelines and procedures, negotiating with state governments, while simultaneously building capacities for its implementation. The fact that all this has been achieved in a relatively short span of just six months is a glowing testimony to the hard work and speedy execution by Indu Bhushan and his team at the NHA.

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In addition, as many as 28 state governments have signed a memorandum of understanding with the NHA to implement NHPM, and are in the final stages of preparation for a formal launch. Over 8,000 hospitals have offered to join the network of empanelled facilities that would provide inpatient care to the identified beneficiaries. To ensure that no one is left out, there is no cap on family size or age. Similarly, there can be no exclusion on account of pre-existing disease conditions, among those who are eligible for benefits from day one of the roll-out of the scheme. As many as 1,350 medical packages—covering surgery, medical and daycare treatments—have been identified so that the coverage includes most of the common medical conditions. The software application driving the scheme is designed in such a way that an individual can avail of the benefits anywhere in the country irrespective of her place of origin, and it is cashless for the beneficiary and the claim settlement is paperless for the hospitals participating in the scheme.

 

The NITI Aayog’s Three-Year Action Agenda highlights the need for creating a wave of new institutions to build a 21st century health system that every citizen of the country would be proud of. Setting up of HWCs and the NHA are steps in the right direction, which were long overdue. The government’s active stewardship in leveraging the potential of the mixed health system is a very welcome development. It is all the more heartening to note the political commitment at the highest levels to transform India’s health system into an affordable, accessible, inclusive and efficient system.

The Ayushman Bharat has the potential to protect millions who are pushed into poverty every year due to catastrophic health expenses. Building a well-functioning health system is a work of decades—it took Germany, for example, 127 years to accomplish universal coverage. Thailand undertook reforms over a period of 30 years prior to announcing its universal health policy in 2002. Now that we have unprecedented political backing for the Pradhan Mantri Jan Arogya Abhiyan, the stage is set for its execution. Needless to say, in a country as large and complex as India, we will be faced with many implementation challenges. It is well worth recounting the Bhagavad Gita dictum of “Yogah Karmasu Kaushalam” (the path to redemption/salvation lies in the skilful execution of the job at hand). Thus, it is imperative we stay the course and pursue these ambitious initiatives with utmost vigour and determination.

4GG8U3jG_400x400.jpgAlok Kumar is Advisor and Vinod Paul is Member (Health), NITI Aayog.

Science City, Kolkata becomes the new insignia of Digital India with its state of the art hi-tech acquisitions

*Sh. Samrat Bandopadhyay

Nestled in the throbbing business arterial route of EM Bypass in Kolkata, the Science City of Kolkata is the largest science center of the Indian subcontinent and one of the finest in the world. Managed by National Council of Science Museums (NCSM), Ministry of Culture, Government of India, the first phase of the centre was thrown open to public in 1997 and the second phase in 2010. The sprawling green campus presenting Science and Technology in a stimulating and engaging manner to visitors of all age groups, including children, is actually built on a previous landfill area of the city. The environment conscious institute today is a place to experience and relive the living history and traditional culture of bygone days. The solid waste management here is also an example for building structures on an eco-friendly and environmentally sustainable basis.

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Science City is the place where visitors throng to cherish and relive the ambience of excitement of dinosaur era in the ‘Evolution Park’ as one walks through the evolutionary phases of life and has a glimpse of those gigantic extinct animals of the past.

The Age of Science and Technology has grown by leaps and bounds. Central Government’s tremendous efforts towards a ‘DIGITAL INDIA’ find a living example in this vibrant learning campus. The digital technology opens a plethora of opportunities for visitors to experience living moments, expositions and immersive images with extraordinary variety.

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The decision of the Culture Ministry to provide a facelift to the existing 2D theatre replacing it with a 3D full dome space theatre system with a particularly high resolution imagery and state-of-art LED dome lighting, sound system along with comfortable seating arrangement, will provide an enthralling and vivid experience that will be etched in visitors’ minds even after leaving the campus of Science City. Scientific phenomena explained through a narrative are set to appeal to the young minds of the country. The erstwhile Space Theatre was first of its kind facility in the country that attracted around 7.2 million footfalls during its operation for two decades. The Ministry of Culture’s plan to fund about 20 cr for the switch from existing 2D celluloid based film projection system to a 3D digital immersive projection system for the theatre will augment a new chapter in its modernization approach and capture the eyeballs of the visitors to a new unprecedented level. The fully built technologically advanced dome will have the scope to display wide range of topics from astronomy, geosciences to other natural scientific phenomena. The Facility which will be ready for visitors by December of 2018 will certainly be a milestone in the field of scientific explorations.

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The renovation of the Science City will be a value add-on to the learning experience for sightseers with a scientific temper and an enduring appreciation for the innovativeness of engineering marvels by architecture professionals and civil engineers of the region. A case in point is the ‘DYNAMOTION’ building architecture, which houses a plethora of interactive exhibits on physical science, along with a unique experience of walking on the floor piano and creating mesmerizing music as one walk past the space.

In the Science Park, people come close to nature with flora and fauna in an environment friendly surrounding and help learn and synergize the basic tenets of science in an all-inclusive manner. The Park’s interactive exhibits are simulative to that learning experience of our age old tradition and interactive kiosks with multimedia facility are an add-on to the learning experience.

Another striking section of Science City is the ‘Digital Panorama on Human Evolution’ which provides a 360 degree view of a narrative in a video format in a huge cylindrical screen. Started in 2016 it is the first of its kind in the country. The presentation hall presents exhibits and mannequins depicting pre-historic human species with varied flora and fauna of those times. There is an awe-inspiring feeling of moving in a space ship as one gazes at the screen unfolding all around. The Science and Technology Heritage of India exhibition gallery houses dioramas exhibiting emerging technologies over the ages with a special focus on mathematics, basic science and scientific development of Metallurgy, Information Technology, Medical Science and town planning of ancient India. The curator of this fascinating exhibition put special emphasis on the fact that the Indian Civilization dated back more than 7000 years while all other civilizations of the world are less than 5000 years old.

The Science City of Kolkata resembles a living architecture of a modern era, typifying a blend of ‘SMART CITY’ with ‘DIGITAL INDIA’ and ethos of ‘MAKE IN INDIA’ built and weaved on the fabric of culture and tradition of the rich and diverse heritage of modern ‘NEW INDIA’!!

*Sh. Samrat Bandopadhyay is Deputy Director (M&C), PIB, Kolkata

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