General Studies Paper 3

Context: Under the highly ambitious National Green Hydrogen Mission, India intends to be “the Global Hub for the Production, Use, and Export of Green Hydrogen” and “to assume technology and market leadership.” The mission’s goal is to generate 5 million tonnes of green hydrogen for domestic use.

Green hydrogen is a clean energy source produced through the electrolysis of water using renewable energy sources such as wind, solar, and hydro power. It has the potential to become a key player in the transition to a carbon-free economy and can help mitigate climate change. The hydrogen produced can be stored and used as a fuel for transportation, industry, and agriculture.

What are the Reasons to Develop Green Hydrogen?

• Reducing Greenhouse Gas Emissions: 
  • The primary reason for developing green hydrogen is to reduce greenhouse gas emissions and mitigate climate change. The use of fossil fuels for transportation and electricity generation is a major contributor to global emissions.
  • Green hydrogen, produced from renewable sources, emits zero greenhouse gases, making it a sustainable and environmentally friendly energy source.
• Energy Security and Independence: 
  • Fossil fuels are a finite resource,and their prices can fluctuate due to global supply and demand. By developing renewable energy sources like green hydrogen, countries can become more energy-independent and less vulnerable to price shocks and supply disruptions.
• Creating New Industries and Jobs: 
  • The development of green hydrogen can create new industries and jobs, particularly in the renewable energy sector. The production, storage, and distribution of green hydrogen require specialized expertise and infrastructure, which can generate employment opportunities.
  • According to the International Renewable Energy Agency (IRENA), the renewable energy sector employed 11 million people worldwide in 2018and is expected to create more than 42 million jobs by 2050.
• Decarbonizing in Sectors which are Difficult-to-Decarbonize: 
  • The potential to substitute fossil fuels with green hydrogen is significant, especially in sectors that are difficult to decarbonize, such as heavy industry and aviation. These sectors contribute significantly to global emissions, and the use of green hydrogen can help reduce their carbon footprint.
• Technological Advancements: 
  • The development of green hydrogen can drive technological advancements and innovations in various sectors. The production, storage, and distribution of green hydrogen require new technologies and infrastructure, which can spur the development of new materials, processes, and systems.

What are the Applications of Green Hydrogen?

• Agriculture Sector: 
  • Green Hydrogen as Replacement to Fossil Fuel in Agriculture:
    • Green hydrogen has the potential to replace traditional fertilizers in agriculture through the production of ammonia using renewable energy sources.
    • Ammonia is a key ingredient in the production of fertilizers,and the current production process relies on natural gas, which is a fossil fuel and contributes to greenhouse gas emissions.
    • Green ammonia produced with help of green hydrogen is carbon-free, green ammonia has other benefits over traditional fertilizers, including improved efficiency and reduced soil acidity.
      • However, the production of green ammonia at scale will require significant investment in infrastructure and the development of new technologies. Currently, the production of green ammonia is more expensive than traditional ammonia production, which may limit its adoption in the short term.
    • Green Hydrogen-Powered Farm Machinery: 
      • Farm machinery like tractors, harvesters, and irrigation systems require a lot of energy to operate. Green hydrogen-powered farm machinery can significantly reduce greenhouse gas emissions while still delivering the power required to carry out essential farm tasks.
    • Green Hydrogen for Water Management: 
      • Water is a precious resource, and managing it efficiently is critical for sustainable agriculture. Green hydrogen can be used to power desalination plants that convert saltwater into freshwater, reducing our reliance on scarce freshwater resources.
    • Transport Sector: 
      • Hydrogen Fuel Cell:
        • A hydrogen fuel cell is a device that converts the chemical energy of hydrogen and oxygen into electricity, water and heat.
        • Hydrogen fuel cell vehicles produce zero emissions, making them an attractive alternative to gasoline and diesel-powered vehicles.They have a longer range than battery electric vehicles and can be refuelled in minutes, making them more convenient for long-distance travel.
      • Industrial Sector: 
        • Cost Savings: 
          • The production of green hydrogen can be done using excess renewable energy that is produced during off-peak hours. This excess energy can be used to produce green hydrogen, which can then be stored and used when the energy demand is high.This can help to reduce the cost of energy and promote sustainable development.
        • Reliable: 
          • Green hydrogen can be produced and stored on-site, making it a reliable and consistent source of energy for industrial processes. This can help to reduce the dependence on the electricity grid and promote energy independence.
        • Reduction in Waste: 
          • Green hydrogen production can be done using waste materials like municipal solid waste and agricultural waste.This can help to reduce waste and promote sustainable development.
        • Increase in Energy Efficiency: 
          • Green hydrogen can be used to power fuel cells, which are more energy-efficient than traditional combustion engines. This can help to reduce energy consumption.

What are the Difficulties in Green Hydrogen Implementation?

• Cost: 
  • The cost of green hydrogen is currently high compared to traditional fossil fuels.The production, storage, and distribution of green hydrogen require specialized equipment and infrastructure, making it more expensive than conventional fuels.
  • However, with advancements in technology and scaling up of production, the cost of green hydrogen is expected to decrease over time.
• Infrastructure: 
  • The widespread adoption of green hydrogen requires the development of a robust infrastructure for its production, storage, and distribution.
  • The infrastructure must be developed in a way that is compatible with existing energy infrastructure to facilitate the transition to green hydrogen.
• Energy Storage: 
  • Green hydrogen production is dependent on renewable energy sources like wind, solar, and hydro power. However, these sources are intermittent, meaning that their output can fluctuate over time.The development of effective energy storage solutions is critical to enable the widespread adoption of green hydrogen.
    • Energy storage solutions like batteries and hydrogen storage can store excess energy produced by renewable sources and provide a constant supply of green hydrogen.
  • Safety: 
    • Green hydrogen is a highly flammable gas that requires special handling and storage.
    • The development of proper safety protocols and regulations is crucial to ensure the safe handling and storage of green hydrogen.
  • Public Acceptance:  
    • The public acceptance of green hydrogen is crucial to its adoption.The public must be educated about the benefits of green hydrogen and its role in mitigating climate change. 

What are India’s Initiatives to Promote Green Hydrogen?

• India has recognized the potential of green hydrogen to decarbonize its economy and achieve its climate goals. The country has launched several initiatives and policies to promote the production, utilization and export of green hydrogen.
• Some of the key initiatives are:
  • National Hydrogen Mission: 
    • The mission was announced in the Union Budget 2021-22 and aims to make India a global hub for green hydrogen and its derivatives.
    • The mission will also facilitate demand creation, pilot projects, R&D, skill development, standards and regulations, and policy framework for green hydrogen.
  • Green Hydrogen Consumption Obligations: 
    • The Ministry of New and Renewable Energy (MNRE) has proposed to introduce green hydrogen consumption obligations for fertilizer and the petroleum refining industry, like the renewable purchase obligations for electricity distribution companies.
      • The obligations will require these industries to consume a certain percentage of green hydrogen in their total hydrogen consumption.
    • Green Hydrogen Hubs: 
      • The MNRE has identified regions that can support large scale production and/or utilization of green hydrogen and develop them as green hydrogen hubs.

What Should be the Way Forward?

• High Cost of Production and Utilization:
  • Green hydrogen is currently more expensive than conventional hydrogen produced from fossil fuels or other low-carbon sources, such as nuclear or blue hydrogen.So, to address this issue, there is a need to develop efficient technologies that can reduce the production cost of green hydrogen.
    • One promising approach is to use more efficient electrolysis systems that require less energy to produce the same amount of hydrogen.This can be achieved using advanced materials for the electrodes or the use of more efficient catalysts.
    • Another approach is to integrate green hydrogen production with other renewable energy technologies such as wind or solar farms.This can reduce the cost of electricity used in the electrolysis process, making green hydrogen more competitive with conventional hydrogen.
  • Implement Regulatory Incentives:
    • The government can play a key role in promoting the adoption of green hydrogen by implementing regulatory incentives, such as tax credits and subsidies,to encourage the production and use of this technology.
  • Lack of Adequate Infrastructure and Supply Chain:
    •  Green hydrogen requires dedicated infrastructure and supply chain for its production, storage, transport and distribution.
      • The existing infrastructure and supply chain for conventional hydrogen are not sufficient or compatible for green hydrogen, efficient and cost-effective supply chain must be developed.
    • Coordination Among Various Stakeholders and Sectors: 
      • Green hydrogen involves multiple stakeholders and sectors across the value chain, such as renewable energy producers, electrolyser manufacturers, hydrogen producers, transporters, distributors and end-users.
        • There is a need for coordination among these stakeholders and sectors to ensure alignment of policies, standards, regulations, incentives and markets for green hydrogen.
      • Awareness and Capacity Building among Potential Users and Producers: 
        • Green hydrogen is still a developing technology that requires awareness and capacity building among potential users and producers.
        • There is a need to demonstrate the benefits, safety and feasibility of green hydrogen in various applications and sectors.
        • There is also a need to develop skills and competencies for green hydrogen production and utilization.

General Studies Paper 2

Context:

• Food security has been a long-standing concern for India, given its large population and limited resources. Access to safe and nutritious food has been considered a fundamental right  for all citizens, and successive governments have implemented policies to ensure food availability and affordability.
• However, the link between food security and national security has become increasingly evident in recent years. India’s vulnerability to climate change, its dependence on food imports, and the growing threat of food-related conflicts have raised alarm bells about the country’s food security.
• The connection between national security and access to food was emphasized when the Norwegian Nobel Committee granted the World Food Program the Nobel Peace Prize in 2020, acknowledging its endeavors to address hunger. The committee specifically acknowledged the correlation between hunger, peace, and conflict.
• A lack of food security can contribute to a variety of threats to national security, including civil unrest, political instability, and conflict. In this context, it becomes crucial to explore the connection between food security and national security in India and the measures required to strengthen the country’s food system.

Why Ensuring Food Security is Important for India?

• Meeting the Nutritional Needs of the Population:
  • India is home to a significant population that is malnourished or undernourished,which affects their physical and mental growth. Ensuring food security means that people have access to nutritious food to meet their dietary needs.
    • According to the Global Food Security Index 2022, India has a prevalence of under nutrition of 16.3%. Further, 9% of children in India are stunted, 33.4% are underweight, and 3.8% are obese.
    • According to the Human Development Report 2021-22, India’s rank on the Human Development Index (HDI) has slipped from 130 in 2020 to 132 in 2022.
  • Supporting Economic Growth:
    • Agriculture is a crucial sector that contributes significantly to India’s economy. By ensuring food security, the government can support farmers and increase their income, which can help drive economic growth.
      • Agriculture is essential in ensuring that India achieves its national food security goal.
      • With over70% of the population engaged in agriculture-related activities, it is the backbone of India’s economy.
    • Reducing Poverty:
      • Food security can play a vital role in reducing poverty levels.By providing access to affordable and nutritious food, people can better manage their expenses, reduce their healthcare costs, and improve their overall quality of life.
        • According to Global Multidimensional Poverty Index MPI 2022, India has by far the largest number of poor people worldwide at 22.8 crore, followed by Nigeria at 9.6 crore.
      • Ensuring National Security:
        • Food security is also essential for India’s national security.A stable food supply can prevent social unrest and political instability, which can threaten national security.
      • Combating Climate Change:
        • Climate change poses a significant threat to India’s food security. By adopting sustainable farming practices and investing in climate-resilient crops,India can better adapt to the changing climate and ensure food security for its population.
          • The International Food Security Assessment for 2022-2032 conducted by GFA-33 USDA, Economic Research Service indicates that India’s large population has a significant impact on food insecurity trends.It is projected that around 333.5 million people will be affected in India during 2022-23.
          • By the next decade, the number of food-insecure people in India is projected to decrease to 24.7 million.

What are the Related Initiatives taken?

• National Food Security Act (NFSA) 2013:
• It ensures access to affordable and good-quality food by subsidizing food grains to those below the poverty line.
• National Food Security Mission:
• It was launched in 2007, as a Central Sector Scheme (CSS)to increase food production and productivity through area expansion and productivity enhancement interventions in rice, wheat, pulses, oilseeds, etc.
  National Agriculture Market (e-NAM) Platform:
• It is an online marketplace for farmers to trade their products without geographical boundaries.
• National Food Processing Mission:
• The Government introduced the National Food Processing Mission to promote agri-based industries for efficient use of farm produce and reduce post-harvest losses.

Other Policies:

• Minimum Support Prices (MSP) for Agricultural products
• Pradhan Mantri Fasal Bima Yojana (PMFBY)
• National Horticulture Mission

What are the Challenges of Food Security in India?

• Inadequate Infrastructure:
  • Inadequate infrastructure such as inaccessible roads, lack of modern storage technologies, and limited access to credit make it difficult for farmers to transport their produce to the market and store them properly. This leads to high wastage and lower profits for farmers.
• Poor Agricultural Practices:
  • Poor agricultural practices like over-cultivation, excessive use of pesticides, and improper irrigation techniques have led to decreased soil fertility and reduced crop yields. This, in turn, affects food production and availability.
• Extreme Weather Conditions:
  • The extreme weather conditions due to climate change have also caused crop failures and food shortages. Floods, droughts, and heatwaves are becoming more frequent and intense, which affects food production and increases food prices.
• Inefficient Supply Chain Networks:
  • Inefficient supply chain networks, including inadequate transportation, storage, and distribution facilities, also contribute to food insecurity in India. This leads to higher prices for consumers and lower profits for farmers.
• Poor Market Infrastructure:
  • Poor market infrastructure, including a lack of market information, low market transparency, and limited access to markets,also contributes to food insecurity in India.
• Fragmented Landholdings:
  • Fragmented landholdings, where farmers own small and scattered plots of land, make it difficult to adopt modern farming practices and technologies. This, in turn, affects food production and availability.

What Should be the Way Forward?

• Investing in Agriculture Production Systems and Research:
  • The government should invest in modern irrigation systems, agricultural research, and development of high-yielding crop varieties to increase agriculture production.
• Improving Storage Facilities for Perishable Commodities:
  • The government should develop adequate storage facilities to prevent post-harvest losses and ensure the availability of food throughout the year.
• Providing Efficient Transportation Networks:
  • The government should invest in transportation networks for distributing food products across the country to ensure the timely distribution of food products across the country.
• Practicing Modern Agriculture Techniques:
  • The government should conduct awareness campaigns to educate farmers about modern agriculture techniques that can increase crop yields and improve their income.
• Prioritizing Agricultural Development:
  • The government should prioritize agricultural development by investing in improved market infrastructure, efficient transportation networks, and better storage facilities for food products.
• Promoting Public-Private Partnerships:
  • The government should promote partnerships between the public and private sectors to improve agricultural productivity and ensure the availability of food products.
• Creating an Early Warning System:
  • The government should develop an early warning system to detect and respond to food shortages before they become widespread.
• Encouraging Sustainable Agriculture Practices:
  • The government should promote sustainable agriculture practices that preserve soil health and reduce the use of harmful pesticides and fertilizers.

General Studies Paper 2

Context: Recently, Japan has approved Official Development Assistance (ODA) to India, for a few Key projects.

• India and Japan have had a long and fruitful history of bilateral development cooperation since 1958. In the last few years, the economic cooperation between India and Japan has steadily progressed.

What are the Key Projects under ODA?

• Patna Metro Rail Construction Project:
  • 5,509 crores have been approved for Patna Metro Rail Construction Project (I).
  • It aims to cope with the increase of traffic demand in Patna by constructing the new metro corridor, thereby contributing toimprovement of the urban environment and development of the economy as well as mitigation of  Climate Change.
• Forest and Biodiversity Conservation in West Bengal:
  • 520 crores approx. have been approved for the Project for Forest and Biodiversity Conservation for Climate Change Response in West Bengal.
  • It aims to mitigate and adapt to climate change, conserve and restore ecosystems by ecosystem-based climate change measures,biodiversity conservation and restoration, thereby contributing to sustainable socio-economic development in the State.
• Rajasthan Water Sector Livelihood Improvement Project:
  • 1,055.53 crores have been approved for Rajasthan Water Sector Livelihood Improvement Project (II).
  • It aims to improve livelihoods of farmers as well as promote gender mainstreaming in agriculture and irrigation sector in the State, by improving water use efficiency and agriculture productivity, through improvement of existing irrigation facilities and agriculture support services.

What are the Other ODAs to India from Japan?

• Delhi Metro is one of the most successful examples of Japanese cooperation through the utilization of ODA.
• India’s Western Dedicated Freight Corridor (DFC) project is funded by a soft loan provided by Japan International Cooperation Agency under Special terms for economic partnership (STEP).
• Besides, Japan and India had committed to build High-Speed Railways in India by introducing Japan’s Shinkansen System.
• India Japan Nuclear Deal 2016will help India build the six nuclear reactors in southern India, increasing nuclear energy capacity ten-fold by 2032

General Studies Paper 2

Context:

India’s G20 presidency would play an important role in promoting individual and collective actions to facilitate the transition towards a sustainable blue economy.

G20 countries & significance of oceans

• The G20 countries together account for around 45% of the world’s coastlines and over 21% of the exclusive economic zones (EEZs).
• The oceans are the
  • reservoirs of global biodiversity,
  • critical regulators of the global weather and climate, and
  • support the economic well-being of billions of people in coastal areas.
• Blue economy:
  • The term ‘blue economy’ includes not only ocean-dependent economic development, but also inclusive social developmentand environmental and ecological security.

G20 & initiatives for blue economy

• Over the last decade, the G20 forum has discussed some specific ocean-related issues. These include
  • The G20 Action Plan on Marine Litter,
  • The Osaka Blue Ocean Vision, and
  • The Coral Research and Development Accelerator Platform.
  • In 2022, holistic discussions on blue economy were initiated at the Ocean 20 launch in Bali.
• Environment and Climate Sustainability Working Group:
  • About:
    • As part of India’s G20 Presidency, theblue economy is articulated as a key priority area under the Environment and Climate Sustainability Working Group (ECSWG).
    • The first meeting of ECSWG marks the beginning of constructive discussions within G20 countries for a sustainable future, led by India’s G20 presidency.
      • This approach is consistent with Prime Minister’s call for the global adoption of ‘Lifestyle for the Environment’ that promotes mindful utilisation over mindless consumption patterns.
    • Aim:
      • The aim is to promote adoption of high-level principles that guide sustainable and equitable economic development through the ocean and its resources, while simultaneously addressing climate change and other environmental challenges.
    • Significance:
      • The G20 comprises a diverse group of countries with varying national circumstances.
      • Several G20 members have released their strategies for developing and/or expanding their blue economy.
      • This forum presents an excellent opportunity to build an effective communication with all stakeholders to share best practices, foster collaborations for advancements in science and technology, promote public-private partnerships, and create novel blue finance mechanisms.

Threats & responsibility

• The ambitious efforts by countries to expand their blue economies are being threatened by intensifying extreme weather events, ocean acidification, and sea level rise.
• Growing marine pollution, over-extraction of resources, and unplanned urbanisation also pose significant threats to theocean, coastal and marine ecosystems, and biodiversity.
• The inherent inter-connectedness of oceans implies that activities occurring in one part of the world could have ripple effects across the globe.
  • Therefore, the responsibility of their protection, conservation and sustainable utilisation lies with all nations.
• Since the blue economyinvolves a range of stakeholders and affects several other sectors of the national economy, effective and efficient ocean and blue economy governance also presents a significant challenge.

India’s initiatives the development of blue economy

• The Government of India has launched bold initiatives topromote the development of a blue economy.
  • TheSagarmala initiative promotes port-led development.
  • The Shipbuilding Financial Assistance Policy encourages domestic shipbuilding.
• The Pradhan Mantri Matsya Sampada Yojana is actively engendering a ‘blue revolution’ through sustainable and responsible development of the fisheries sector.
  • The Sagar Manthan dashboard tracks vessels in real-time.
  • TheDeep Ocean Mission explores deep-sea resources in the EEZ and continental shelf as well as development of technology for harnessing them.
  • India adopted the Coastal Regulation Zone notification to classify and better manage coastal regions and conserve ecologically sensitive coastal and marine areas including ecosystems.
• As the host of World Environment Day in 2018, India’s PM gave a clarion call to eliminate single-use plastic.
  • In 2022, the global community rallied together for a multilateral treaty on addressing plastic pollution.
• The same year, India introduced an amendment to the Plastic Waste Management Rules banning select single-use plastic items and introduced policies for extended producer responsibility in waste management in order to combat plastic pollution, including in the marine environment

Way ahead

• India’s commitment to prioritising oceans and the blue economy under its presidency would ensure continued discussions on this crucial subject and pave the way for future G20 presidencies.
• The outcomes of this forum must further inform other international negotiations under the United Nations Framework Convention on Climate Change, the Convention on Biological Diversity, the Intergovernmental Negotiating Committee on Plastic Pollution, the United Nations Convention on the Law of the Sea, etc., that are closely interlinked.
• The stewardship of oceans is an investment that will sustain future generations. The spirit of ‘One Earth, One Family, One Future’ must unite the global community for the well-being of our ocean commons.

General Studies Paper 2

Context: An agreement was signed recently between China and the Central American country of Honduras to establish diplomatic ties, after Honduras ended its diplomatic ties with Taiwan.

About

• China has never recognized Taiwan as an independent political entity, arguing that it was always a Chinese province under its “One China” policy.
• Despite the policy being a contentious issue between China and Taiwan for decades, Taiwan has been engaging in separatist activities for independence.
• Currently, only 13 countries recognize Taiwan, including Marshall Islands, Nauru, Palau, Tuvalu, Eswatini, Vatican City, Belize, Guatemala, Haiti, Paraguay, Saint Kitts and Nevis, Saint Lucia, and Saint Vincent and the Grenadines.

What is the One China Policy?

• The “One China” policy refers to the idea that China is one country, consisting of mainland China and
• It dates back to the origins of the country in 1949when the Mao Zedong-led Communist Party won the Chinese civil war and the nationalist Kuomintang fled to Taiwan and set up the government of the Republic of China.
• Both sides claimed to be the legitimate government of China, and for many years Taiwan was recognized as such by much of the international community.
• China asserts that Taiwan is a province of China and therefore part of “One China,” while Taiwan maintains its own government and claims to be an independent country.

Major issues between China and Taiwan:

• Sovereignty: China considers Taiwan as a renegade province that must eventually be reunified with the mainland. However, Taiwan has its own government, military, and economy and considers itself a sovereign state.
• Political Differences: Taiwan is a democratic country, while China is a one-party communist state. The differences in political ideology have contributed to tensions between the two countries.
• Military Threats: China has not ruled out the use of force to reunify with Taiwan and has conducted military exercises near the Taiwan Strait in the past, which have increased tensions between the two sides.
• Economic Competition:Both China and Taiwan are economic powerhouses, and there is significant competition between the two in terms of trade and investment.
• Diplomatic Recognition: China has been using its diplomatic clout to isolate Taiwan by convincing other countries to cut ties with Taiwan and recognize China instead.
• Taiwan’s International Status:Taiwan is not recognized as a sovereign state by the United Nations and is unable to join international organizations.
• Cross-Strait Relations:There are also a number of other issues that affect cross-strait relations, including Taiwan’s relationship with the United States, Taiwan’s national identity, and the possibility of a peaceful reunification.

Diplomatic Status of Taiwan

Stand of UN:

• The United Nations (UN) officially recognizes the People’s Republic of China as the only legitimate representative of China,including Taiwan.
• This is based on the “One China” policy, which holds that there is only one China, of which Taiwan is an integral part.
• As a result,Taiwan is not a member of the UN and has no representation in most UN specialized agencies.

Stand of USA:

• The United States,for its part, has maintained a “One China” policy since 1972, recognizing the PRC as the sole legitimate government of China but also maintaining unofficial ties with Taiwan.
• This delicate balancing act has become increasingly difficult in recent years as tensions between China and the US have risen, with the US taking a more confrontational stance toward China on a range of issues.
• The US One China Policy contains more elements than the “One China” principle, including the US interest in a peaceful process of cross-Strait dispute resolution and differing interpretations of Taiwan’s legal status.

Stand of India:

• It officially recognizes the One China policy and maintains diplomatic relations with the People’s Republic of China.
• India hasnot recognized Taiwan as a sovereign state and instead refers to it as a “part of China” which has remained consistent over the years.
• However, India maintains unofficial and non-governmental contacts with Taiwan including business, cultural, and people-to-people exchanges.
• India also recognizes the importance of Taiwan as a vibrant democracy and an important economic partner.

Way ahead

• The issue of the “One China” policy is likely to remain a thorny one for the foreseeable future, with both sides firmly entrenched in their positions.
• There are signs however that the situation may be evolving, with China becoming more assertive in its claims on Taiwan and the US taking a more confrontational stance toward China.
• Ultimately, the future of Taiwan and its relationship with China is likely to be determined by a complex mix of economic, political, and strategic factors, and will continue to be a major flashpoint in the region for years to come.

General Studies Paper 2

Context: Experts deliberate on the progress of the Indian health system and the challenges it still faces.

About

• Over the years, the Indian health system has overcome seemingly insurmountable problems, long considered hopeless.
• As per National Family Health Survey (NFHS-5) even under the best-case scenario, India would achieve a total fertility rate of 2.1 (replacement level) only by 2041.
• Healthcare in India is on the cusp of significant transformation, with its changing demographics, increasing consumer spending and rising lifestyle diseases.
• At a time when India is having the youngest population for more than three decades to come, there is a needto confront health challenges to redeem that advantage fully.

Healthcare Sector of India

• India’s healthcare sector is one of the largest in terms of revenue and employment, encompassing hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment.
• The healthcare sector in India is growing rapidly, driven by increased expenditureby public and private players, and strengthening coverage and services.
  • The Indian healthcare sector is expected to reach US$ 372 billion in 2022, recording a three-fold rise and growing at a CAGR of 22% between 2016-22.
  • India’s public expenditure on healthcare stood at 2.1% of GDPin 2021-22 with a poor doctor-population ratio of 1:854.
  • The hospital industry in Indiais forecast to increase to Rs. 8.6 trillion (US$ 132.84 billion) by FY22 from Rs. 4 trillion (US$ 61.79 billion) in FY17 at a CAGR of 16–17%.
  • Premiums underwritten by health insurance companies grew to Rs. 73,582.13 crores(US$ 9.21 billion) in FY22.
  • The Indian medical tourism market was valued at US$ 2.89 billion in 2020 and is expected to reach US$ 13.42 billion by 2026 while the e-health market sizeis estimated to reach US$ 10.6 billion by 2025.
  • FDI inflow for the drugs and pharmaceuticals sectorstood at US$ 19.90 billion between 2020-22.

Major challenges of Healthcare Sector in India:

• India has made significant strides in its healthcare sector, however, there remain several challenges that need to be addressed.
• Health Challenges:
  • Five main interrelated challenges facing India’s population: cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and obesity.
  • Rising obesity rates, particularly in Delhi, Tamil Nadu, Kerala, Punjab, Telangana, Andhra Pradesh, and Karnataka, increase the risk of other health issues.
  • Building awareness and promoting healthy lifestyles is necessary to save lives and prevent chronic medical conditions.
• Infrastructure:
  • The state of infrastructure varies across states with some having better arrangements than others.
  • Urban areas need to bridge the gap in hospital services between large urban areas and tier II and III cities.
  • Standalone hospitals and nursing homes provide much-needed service but are unable to provide multi-speciality, leave alone tertiary and quaternary care.
  • The gaps between services available in metros and big cities and in districts must be bridged.
• Health Insurance:
  • Over the past three years, more than four crore Indians have bought health insurance.
  • Ayushman Bharat insurance scheme for 10 crore poor families provides insurance against hospitalization for up to Rs 5 lakh per year per family.
  • Nearly 74 per cent of Indians are either covered or eligible for health insurance coverage, but millions remain uninsured.
  • Out-patient doctor consultation costs, diagnostics, and drugs remain a financial burden for many.

Steps taken by Government:

• Ministry of Health and Family Welfare (MoHFW)allocated Rs. 86,200.65 crores (US$ 11.28 billion) in the annual budget 2022-23 for major health schemes including:
  • Pradhan Mantri Swasthya Suraksha Yojana, National Health Mission, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and PM-ABHIM to strengthen India’s health infrastructure
• E-medical visa facility extended to citizens of 156 countries to promote medical tourism
• Ayushman Bharat Digital Mission was launched to connect digital health solutions of hospitals across the country
• ‘Medicine from the Sky’ project launched in 2021 for drone delivery of life-saving medicines and jabs in far-flung regions of the country
• The Ministry of Tourism established the ‘National Medical & Wellness Tourism Board’ to promote medical and wellness tourism in India.
• The government introduced the National Ayush Mission for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.

What more can be done?

• Address lifestyle risk factors: Promote awareness among the population about the need for a healthy lifestyle to prevent cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.
• Improve infrastructure: Ensure that primary healthcare facilities are fully functional and equipped with basic facilities, and improve the provision of core health services in state-run district hospitals.
• Bridge the gap in hospital services:Ensure that private hospital chains, standalone hospitals, and nursing homes provide multi-speciality, tertiary, and quaternary care to the population, especially in tier II and tier III cities.
• Increase health insurance coverage: Encourage more people to buy health insurance, particularly the uninsured population, by expanding the coverage of the Ayushman Bharat insurance scheme and other state-run insurance schemes.
• Use AI and digital technology: Leverage the benefits of AI and digital technology in healthcare to improve clinical judgments, surgical procedures, and pandemic forecasting.
• Implement policies and regulations: Develop and implement policies and regulations to ensure the quality, safety, and affordability of healthcare services across the country.
• Increase government spending on healthcare: Increase the government’s spending on healthcare to ensure that people can access quality healthcare services at affordable costs.

Way ahead

• India has successfully achieved its replacement fertility rate in 2020, much earlier than expected. However, there is a need to build awareness about healthy lifestyles and improving infrastructure can save millions from illness and premature death.
• India’s healthcare sector is highly diversified and full of opportunities in every segment, including providers, payers, and medical technology and is a leading destination for high-end diagnostic services with tremendous capital investment for advanced diagnostic facilities.
• Rising income levels, an ageing population, growing health awareness and a changing attitude towards preventive healthcare is expected to boost healthcare services demand in the future.

General Studies Paper 2

Context:

India has set an ambitious target to eliminate tuberculosis (TB) by 2025, five years ahead of the global target. The government, scientists, entrepreneurs and the community at large are working towards achieving this goal. Despite being the largest contributor to global TB cases, India has seen a decline in the number of cases in 2021, with improvements in reporting and a reduction in drug-resistant TB cases.

What is Tuberculosis (TB)?  

• Tuberculosis (TB) is an infectious airborne bacterial disease caused by Mycobacterium tuberculosis. It most commonly affects the lungs but can also damage other parts of the body.

What is the current status of TB?  

• In the decade between 2010-20, 1.5-2 million individuals died every year because of tuberculosis. TB disproportionately affects people in low-income nations, the poor and the vulnerable. According to WHO’s Global TB report 2021, with 25.9 lakh TB cases, India is home to 25% of the global tuberculosis cases. India has reported more than 20% decline in case notifications. The country reported 18 lakh tuberculosis cases in 2020 as compared to 24 lahks in 2019.

What is the need for Eliminating TB earlier in India?     

• Eliminating TB earlier in India is crucial for a number of reasons, including:
• Health: TB is a major cause of illness and death in India, and eliminating the disease would significantly improve the health and well-being of the population.
• Economic impact: TB has a significant economic impact, as it can lead to loss of income and productivity for individuals and families. Eliminating TB would reduce this impact and help to boost the economy.
• Poverty reduction: TB disproportionately affects people living in poverty, and eliminating the disease would help to reduce poverty and promote economic development.
• Global health: TB is a global health concern, and eliminating the disease in India would contribute to the global effort to control and eventually eliminate TB.
• Sustainable Development Goals:Eliminating TB is an important target under the United Nations’ Sustainable Development Goals (SDGs), and achieving this goal in India would contribute to overall progress towards the SDGs.
• Social justice: Eliminating TB would help to promote social justice by reducing the burden of the disease on vulnerable and marginalized populations, such as those living in poverty or with limited access to healthcare.

What are the government’s steps for Eliminating TB in India?  

• India has implemented a number of steps to eliminate tuberculosis (TB) as a public health problem in the country. Some of the key measures are:
• Strengthening the healthcare system: The government has increased healthcare facilities, employees, and TB diagnosis instruments. The government has increased access to more accurate molecular diagnostic tests like CB-NAAT and TureNat. The government has also implemented a universal drug susceptibility test, meaning that antibiotic susceptibility of the mycobacterium is determined for all newly diagnosed cases.
• Improvements in treatment protocols: Injectable kanamycin, which caused kidney failure and deafness, has been replaced by Bedaquiline and Delamanid. These new pharmaceuticals have also been included in the new National List of Essential Medicines, giving the government the authority to control their market pricing.
• Recently, the government also rejected U.S. pharmaceutical giant Johnson & Johnson’s (J&J) attempt to extend its monopoly on the manufacturing of the anti-tuberculosis drug Bedaquiline in India beyond July 2023.
• Implementing the Revised National Tuberculosis Control Program (RNTCP):The RNTCP is a national program that provides free diagnosis and treatment for TB patients. The program has been expanded to cover the entire country.
• Use of GeneXpert technology: The government has introduced the use of GeneXpert technology, which allows for rapid diagnosis of TB and drug-resistant TB.
• Engaging with private healthcare providers: The government has engaged with private healthcare providers to improve the quality of TB care and ensure that TB patients receive appropriate treatment.
• Targeting high-risk populations: The government has targeted high-risk populations, such as people living with HIV/AIDS, migrants, and those living in poverty, to improve TB diagnosis and treatment. An online Ni-kshay portal has been set up to track the notified TB cases.
• Target setting: The national strategic plan 2017-2025 sets the target of India reporting no more than 44 new TB cases or 65 total cases per lakh population by 2025. It also aims to reduce the mortality to 3 deaths per lakh population by 2025. The plan also aims to reduce catastrophic costs for the affected family to zero.
• Promoting TB awareness: The government has launched public awareness campaigns to promote the importance of TB prevention, diagnosis, and treatment.
• Adopting a patient-centric approach: The government has adopted a patient-centric approach to TB care, with a focus on providing patient-friendly services and improving patient outcomes.
• Community engagement programme: The government launched the community engagement programme where Ni-kshay mitras can adopt TB patients and provide them monthly nutritional support.

What are the challenges in Eliminating TB in India?  

• High burden of TB cases: India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022. This makes it difficult to identify and treat all cases in a timely manner.
• Drug-resistant TB: India has a high burden of drug-resistant TB, which is more difficult and costly to treat than regular TB. Inadequate use of antibiotics and poor adherence to treatment regimens have contributed to the emergence of drug-resistant strains.
• Limited access to healthcare:Many people in India, particularly in rural areas, do not have access to quality healthcare facilities or cannot afford to seek medical care. This can result in delays in diagnosis and treatment, and may also lead to the spread of TB.
• Stigma and discrimination: TB is still stigmatized in India, and many people are reluctant to disclose their illness or seek treatment due to fear of discrimination or social isolation.
• Poor living conditions: Overcrowded living conditions, poor sanitation, and lack of access to clean water can increase the risk of TB transmission.
• Limited awareness: Many people in India are not aware of the signs and symptoms of TB or the importance of completing the full course of treatment. This can lead to delays in diagnosis and treatment and contribute to the spread of TB.
• Insufficient funding: Despite being a major health problem in India, TB often receives insufficient funding and attention from policymakers and healthcare providers.

What should be done for eliminating TB in India?  

• Implement a comprehensive TB control program: The Indian government should develop and implement a comprehensive TB control program that includes early diagnosis, effective treatment, and follow-up care.
• Expand access to healthcare: Efforts should be made to expand access to healthcare facilities, particularly in rural areas where access is limited.
• Increase funding: TB prevention and treatment should be a priority for the government and policymakers, and funding should be increased to support research, prevention programs, and treatment efforts.
• Targeted prevention programs: Programs aimed at preventing TB in high-risk populations, such as healthcare workers, people with HIV, and people who are homeless, can help to reduce the overall burden of the disease.
• Increase public awareness: This can be done through mass media, community outreach, and social media.
• Reduce stigma and discrimination: This can involve working with community leaders, healthcare workers, and affected individuals to promote acceptance and understanding.
• Improve living conditions: Efforts should be made to improve living conditions, particularly in overcrowded and impoverished areas, to reduce the risk of TB transmission.
• Invest in research and development:Investment in research and development can help to identify new diagnostic tools and more effective treatments for TB. For example, The recent development of artificial intelligence software for detecting hot spots in the lungs from digital chest X-rays is a promising tool for mass active case finding of TB in the community.
• Collaborate with other countries and organizations: Collaboration with other countries and international organizations can help to share best practices, knowledge, and resources for TB control.

General Studies Paper 1

Context: According to recent studies, the changing character of Western Disturbances might be the primary cause of the abnormal winter seasons in India.

• India has not experienced a normal winter season in the past three years. The second wettest season in the country after the  monsoons has remained unusually dry and hot.

How Western Disturbances Affected Winters in India Recently?

• The northwest region of India, which receives almost 30% of its annual rainfall during the winter season, saw an 83% and 76% rainfall deficit in December 2022 and February 2023 respectively.
• The absence of Western Disturbances caused the north Indian plains to experience severe cold waves and cold days in December 2022 and most of January 2023 due to the cold northern winds flowing down from the Himalayas.
• Western Disturbances are also responsible for hailstorms that damage standing crops, fog events that interrupt air, rail and road services and cloud bursts that result in flash floods.

What are Western Disturbances?

• About:
  • Western Disturbances are a series of cyclonic storms that originate in the Mediterranean region, travel over 9,000 km to bring winter rains to northwest India.
    • A Western Disturbance collects moisture from the Mediterranean Sea, Black Sea,and Caspian Sea and traverses over Iran and Afghanistan before hitting the western Himalayas.
  • While the storm systems occur throughout the year, they travel to India mostly between December and April because the trajectory of the subtropical westerly jet stream,which transports them, shifts during the winter months to the rim of the Himalayas.
    • For the rest of the year, the jet stream travels from above the Himalayas to the Tibetan Plateau and China. Its trajectory changes as per the position of the Sun.
  • Significance for India:
    • Western Disturbances are the primary source of snowfall that replenishes the Himalayan glaciers during winter.
      
      • These glaciers feed major Himalayan rivers like the Ganga, Indus and Yamunaas well as myriad mountain springs and rivulets.
        
    • These low-pressure storm systems help farmers in India grow their rabi crop.
      
  • Issues:
    • The Western Disturbances are not always the harbingers of good weather.Sometimes WDs can cause extreme weather events like floods, flash floods, landslides, dust storms, hail storms and cold waves, destroying infrastructure and impacting life and livelihoods.

How Western Disturbances are Affected by Other Climatic Phenomena?

• La Nina Event:
  • For the past three years, the world has been in a La Niña phase, which refers to the cooling of ocean surface temperature in the Pacific Ocean.
    • It weakens the temperature gradient for the formation of Western Disturbances as it reduces the temperature of the hot tropical air.
  • North Atlantic Oscillation:
    • Western Disturbances are also influenced by the North Atlantic Oscillation, a random fluctuation of air pressure over the North Atlantic Ocean due to a high-pressure region above the Azores Islands in the central North Atlantic and a low-pressure region over Iceland.
      • Due to this, the weather system is currently in a negative phase, as both low- and high-pressure systems are weak, and it makes Western Disturbances 20% less frequent and 7% less intense than a positive phase.
    • Subtropical Jet Stream:
      • The northward shift of the subtropical westerly jet stream not only reduces the chance of Western Disturbances striking India but also increases the chance of them affecting higher latitudes such as the Tibetan Plateau or even as far up as China and Russia.
        • This could indirectly affect the southwest monsoon, which accounts for 80% of India’s annual rainfall.
      • Interaction with Southwest Monsoon:
        • The warming of the Arctic region makes the polar front jet wavier, causing Western Disturbances to visit India more frequently during summers.
        • Western Disturbances during summer, monsoon, and post-monsoon periods increase the chances of them interacting with the southwest monsoon and other associated local convection systems such as tropical depressions that travel northward from either the Bay of Bengal or the Arabian Sea.
          • Such interactions can cause catastrophic weather disasters.
          • For instance, In May 2021, a remnant of the extremely severe cyclone Tauktae, which made landfall along the Gujarat coast,travelled all the way to Delhi and interacted with a Western Disturbance to cause heavy rainfall in Delhi and its vicinity.

General Studies Paper 2

Context: The International Monetary Fund (IMF) recently confirmed a USD 3 billion bailout plan (under Extended Fund Facility (EFF)) for Sri Lanka’s struggling economy.

• It is also negotiating with Pakistan for a USD 1.1 billion bailout plan on account of its severe economic crisis marked by falling currency and price rise.

What are IMF Bailouts?

• Bailout:Bailout is a general term for extending financial support to a company/country facing a potential bankruptcy threat.
  • It can take the form of loans, cash, bonds, or stock purchases.
  • A bailout may (not) require reimbursement but is often accompanied by greater oversight and regulations.
• IMF Bailouts:Countries seek help from the IMF usually when their economies face a major macroeconomic risk, mostly currency crisis (such as the ones Sri Lanka is facing).
  • Countries seek such assistance from the IMF to meet their external debt and other obligations, to purchase essential imports, and to prop up the exchange value of their currencies.

How is an IMF Bailout Provided?

• Procedure:
  • The IMF lends money to the troubled economies often in the form of Special Drawing Rights (SDRs).
    • SDRs simply represent a basket of five currencies, namely the S. dollar,the euro, the Chinese yuan, the Japanese yen, and the British pound.
  • This lending is carried out by a number of lending programs such as extended credit facility, flexible credit line, stand-by agreements, etc.
  • Countries receiving the bailout can use the SDRs for various purposes depending on their individual circumstances.
• Conditions:
  • A country may have to agree to implement certain structural reforms as a condition to receive IMF loans.
  • Criticism of Lending Conditions:
    • Believed to be too tough on the public
    • Often accused of being influenced by international politics
    • Free-market supporters criticise the IMF for being too interventionist
  • Acclamation:
    • Conditions are essential for successful lending; it may not make sense for IMF to throw money at a country if its faulty policies that caused the crisis remain untouched.
    • Countries with poor institutional functioning and high corruption are most likely to misspend the bailout money.

What are the Impacts of Providing IMF Bailouts?

• Advantages:
  • They ensure continued survival of the country under difficult economic circumstances and help solve  BoP problems without resorting to measures that can be even more harmful to national/international prosperity.
  • A complete collapse of the financial system can be avoided when industries too big to fail start to crumble.
  • Insolvency of institutions that are needed for the smooth functioning of the overall markets can be avoided.
  • In addition to financial support, the IMF can provide technical assistance and expertise to help a country implement economic reforms and strengthen its institutions.
• Disadvantages:
  • IMF’s strict conditions for economic policy reforms may result in reduced govt spending, increased taxes which can be politically unpopular and may lead to social unrest.
  • Seeking an IMF bailout may harm a country’s reputation in the eyes of investors and lenders, making it more difficult for the country to access international capital markets.
  • Repeated IMF bailouts can create a sense of dependency on external funding and discourage countries from implementing necessary long-term reforms to address their economic problems.
  • IMF bailouts may be viewed as an admission of economic failure by a govt, which can lead to political instability and even the collapse of the govt.

General Studies Paper 2

Context:

Recently, the Indian Patent Office rejected U.S. pharmaceutical giant Johnson & Johnson’s (J&J) attempt for Evergreening of Patent on manufacturing of the anti-tuberculosis drug Bedaquiline in India beyond July 2023.

• Bedaquiline is a crucial drug in the treatment of multidrug resistant TB patients for whom the first-line drug treatment — using Isoniazid, Rifampicin, Pyrazinamide and Ethambutol — has stopped working.

Why was the Patent Application Rejected?

• J&J’s patent application was fora fumarate salt of a compound to produce bedaquiline tablets.
• It was argued that J&J’s method to produce a “solid pharmaceutical composition” of bedaquiline doesn’t require an “inventive step”.
  • According to the Indian Patent Act 1970 Section 2(1) (ja), an ‘inventive step’ is an invention that is “not obvious to a person skilled in the art”.
• The current application drew significantly from a previous patent, which discussed a similar compound on which bedaquiline is based.
• The Patents Act, 1970 has imposed certain ‘restrictions’ on patentability.
  • A patent cannot be granted on ‘mere use of a known process, machine or apparatus unless such known process results in a new product or employs at least one new reactant’.
  • Section 3(d) of the Act does not allow ‘evergreening’ of patents to prevent innovator pharma companies from extending the patent beyond the stipulated period of 20 years, to ensure that the monopoly does not extend forever.
• As of now it is still a patented product and there are no generic versions. However, after the expiry of the Bedaquiline patent, the drug makers can make the generic versions per the law.

Why is the Rejection Notable?

• The rejection is expected to lower the cost of bedaquiline by up to 80%.
  • India has the largest population of people living with drug-resistant TB. J&J’s patent on bedaquiline meant the drug cost USD 400 (revised to USD 340 in 2020) per person, plus the cost of other drugs.
• So far, the Indian government has directly procured the drug and distributed it through State-level TB programmes. After July 2023, manufacturers of generic drugs in India will be able to produce generic versions of bedaquiline.

What is the Evergreening of Patents?

• About:
  • The evergreening of patents is a practice of tweaking drugs in order to extend their patent term and thus their profitability.
  • The Indian Patents Act 1970introduced many provisions to prevent the mischievous practice of “evergreening” of patents.
  • This is to aid millions of people who can’t afford the expensive modified drugs, as well as the development of the domestic generic drug
• Concerns:
  • The process does not produce any increase in the therapeutic efficacy of the drug. In many countries, minor reformulations can qualify for patent protection. The result is that it prevents competition in the market and is considered harmful to the market and consumers.
  • Companies extend the term of protection and charge more for drugs while defending costs incurred in research and development as no cost has been incurred for such compositions as it is only a minor combination or modification of existing drugs.
  • Due to the lack of generic drugs, the variety translates into an increase in the cost of healthcare for consumers.
  • The persistence of patents primarily affects consumers in underdeveloped and developing countries who cannot afford the brand name drugs that can save them from deadly diseases.

What is a Related Supreme Court Decision?

• A popular precedent in this regard is Novartis vs Union of India casein which the Supreme Court (SC) rejected an appeal filed by Novartis rejecting the patent and upheld that the beta crystalline form of Imatinib Mesylate was a new form of the known substance i.e., Imatinib Mesylate, wherein the efficacy was well known and rejected the patent.