April 16, 2024

Login to your account

Username *
Password *
Remember Me
Vimal Kumar

Vimal Kumar

Vimal Kumar is educational enthusiast, Toastmaster, and Naval architect. He is exploring another dimension of him by attempting to write convoluted whirlwind of mind.

 NITI Aayog, a Government of India think tank, published ‘Health System for a New India: Building Blocks’ in November 2019. It was released by NITI Aayog Vice Chairman Rajiv Kumar in the gracious presence of co-founder of Microsoft and co-chairman of Bill and Melinda Gates Foundation, Bill Gates. The report incorporates more than a year’s worth of research and dialogue with key government, private sector, and international stakeholders. Together, the report’s findings and recommendations provide integrated evidence on the current state of the health system in India, and potential options and directions for future reform to raise quality and value in the health system.  

 This report was guided by international experts, along with other national counterparts representing the government, private sector, insurance companies, researchers, and academia. Praising the significant improvements made in India's health sector, Bill Gates said primary healthcare is extremely important for all. India is in a very hopeful situation and is set to be an example for other countries. He also mentioned that the private sector needs to be involved to meet key challenges and that the Gates Foundation through its initiatives will extend all possible help.

 Focus Areas

It is highlighted a need to build India’s opportunities, the vision for health over the next fifteen years to transform the delivery of health services at greater pace, without financially burdening its citizens. The report identified five focus areas of future health system, deliver on unfinished Public health agenda, change health financing away from out-of-pocket so spend into large insurers, integrate service delivery vertically and horizontally, empower citizens to become better buyers of health, harness the power of digital health.

Key Challenges

With the continuous efforts in the health and associated sectors, as per NITI Aayog report, India Total Fertility Rate (TFR) has reduced sharply from 3.4 in 1992–93 to 2.2 in 2015–16. Millennium Development Goals in respect of the Maternal Mortality Ratio (MMR level of 130 against a target of 139) and Under-5 child mortality target (U5 MR level of 43 against a target of 42) is considerable achievements. However, numerous challenges persist. Primary challenges are fragmented delivery of healthcare services, health financing, and risk pooling. Health care services is completely fragmented. Over 98 per cent of healthcare facilities in India are those which employ ten persons or less. This cause health records of patients lie buried in manual systems or left unused for cross-sharing for framing of public policy and research.

 Health financing is fragmented at all three levels—revenue sources, health insurance (financial risk pooling), and strategic purchasing (how funds are used to set incentives for service providers to maximize efficiency, responsiveness, and quality in the health service provider market). There are elevated levels of fragmentation in the sources of revenues, with most health expenditure (about 64 per cent) coming directly from households, out-of-pocket. Disease, in combination with out-of-pocket expenditure, push considerable number of households below poverty line. Government spending on healthcare, 1.1 per cent of GDP (among the lowest in the world for low-middle-income countries), is also fragmented among union and state levels.


India has low level and very fragmented risk pooling, with household out-of-pocket funding at 64% of total expenses dominating the overall system financing. Source: ICHSS team analysis based on multiple public and international sources (National Health Profile 2017, National Health Accounts 2015, Union, ESIS reports)

Risk pooling—before the initiation of Pradhan Mantri Jan Arogya Yojana (PM-JAY)—was low, with merely less than 35 per cent of the population participating in any risk pooling scheme and less than 10 per cent being covered by a functioning risk pooling mechanism (one that provides effective protection against catastrophic events). The elevated level of out-of-pocket expenditure is also a clear sign of the lack of risk pooling.

Severe fragmentation, compounded by market failures and governance challenges, act as a vicious circle driving low health sector performance. Source: NITI Aayog

How critical health system transformations can help

Based on Economic calculations by Ajay Mahal and Cristian Baeza, by introducing critical health system transformations, India can save more than a million additional children lives and reduce working age adult’s death by an additional 16% and that will have consequential impact on increased real GDP 64% by 2030. At same time, it will help to reduce out-of-pocket expenses which will save at least 1.5 million additional households from falling into poverty due to illness. Further, such system will Improve consumer experience and citizen satisfaction. It is also expected to offer globally competitive healthcare insurance and service provision industry which will have substantial impact on employment and help India to emerge as place of medical tourism.


The institution recommended countermeasures to tackle the key challenges. Recommendation focussed on, reduction in out-of-pocket expenditure, risk pooling, strategic purchasing, health-service provisioning, and digital health. Reduced out-of-pocket expenditure in association with enhanced spending to have larger risk pools and better integration—through a single set of regulatory rules— will facilitate the development of payment innovations. It is also recommended to empower patients to become better purchasers and implement PM-JAY with an eye on its potential to influence the overall healthcare transformation in India.


Access the report at https://niti.gov.in/sites/default/files/2019-11/NitiAayogBook_compressed.pdf

Disclaimer:  The information in this article is intended to provide a general guide to the subject.


Let us impart adequate knowledge and offer enough opportunities to ensure the perennial flow of compassion in the next generation and generations to follow.

It was as a usual Monday morning in the city of Varco—a city of tall buildings, wider roads, and impatient trains. Elevators were running up and down, escalators were making rhythmic melodramatic sound and humans were running frantically around to catch the train. My run ended as I boarded the train through the last door of the end coach and found a place to stand comfortably. During this time of the day, there are not only office-goers but also various other sects from society.  Among all, there were two children in their school uniforms accompanied by their father. The elder child was nine and the younger one appeared to be five. They also entered through the same door as I did. The elder child threw himself on the red coloured seat, one of the paired seats. Whereas their father managed to find a place to stand and enhanced his balance by holding an adjacent metallic pole. The younger one did not manage to find a seat and the subdued thought of being left behind was making him restless. He was curling his supple body around his father’s torso. Meantime, eyes were prying around and trying to maintain gaze with any sensible eye, who could offer him a seat; however, no eye was available for interaction and no opportunities seemed feasible. 

 A lady was seating just on the opposite side of the paired seat. Her vigilant eyes had a glance at him and decided to give the seat to him. His tireless search and anguished desperation ended, and he took the seat shyly and mumbled, “thank you.” The elder boy was watching intently, had a sudden stroke of thought: why only reserved seats and not any seat should be meant for a person, who needs it more than the person occupying it? Even he could not find a convincing answer, another question popped up: how do we decide that whose needs are bigger? Are there any criteria to decide or its left to the human’s judgement? Numerous entangled mires of questions lead to strong inner-conflict and inflicted remorse and guilt as he just lost his opportunity to wash it off.

As the journey continued, faces, phones, and fellow passengers kept changing; however, silence, gloominess, and reluctance towards humane interaction remained the same. At next stop, an old lady pushing a luggage cart entered through the same door. She had supported her mortal body with buckled feet which were bulged outward. Her hands were placed on the cart to support it and her weight, simultaneously. She moved in slowly. Her eyes were not looking around but were fixed steadily on the floor as if she was not vying for any seat. It appeared as if her age had already taught her that the language of an eye is beyond human’s comprehension.

 The elder boy was seeing another opportunity to come out of inflicted blow. He was looking intermittently at his father to get concurrence and at the old lady to convey his intent. It kindled little hope, and she moved a little nearer. His father insisted with contorted facial gestures to remain seated. One side, it was the parent’s pressure to remain seated; on the other side, it was a moral obligation. His butts were barely rested on the seat. Despite this muddied situation, he finally decided to give the seat to the old lady and rose above. She walked closer. In a fraction of moment, his father lost his temper and started shouting indiscriminately. His butts, little raised above, fell firmly on the seat and the old lady’s hope to rest her tired muscles were trampled.

Next week, I was waiting at the same place near to the last door of the end coach. I looked around, but I could not have a glimpse of boys or their parent. Yes, there was a little girl along with her mother. She was probably eight years old and her mother age could be… That is a difficult guess! The little girl was pulling a trolley mounted bag, at least half of her weight, and watching inquisitively around, and her mother was glued to her phone.

 The train entered the station and coach door aligned with the station door with mechanical musical melody and opened simultaneously in the shadow of blinking red light. The little girl ran amok and slept on a pair of seats, as her little body can barely reserve even one seat. The coach was again filled with passengers and the deafening silence. Her mother entered slowly and sat on one of the grabbed seats and continued with her business. Little girl, swinging her feet, kept watching the fellow passengers and often reading without comprehending and assimilating “Give the seat to the passenger, who need it more than you do.”

 It should not be misconstrued that humans are no longer compassionate animal, or its compassion reserve is depleted beyond replenishable level; at same time, it cannot be affirmed and ascertained that we are imparting adequate knowledge or offering enough opportunities to ensure the perennial flow of compassion in next generation and generations to follow. Being compassionate towards fellow humans and animals is innate human nature and there could be nothing more soothing and joyful to our mind, body and soul than living in the atmosphere of compassionate behaviours. However, it appeared to be partially covered with earthly dust, which is created due to the incessant frolicking of humans in the fear of being insecure. There is a need to take a pause and think in the ambience of being content and fulfilled.

Reasons are always numerous, but sometimes consequences are uglier than the ugliest, and so, for these behaviours. We are offering extraordinarily little opportunities for our children to learn and imitate. The utmost responsibility lies with us as an adult to reform our behaviours which could offer an opportunity for upcoming generations to follow through and pass on.


Despite level of staggering economic development around the world, there are many poor people around the globe. Poverty has its deep-rooted home in most of the countries. There is poverty in India, Pakistan, and Bangladesh. Contrary to established myth, there is poverty in UK, Singapore, and even in the capital of planet, the USA. If we go little deeper in statistics, according to the Brookings report India had 73 million people living in extreme poverty which makes up 5.5% of its total population and at same time U.S. Census Bureau found that 38.1 million people in USA is below poverty line about one in eight. Being in poverty in nothing but wretchedness and whatever attempts are made, words are incapable to demonstrate the pain agony inflicted by the poverty.

Poverty has different shades of colour. Colour of poverty in United States and that of poverty in India is not same. However, it inflicts same wretchedness, pain, and agony but underlying foundation is uniquely different. In some places, people are hungry for food.  Some places, people are deprived of shelter. In some places, people are deprived of internet, access to social media, etc. These are still termed as poverty but relative in nature. However, there is a type of poverty, which is uniformly common throughout the globe or at least at places where it managed to make a colony. It is perceptional poverty which get subsistence from the uncontrolled expectation.

Seneca, Roman stoic philosopher once said, "It is not the man who has too little, but the man who craves more, that is poor." Craving or uncontrolled expectation is the creeping foundation at which ugly castle of perceptional poverty exists. If foundation has no existence, castle have no existence, either. Perceptional poverty is not true poverty but inflict similar pain of poverty. Probably, it is not at all a poverty but perceived as poverty of same size, colour, and dimension of true poverty. It is like unsatiated thirst or unrequited love where desire to seek something else, which is, of course, illusional in nature, is stronger than to seek the true need.

So, the questions pop up: how cravings or uncontrolled expectations kick in. In fact, we as human do not know. Not easy to comprehend. If we know and observe consciously, probably, cravings will not originate at first place. It comes sneakingly, tempt us to ride on its cushioned back, and we feel dejected and fallen apart as we become aware about where we are! However, the point is not to keep observing our behaviour every minute and second. It may not be possible either without draining our vital energy. Certainly, we can do such observation selectively at moment or places at which cravings, generally, kick in. 

At this point of time in human development, there are numerous decoys developed due to either natural course or deliberately designed for cravings to originate. Such traps could be environment like shopping malls, shops, movie theatre with twinkling sensation of aroma, music, light which evoke the memory of good times, embedded commands in form of advertisements, social media indulging human for grossly exposure to unrealistic world and infusing a sense of insecurity and deprivation. Environment plays a key role in moulding our behaviour in their way. Typically, shopping malls, shops, and bars are designed with features but could not be limited to lights, music, even geometry which evoke the memory of good times. We have innate inclination to colour ourselves in the light of surroundings. If something fake falsifying is blatantly displayed as great convincingly, we are inclined to behave that way. There was an interesting study carried out in University of California to understand interpersonal dynamics in a simulated prison environment. In the study, half of the volunteers were acted as prison workers, and other half acted as prison inmates. Results were astounding. Previously tested to psychologically sound people, the participants (inmates and guards) became increasingly hostile, crude, rebellious and abusive. One of prison inmates became so hysterical and emotionally distressed that experiment was called off in one week instead of planned duration of two weeks. All data lead to the conclusion that this simulated prison developed into a compelling prison environment, and as such, it elicited intense pathological reactions from the participants. A loss of personal identity by the prisoners and the arbitrary control of their behaviour resulted in a syndrome characterized by passivity, dependency, depression, and helplessness.

Embedded commands in form of advertisements, social media indulging human for grossly exposure to unrealistic world and infusing a sense of insecurity and deprivation. Embedded commands like "buy now", how great you are!", or "enjoy life" are kind of auto suggestions which changes our attitudes or beliefs unnoticeably and subconscious mind create internal realities in form of cravings, expectations to align with the such command. Social media often adds fuel to such fire.  The University of Pittsburgh School of Medicine conducted a study and found a few disturbing trends. Study participants who spent the most time on social media each day were 2.2 times more likely to report that they had issues with body image and eating. Contrary to that, participants who spent less time on social media did not report those concerns.

Couple of days ago, during the festive season of Christmas and New year 2020, I, along with my wife and daughter, was sitting idle at home during the seasonal blip of holiday. It all started with bringing our little daughter to outside as she was getting cranky at home. We went to a shopping mall, which is home of all kind of necessary and unnecessary shops along with playground for the kids. We were welcomed by lights, hung around giant Christmas tree, dimming and glowing at a usual pace. Tree was covered with red leaflet calligraphed "Season of Love."  Some of leaflets were still hanging and displaying what season we are in, some were fallen apart, and some were trampled and crumpled under the reckless feet of shoppers.

We held an escalator and kept inching up in its metallic, melodious, and thudding sound and reached fourth floor, where children playground was located. My daughter with giggling face started climbing the ladder for the joy of spiral slide and we became busy with our mobile in clicking pictures of her and ours. While keeping an eye on her, our eyes were pulled by large billboard. We could see "Sale, Sale, Sale, up to 80% off" marked in red bold fonts. Height of the fonts were almost that of a human adult. We took a leisurely stroll to see what outlet has to offer and waited and went in one fitting room to another. It was almost couple of hours and time to be back home. While placing stroller and multiple bags of clothes in the boot of taxi, I felt tired with the tinging numbness of nothing but being poor.


Trending Now

Hindu: Am I?

Hindu: Am I?

Dec 15, 2019 Rate: 4.00