The Indian Express

 

Head Line: Explained: What Madras HC suggested on age of consent & age gap, and the implications

https://indianexpress.com/article/explained/what-madras-high-court-suggested-on-age-of-consent-age-gap-and-the-implications-pocso-act-5701591/

1) Mains Paper II: Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.

Why in news:

  • While acquitting a young accused of sexual assault charges under the Protection of Children from Sexual Offences (POCSO) Act Friday, Madras High Court made two significant suggestions — that the age for the definition of a “child” be taken as 16 rather than 18, and that the Act account for the difference in age between the offender and the girl involved in consensual sex.

The takeaways from HC ruling:

  • “… The definition of ‘Child’ under Section 2(d) of the POCSO Act can be redefined as 16 instead of 18.
  • Any consensual sex after the age of 16 or bodily contact or allied acts can be excluded from the rigorous provisions of the POCSO Act and such sexual assault, if it is so defined can be tried under more liberal provision, which can be introduced in the Act itself and in order to distinguish the cases of teen age relationship after 16 years, from the cases of sexual assault on children below 16 years,”.
  • “The Act can be amended to the effect that the age of the offender ought not to be more than five years or so than the consensual victim girl of 16 years or more.
  • So that the impressionable age of the victim girl cannot be taken advantage of by a person who is much older and crossed the age of presumable infatuation or innocence,” Justice V Parthiban observed, directing the government authorities to place the decision “before the competent authority and initiate appropriate steps to explore whether the suggestions made by this Court are acceptable to all stakeholders.”
  • While legal experts and child rights activists welcomed the redefinition of “child”, some of them called for further discussions on the suggestion for an amendment that would factor in the age difference.

 Definition of child: Different opinions:

  • Supreme Court advocate Vrinda Grover called for decriminalisation of consensual sex between those aged between 16 and 18.
  • “This provision denies young persons falling in this age bracket consensual sexual agency, and subjects them to the control of families which motivated by casteist, communal or orthodox and regressive views lodge false criminal complaints,” she said.
  • Criminal lawyer and senior advocate Rebecca John said: “On the one hand, when the age of the juvenile in conflict with law was lowered from 18 to 16 (Juvenile Justice Act) in violation of all international conventions, the move was regressive.
  • And on the other hand, study after study tells us, in the age group between 16-18, there is a lot of experimental consensual sexual acts that take place.
  • What happens is that when these children are caught, or if parents find out, then in most of the cases, the parents of the girl lodge a complaint that it was non-consensual.”
  • Child rights expert and Delhi High Court advocate Anant Kumar Asthana observed that after the age of consent was raised to 18 years through the POCSO Act, 2012, “there has been a massive swell in incarceration of young people across the country, even in cases where sexual relation was outcome of a love affair or was consensual.
  • Courts dealing with such cases had very little discretion left. The view of Madras High Court is a ray of hope that the government will now take steps to eliminate this unwarranted criminalisation of consensual or romantic sexual relations”.
  • While agreeing that criminalisation of sex in this age group is unfair, former National Commission for Protection of Child Rights chairperson Dr Shantha Sinha said: “The issue of consent would have to be decided from the circumstances rather than putting the victim on the stand and asking her if she gave consent.
  • You have to look at the amendments in a more nuanced way and not victimise the child further through this line of questioning.”

 

Head Line: Desire to provide equitable healthcare will reinforce to voters that they matter to politicians

https://indianexpress.com/article/opinion/columns/lok-sabha-elections-pradhan-mantri-jan-arogya-yojana-pmjay-healthcare-system-india-poverty-5701511/

2) Mains Paper II: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Context:

  • As THE COUNTRY VOTES for a new government, equitable and accessible healthcare is being talked about.
  • The next big promise of healthcare for the poor is pitched to be the Pradhan Mantri Jan Arogya Yojana (PMJAY).
  • The proposed plan, while facilitating access to a subset of the population, will cost roughly $1.7 billion.
  • However, the PMJAY, which promises health through insurance for millions of vulnerable Indians, will do little to strengthen our public sector while redirecting spending to the unregulated private sector.

India’s life expectancy:

  • An average Indian lives about 10 years less than an American.
  • Since Independence, India’s life expectancy, which was 31 years, has increased about by six months every year.
  • While it stands at 68 today, it is strikingly non-representative of any particular state.
  • An average Keralite lives to around 75 years, while an Assamese resident lives to about 63 years.
  • Therefore, an Indian national could live 10 years more or less simply based on his/her geography.

Healthcare in India:

  • The Health Survey and Development Committee or the Bhore committee from 1943 established the framework for our healthcare system.
  • Barring some iterations, the fundamental design has remained the same.
  • However, the past few decades have seen stagnant public-sector spending along with the exponential growth of the private sector. While total spending on health as a portion of India’s GDP stands around 3.9 per cent (World Bank data), public spending as part of our GDP stands just above 1 per cent, with a proposed plan to double it by 2025.
  • A country ranked 112/164 in per capita income must be cognisant of such disparities and health expenditures that push individuals and families, some in middle and upper middle class, deeper into poverty.
  • We ought to be enhancing our existing infrastructure, promoting and reinforcing excellence in care within government centres rather than diverting public funds into private health enterprises.
  • A catastrophic illness is often the inflexion point for many households in India, and they may be well above the government cut off for the PMJAY scheme.

Problems of Healthcare in India:

Out-of-pocket expenditure for health

  • Out-of-pocket expenditure for health stands at a worrying 70 per cent, notwithstanding the government provisioning universal health coverage.
  • In stark contrast, the Kenyan government spends about 3.5 per cent of its GDP on health while Brazil and the US spend 8.9 per cent and 16.8 per cent respectively. In terms of per capita cost, India spends about Rs 1,112 per person (about $15), while Switzerland and the US spend $6,944 and $11,193 respectively.
  • There is a clear prioritisation away from those who need healthcare services the most, in terms of spending patterns in the last few decades.

Dearth of skilled human resources

  • Another critical area of concern adversely impacting the public health sector is the dearth of human resources.
  • Unfortunately, any consideration of alternate human resources such as nurse practitioners have failed to gather momentum.
  • The rural health statistics report show that 8 per cent of primary health centres (PHCs) function without a doctor, 38 per cent without a lab technician and 22 per cent without a pharmacist.
  • At the community health centre level, there was a considerable shortage of specialist allopathic doctors.
  • The Higher-Level Expert Group (HLEG) for universal health coverage put forth by the then Planning Commission recommended a doctor-population ratio of 1:1,000, identical to WHO recommendations.
  • Interestingly, India’s national average stands at 1:921 for allopathy and AYUSH (ayurveda, yoga and naturopathy, unani, siddha and homoeopathy) combined, and 1:1,586 for allopathy alone.
  • While six states — Delhi, Karnataka, Kerala, Goa, Punjab and Tamil Nadu — have numbers better than the national average, several states including Jharkhand (1:8,180), Haryana (1:6,037) and Uttar Pradesh (1:3,767) have a horrific doctor-population ratio.
  • In 2004, the Ministry of Health and Family Welfare suggested that each government doctor catered to roughly 15,980 people.
  • This is particularly relevant to an estimated 68 per cent of individuals in rural India, who depend on the government machinery to access quality health services.
  • A 4:1 distribution of health workers favouring urban India adds to this inequity and serves to expose how blatantly non-representative our national metrics are.

Public spending on quality of medical education

  • The growth of the private sector has witnessed an explicit rise in the number of private medical colleges.
  • Sadly, the distribution of many of these colleges follow the urban landscape, likely for financial incentives.
  • During this time, public medical colleges, while growing in modest numbers, suffer from dilapidated conditions in terms of funding, infrastructure, quality of academic scholars, in-house research and the lack of a larger ecosystem that prioritises world-class medical education and research.
  • Consequently, the QS world rankings fail to feature a single Indian medical institution in the top 100 medical schools despite having 579 odd medical colleges that produce about 52,000 doctors each year.

Brain drain

  • The exodus of our health personnel (both trainees as well as graduates) has a deleterious impact on our health system as well.
  • One-fourth of all medical providers across disciplines in the US are foreign born and many are from India.

What needs to be done:

  • Public spending should also be geared to improving the quality of medical education.
  • Technology should be brought in as a tool to enhance the student experience.
  • In the long term, improving medical education and academic scholarship within public institutions and a significant expansion of private, not-for profit, and philanthropically-enabled medical schools and public health schools will help create a better healthcare system.
  • It will limit students flocking to other nations for better education, and hopefully bring about a reversal.
  • A critical area of growth would be creating space for not-for-profit medical institutions of international standards to not only close the academic and infrastructure gaps but also to address the exploding human resource crisis in the health sector.
  • The need for world class institutions of excellence and breaking into world rankings is not just a matter of pride for a country of 1.3 billion people, it is critical to creating a workforce that is adept in meeting the challenges of tomorrow.

Benefits of Public Funding in Healthcare:

  • There is an economic benefit from the mitigation of loss of billions of dollars to overseas institutions.
  • It will prevent the debt that many students and families incur in their quest for higher education as well as the disruption of life from unstable geopolitical climate in the country of immigration.
  • It will certainly address our own human resource crisis in health services.
  • Re-directing public funding and re-invigorating our public sector to create an equitable, sustainable healthcare system for all remains our top priority and our greatest challenge.

Equitable healthcare will restore social justice and will reinforce to the average voter that s/he matters and does so equally in the eyes of the government.

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