GS-II: Urban spaces need better-designed homes and an egalitarian housing policy.

Context

Homelessness is on the rise and has been for the past half a century. Eight years ago, after the 2011 Census, the demand for new housing was at 25 lakh units. With demand rising exponentially and increasing migration numbers the current requirement for shelter stands at 30 lakh units.

Challenges in providing housing

1. Ineffective Programmes

• Pradhan Mantri Awas Yojana aims to provide cheaper houses quickly to low-income groups, with substantial interest subsidies on housing loans. The previous scheme, Awas Yojna, has been attempting the same since 1985 without much success.
• State housing boards have similar unachievable goals.

2. Idea of worship

• In the early 1950s, new houses in most cities relied on the bungalow model. The home’s ownership, independence, and property rights were paramount.
• 70 years later, despite a 100-fold increase in city population density and land values, little has changed from that ideal.
• The unwillingness of a homeowner to rent out when the legal rights grossly favour tenants.

Factors need to be evaluated in the search for a new model

• Stringent urban land reforms would be the first step in that direction
• Making housing part of city infrastructure projects, the government takes away land and construction from private builders and creates diverse pockets of housing in different parts of the city.
• Ensuring citizens have easy access to subsidized rental housing without legal rights of ownership. Rental units would allow residents to live close to the office and employment, keeping the neighbourhood changing and dynamic.
• It is imperative that a system of tax incentives and new rental regulations be used to achieve that goal
• The imposition of a high un-occupancy tax on buildings that are vacant will help to inhabit almost a third of private housing that remains empty in most cities.
• Stricter construction restrictions are put in place; the government should see housing as a social service and not a business venture
• Expanding the supply of low-income housing
• Current densities of residential space need more efficient modifications – smaller multifunctional and compact unit makes more sense. Given the high land values, unless there is an increase in floor area ratio (FAR) and a decrease in a home’s occupancy footprint, economies of scale will never be achieved in city residential areas
• Subsidies on efficient space planning, environmental considerations, and design that create shared community spaces should be encouraged and rewarded.

Conclusion

Housing in India is both inefficient, poorly constructed, and thoughtlessly designed and conforms to outmoded ideas that still hark to the bungalow prototype. Unless more thoughtfully-designed homes with newer materials and technologies and a more egalitarian housing policy become part of future government programs, it is these citadels of waste and decay that will remain the public face of the city.

GS-II: Health care is ailing.

Context

The National Medical Commission Bill passed by Rajya Sabha addresses these concerns.

Why medical education needs these regulations?

• To ensure that doctors are appropriately trained and skilled to address the prevailing disease burden
• To ensure that medical graduates reflect a uniform standard of competence and skills
• To ensure that only those with basic knowledge of science and aptitude for the profession get in
• To ensure ethical practice in the interest of the patients
• To create an environment that enables innovation and research
• To check the corrosive impact of the process of commercialization on values and corrupt practices
• The problem of inappropriately trained doctors of varying quality has been known for decades. The report of the Mudaliar Committee set up in 1959 pointed out how doctors had neither the skills nor the knowledge to handle primary care and infectious diseases that were a high priority concern then as now
• Standards vary greatly with competence levels dependent upon the college of instruction.

Importance of the Bill

• In setting curricula, teaching content, adding new courses and providing the much-needed multi-sectoral perspectives.
• It has the potential to link the disease burden and the specialities being produced. In the UK, it is the government that lays down how many specialists of which discipline needs to be produced, which the British Medical Council then adheres to. In India, the MCI has so far been operating independently.
• It can encourage and incentivise innovation and promote research by laying down rules that make research a prerequisite in medical colleges.

Limitations

1. Bill has proposed mandating the NEET and NEXT. NEET was mooted for three reasons:

• To reduce the pain of students taking almost 25 examinations to gain admission in a college.
• Given the abysmal level of high school education, to ensure a minimum level of knowledge in science.
• To reduce corruption by restricting student admission to those qualifying the NEET.
• NEXT is an idea borrowed from the UK that has been struggling to introduce it. In all such countries, the licensing exams are stretched into modules, not a multiple choice questions type of exam. Bill has virtually given up inspections for assuring the quality of education.

2. Relying only on the NEXT as the principal substitute is to abdicate governance. Undoubtedly, there are grey areas giving scope for corrupt practices and the production of substandard doctors.
3. The reduced oversight allowing extensive discretionary powers to the government makes it virtually an advisory body
4. Permitting a registered medical practitioner to prescribe medicines.
5. While there is a need to decentralize, to give to non-medical personnel some powers and authority it needs tight regulation and supervision.

Conclusion

Government has under this Bill, arrogated to itself an unprecedented power to appoint people in the various arms of the proposed structure. The quality and integrity of these people will then define the future of the health system in India.

GS-II: What’s NEXT?

Context

In its second iteration, the National Medical Commission (NMC) Bill seems to have gained from its time in the bottle, like ageing wine. The new version has some sharp divergences from the original.

Background

• Presented in Parliament in 2017, it proposed to replace the Medical Council Act, 1956, but it lapsed with the dissolution of the Lok Sabha.
• The NMC will have authority over medical education approvals for colleges, admissions, tests and fee-fixation.
• The provisions of interest are in the core area of medical education. The Bill proposes to unify testing for exit from the MBBS course, and entry into postgraduate medical courses.
• A single National Exit Test (NEXT) will be conducted across the country replacing the final year MBBS exam, and the scores used to allot PG seats as well.
• It will allow medical graduates to start a medical practice, seek admission to PG courses, and screen foreign medical graduates who want to practise in India.

Changes in National Exit Test (NEXT)

• It offers a definite benefit for students who invest much time and energy in five years of training in classrooms, labs and the bedside, by reducing the number of tests they would have to take in case they aim to study further.
• There are detractors, many of them from Tamil Nadu — which is still politically opposing the National Eligibility-cum-Entrance Test (NEET) — who believe that NEXT will undermine the federal system, and ask whether a test at the MBBS level would suffice as an entry criterion for PG courses.
• The Bill has also removed the exemption hitherto given to Central institutions, the AIIMS and JIPMER, from NEET for admission to MBBS and allied courses.

Benefits

• In doing so, the government has moved in the right direction, as there was resentment and a charge of elitism at the exclusion of some institutions from an exam that aimed at standardising testing for entry into MBBS.
• The government also decided to scrap a proposal in the original Bill to conduct an additional licentiate exam that all medical graduates would have to take in order to practise, in the face of virulent opposition.
• It also removed, rightly, a proposal in the older Bill for a bridge course for AYUSH practitioners to make a lateral entry into allopathy.

Way Forward

• It is crucial now for the Centre to work amicably with States, and the Indian Medical Association, which is opposed to the Bill, taking them along to ease the process of implementation.
• At any cost, it must avoid the creation of inflexible roadblocks as happened with NEET in some States.
• The clearance of these hurdles, then, as recalled from experience, become fraught with legal and political battles, leaving behind much bitterness.
• NEXT will have to be a lot neater.