1. Government Sponsored Health Insurance Schemes (GSHISs)
    1. Almost 20% of Indian population covered by GSHISs by 2010 (240 million people), expected to reach 50% or 630 million people by 2015
    2. These schemes include RSBY and Rajiv Aarogyasri in AP, Central Government Health Scheme, Employee State Insurance Scheme, Vajpayee Arogyasri etc.
  2. RSBY (Rashtriya Swasthya Bima Yojana)
    1. Health Insurance for the Poor, focused on secondary care
    2. RSBY has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families.
  • The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization.
  1. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the diseases that require hospitalization.
  2. Government has even fixed the package rates for the hospitals for a large number of interventions.
  3. Pre-existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family which includes the head of household, spouse and up to three dependents.
  • Beneficiaries need to pay only Rs. 30/- as registration fee while Central and State Government pays the premium to the insurer selected by the State Government on the basis of a competitive bidding.
  • Why the need of RSBY or BPL Health Insurance?
    1. Debt Trap: For people living below poverty line illness could result in the family falling into a debt trap.
    2. Preventative and Early Care: When the need to get the treatment arises for poor families they often ignore it because of lack of resources, fearing wage loss, or wait till the last moment when it’s too late.
    3. Protection of financial and other assets of the poor: Even if they do decide to get the desired health care it consumes their savings, forces them to sell their assets and property or cut other important spending like children’s education.
    4. Responsibility of the State
  1. Features of RSBY:
    1. Can choose private or public hospital
    2. Business Model for many stakeholders and private players as well:
      1. Insurers
        1. The insurer is paid premium for each household enrolled for RSBY. Therefore, the insurer has the motivation to enroll as many households as possible from the BPL list. This will result in better coverage of targeted beneficiaries.
      2. Hospitals
        1. Hospitals get refunded by the insurers and money flows directly from the beneficiary to them. Hence they have an incentive to treat the patient. The insurer assures no unnecessary charges are charged by hospitals and business practices are ethical.
      3. Intermediaries
        1. NGOs and MFIs are also paid for services to reach out to beneficiaries
      4. Government
        1. By paying only a maximum sum up to Rs. 750/- per family per year, the Government is able to provide access to quality health care to the below poverty line population. It will also lead to a healthy competition between public and private providers which in turn will improve the functioning of the public health care providers.
      5. IT Intensive
        1. Every beneficiary issued smart cards
      6. Safe and full-proof
        1. Use of biometric enabled smart cards makes the system full proof
      7. Portability
        1. Car can used at any hospital empaneled by RSBY. Its also can be split for migrant workers
      8. Cash less and paper less transactions
      9. Robust Monitoring
    3. ICDS (Integrated Child Development Scheme) – Nutrition and Health
      1. Launched in 2nd October, 1975
      2. CSS
  • Provides food, preschool education and primary healthcare to children below 6 years of age and their mothers.
  1. Aims to promote proper mental, physical and social development of children in India, reduce mortality rates among children, increase nutrition levels and reduce school dropouts
  2. Reaches over 34 million children (0-6 years age) a year and over 7 million mothers
  3. Scope of Services:
    1. Immunization
    2. Supplementary Nutrition
    3. Health Checkups
    4. Referral Services
    5. Pre-school Non formal education
    6. Nutrition and Health Information
  • Provided by Ministry of Health and Family Welfare
  • These services are provided by Anganwadi Centres established mainly in rural areas and staffed with frontline workers.
  1. Programs aim is to fight malnutrition and ill health and also promote gender equality by providing equal resources to the girls as boys
  2. Impact:
    1. By end of 2010, the programme is claiming to reach 80.6 lakh expectant and lactating mothers along with 3.93 crore children (under 6 years of age).
    2. There are 6,719 operational projects with 1,241,749 operational Aanganwadi centres.
    3. A study in states of Tamil Nadu, Andhra Pradesh and Karnataka demonstrated significant improvement in the mental and social development of all children irrespective of their gender.
    4. A 1992 study of National Institute of Public Cooperation and Child Development confirmed improvements in birth-weight and infant mortality of Indian children along with improved immunization and nutrition.
    5. However, World Bank has also highlighted certain key shortcomings of the programme including inability to target the girl child improvements, participation of wealthier children more than the poorer children and lowest level of funding for the poorest and the most undernourished states of India.
  3. National Health Mission – Launched in 2005 by UPA, initially for 18 states
  4. National Rural Health Mission – focused on primary care
    1. Launched in 2005 as a part of the overarching National Health Mission
    2. Main mission is to provide effective healthcare services to rural masses in the country with a focus on states with poor public health indicators and weak healthcare infrastructure.
  • Characterized by (1) significantly increased financing, (2) Flexibility around hiring contractual staff (3) Supply chain reforms (4) Introduction of a cadre of grassroots workers paid entirely on the basis of performance (5) overall increased emphasis on public health expenditure
  1. The program under NRHM can be broadly categorized under the two:
    1. Reproductive & Child Health Programs – address challenges of maternal and newly born health issues
    2. National Disease Control Programs
  2. Goals of NHM:
  3. Initiatives of NHM:
    1. Accredited Social Health Activists (ASHAs)
      1. Community Health volunteers called Accredited Social Health Activists (ASHAs) have been engaged under the mission for establishing a link between the community and the health system.
      2. ASHA is the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services in rural areas.
      3. ASHA Programme is expanding across States and has particularly been successful in bringing people back to Public Health System and has increased the utilization of outpatient services, diagnostic facilities, institutional deliveries and inpatient care.
    2. Rogi Kalyan Samiti (Patient Welfare Committee) and Hospital Management Society
      1. Manage affairs of hospitals
  • Untied Grants to sub Centres
    1. Untied Grants to Sub-Centers have been used to fund grass-root improvements in health care. Some examples include:  Improved efficacy of ANMs in the field that can now undertake better antenatal care and other health care services.
    2. Village Health Sanitation and Nutrition Committees (VHSNC) have used untied grants to increase their involvement in their local communities to address the needs of poor households and children.
  1. Health Care Contractors
  2. Janani Suraksha Yojana
    1. JSY aims to reduce maternal mortality among pregnant women by encouraging them to deliver in government health facilities.
    2. Under the scheme one time cash assistance is provided to eligible pregnant women for giving birth in a government health facility.
    3. Large scale demand side financing under the Janani Suraksha Yojana (JSY) has brought poor households to public sector health facilities on a scale never witnessed before.
  3. Janani Shishu Suraksha Karyakaram
    1. As part of recent initiatives and further moving in the direction of universal healthcare, Janani Shishu Suraksha Karyakarm (JSSK) was introduced to provide free to and fro transport, free drugs, free diagnostic, free blood, free diet to pregnant women who come for delivery in public health institutions and sick infants up to one year.
  • Rahstriya Bal Swasthya Karyakaram
    1. A Child Health Screening and Early Intervention Services has been launched in February 2013 to screen diseases specific to childhood, developmental delays, disabilities, birth defects and deficiencies.
    2. The initiative will cover about 27 crore children between 0–18 years of age and also provide free treatment including surgery for health problems diagnosed under this initiative.
  • National iron + initiative
    1. The National Iron+ Initiative is an attempt to look at Iron Deficiency Anaemia in which beneficiaries will receive iron and folic acid supplementation irrespective of their Iron/Hb status. This initiative will bring together existing programmes (IFA supplementation for: pregnant and lactating women and; children in the age group of 6–60 months) and introduce new age groups.
  1. National Mobile Medical Units
  2. National Disease Control Program
  3. National Vector Borne Diseases Control Program
  • Revised National Tuberculosis Control Program
  • National AIDS Control program
  • Immunization: 
    1. ‘Mission Indradhanush’
    2. Launched recently, the mission aims to cover all un-vaccinated or partially vaccinated children by the year 2020, against seven vaccine preventable diseases.The diseases that come under the mission are diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B.
    3. Four special vaccination campaigns are being conducted under the programme, between January and June 2015.
    4. About 201 districts are covered in the first phase and 297 will be targeted for the second phase.
  1. Clean Drinking Water under National Rural Drinking Water Program (NRDWP)
    1. Solar power based water supply schemes launched across rural ad far-flung areas to provide clean water where electricity is a constraint
  • Swachh Bharat Mission (Gramin)
    1. Aimed at ODF – open defecation free India by 2019


  1. The Case for Universal Health Care
    1. Essential public good for development of people’s capabilities, productivity enhancement of the workforce
    2. Private health care is not a good substitute because of affordability,
  2. 12th FYP on Health
    1. Problems in the Public Health Care Domain in India:
      1. Low Spending on Public Health:
        1. Only 1.3% of GDP spent on health care compared to almost 4.3% of other major developing countries like Brazil and almost 7-8% of the developed countries.
      2. Availability
        1. Low number of doctors, nurses and auxiliary nurses and midwives (ANMs) Widespread geographical variation within India.
  • Affordability
    1. Lack of extensive coverage by the government deprives a huge population from basic health services.
    2. Lack of medicines causes the prices to be inflated artificially at private hands.
    3. A large fraction of the out of pocket expenditure arises from outpatient care and purchase of medicines, which are mostly not covered even by the existing insurance schemes. In any case, the percentage of population covered by health insurance is small.
  1. Quality 
    1. Many practitioners in the private sector are not qualified to be doctors.
    2. Regulatory standards to control hospitals are inadequate.
  2. Total expenditure (public+private+household out of pocket) around 4.1% of the GDP, which is almost similar to other developing countries, however public expenditure is only 27% of this total expenditure, which is very low by any standard. Government must increase its expenditure drastically. Lowest among BRICS – Brazil and SA in 9% range (total expenditure).
    1. First focus should on public health infrastructure. Could be supplemented by PPPs and move towards the UHC system in the long run as it takes a lot of time to develop.
    2. A large fraction of the out of pocket expenditure arises from outpatient care and purchase of medicines, which are mostly not covered even by the existing insurance schemes. In any case, the percentage of population covered by health insurance is small.

    1. Reduction of Infant Mortality Rate
    2. Reduction of Maternal Mortality Ratio
  • Reduction of Total Fertility Rate
  1. Prevention and Reduction of Undernourishment
  2. Prevention and reduction of anemia in women aged 15-49 years
  3. Raising child sex ratio in the 0-6 years age group from 914 to 950
  • Reduction of out-of-pocket expenses of poor households
  1. Problems with current programs like National Health Mission and Integrated Child Development Scheme and recommendations. 
    1. Spatial Area Mapping 
      1. Anganwadi Centres where people can access public health services (especially women, pregnant women, young children for vaccination etc.) are located in upper class areas within the villages. This creates barriers for extremely poor, lower class individuals to access these centers and they become less effective.
    2. Concentration of services in High-burden Pancahayats:
      1. Worst effected blocks must be focused on as they are too burdened.
  • Reduce Out-of-pocket spendings of these individuals
  1. Workload, motivation and training of employees
  2. Reach unaccessible areas through MMUs (Mobile Medical Units)
    1. The success of Assam and Kerela’s water medical units on large boats have been quite successful in reaching extremely unaccessible areas.
  3. Infrastructure improvements; Repositioning of the AWCs
  4. PPP in Health Sector

Inquiry into Civil Servants:

Protections provided:

Article 311

  1. A civil servant cannot be dismissed by any authority that is subordinate to the one by which he was appointed.
  2. An enquiry is important to present the information of the charges he has been framed with and to give him the ‘Right to be heard’.

DSPE Section 6A

  1. Prior Concurrence on registration of a case: Section 6A of the DSPE Act 1946
  2. Section 6A of DSPE was abolished by SC as it is against Article 14

Recommendations by Committees:

  1. AD Gorwala Committee Report, 1951 → Greater understanding between ministers and civil servants
  2. Hota Committee, 2004
    1. Amending certain sections in the Prevention of corruption Act and code of Criminal procedure to protect honest civil servants
  3. Code of Ethics
  4. Public evaluation of performances

T.S.R Subramanium vs Union of India

  • Creation of an independent Civil Services Board both at the Centre and the State for promotion and transfers of bureaucrats
  • Provision of fixed tenure in service giving them protection against biased transfer by politicians
  • All bureaucrats should record the directives given to them from their administrative superiors and political authorities

Indian Administrative Service (Cadre) Rules, 1955, have been amended and a new clause inserted-

  • The Central Government, in consultation with the State Government or State Governments concerned, may determine the tenure of all or any of the cadre posts specified for the State concerned in item 1 of the Schedule to the Indian Administrative Service (Fixation of Cadre Strength) Regulation, 1955
  • A cadre officer appointed to any post for which the tenure has been so determined, shall hold the minimum tenure as prescribed except in the event of promotion, retirement, deputation outside the State or training exceeding two months
  • An officer may be transferred before the minimum prescribed tenure only on the recommendation of a Committee on Minimum Tenure as specified in the Schedule annexed to these rules

Steps taken by Supreme Court:

  • Spend a minimum of two years in a posting before they can be transferred
  • Setting up of a Civil Services Board to check political interference
  • Advices with regards to appointments and postings should be recorded ensuring transparency and accountability

Impact on the Officer:

  • Motivation is important. The loss of morale when asked to leave behind his/her vision and a failed opportunity to bring about a change is painful.
  • Uncertainty of tenure leads to fear and instability in the mind that should be without fear for the proper delivery of services.
  • Incentives encourage hard work but punishment attracts more malfunctioning, crippling the quality of governance.

Way forward:

  • The nature of transfer should be done in an independent manner on sound administrative grounds that are clearly spelt out.
  • Fixed Tenures for critical ranks like DGPs, District SPs & SHOs; to ensure smooth functioning of administration
  • The tenure should be directly linked to performance targets and fast-track advancements on the basis of forward-looking career management policies and techniques should be managed by autonomous Personnel Boards for assisting the high level political authorities in making key decisions.
  • Civil service boards should be constituted under statutory provisions
  • The repeated shuffling is a menace for good governance and if the officer is concerned about the disruption in the flow of services due to his transfer, he should be given a chance to take his case before an Ombudsman.
  • Ministers must uphold the political impartiality of the civil service and not ask the civil servants to act in any way which would conflict with the duties and responsibilities of the civil servants.

Civil Services — Posting Officers indiscriminately — Blurred division of Responsibility- Case of Punishment Posting

  • In India, the elected representatives are responsible to the people and the civil servants are responsible to the Ministers. Due to some vested interests, ‘political neutrality’ has paved way for ‘political interferences’ and this has led to the phenomena of ‘politicisation of the civil service’.
  • Recently, the cases of arbitrary and questionable moves by the political masters have increased manifold and has strengthened the temptation to resort to collusive practices to avoid untimely transfers and to play safe, giving rise to ‘political neutrality’ as a new hallmark.

Recent examples

  • Maria, who was heading the high-profile Sheena Bora murder case was shunted out of the post and promoted as Director General of Police Home Guards.
  • “Tried hard to address corruption and bring reforms in Transport despite severe limitations and entrenched interests. Moment is truly painful.” –Khemka(46th transfer in the service of 22 years)

 Constitutional Provisions

  • Articles 53 and 154 vests the executive power of the Union and the States in the President or Governor directly or through officers subordinate to him and these officers constitute the permanent civil service governed by Part XIV of the Constitution.
  • The President or Governor is required to act according to the aid and advice of his/her Council of Ministers, appointed under Articles 73 and 163 of the Constitution and this grants a political colour to the work-process.
  • The Minister has the mandate of the people to govern, but the Secretary has an equivalent constitutional mandate to advise the Minister. Once his/her advice has been suitably considered, unless the Minister passes an illegal order, the Secretary is bound to implement it and the Minister is required to support the Secretary who is implementing his/her order.